Eli H. Newberger

CHILD ABUSE AND PEDIATRIC SOCIAL ILLNESS: An Epidemiological Analysis and Ecological Reformulation

Children under four years of age hospitalized for child abuse, domestic accidents, failure to thrive, and ingestions were matched with controls admitted for comparably acute medical conditions. A structured parental interview yielded significant case-control differences. Discriminant analysis suggested interrelationships among the case groups and cluster analysis identified three cohesive groups in terms of severity of symptoms. This reformulation provides a matrix for organizing data and an alternative to the present manifestational classification system.

Failure to thrive: a controlled study of familial characteristics.

The significance of ecological stress factors in the etiology of failure to thrive (FTT) was explored through structured interviews with mothers of 42 infants who were failing to thrive and 42 matched controls. Three factors distinguished the FTT families from the controls. They had a more sickly child, were more isolated from neighborhood and family support, and had a larger discrepancy in parents education. Demographic, pregnancy, contemporaneous stress factors were not significant. The data suggest that the usual assumption that FTT is due to inadequate mothering needs to be reassessed.

Child abuse; principles and implications of current pediatric practice

This article summarizes data and experience with child abuse pertinent to child health practice. Because of the complex origin of child abuse, and because of institutional and social changes that will have to accompany excellent practice if child abuse is to be treated and prevented, issues of program and policy development are also addressed.

Interdisciplinary group process in the hospital management of child abuse and neglect

The group process aspects of child protection in a childrens hospital are examined. A team approach to case management enables personal support for individual members experiencing the strong emotions attached to protective service cases, eases the burden of individual decision-making, and divides the complex tasks of data gathering and analysis. Confusion is fostered by inattention to personal and group expectations, individual roles, the status structure, and the methods for maintaining social cohesion. A team handbook may help to standardize decision-making, but in such efforts to reduce conflict, group norms may be obscured. Task-oriented and social-emotional norms are discussed, and guidelines are offered to foster a more adequate approach to group problem solving.

Case vignette -- mandated child abuse reporting

Case Vignette: Martha Harris has been a licensed mental health professional for nearly a decade. As she arrived at her office early this morning, the phone was ringing. Speaking in a tremulous voice, the caller stated, I was given your name by my internist, Dr. Williams. I think my husband may be abusing our 5-year-old sexually. Can you help? After a few minutes of conversation, Martha offers to schedule a prompt appointment. The caller interrupts and asks, You wont have to report this will you? As a mandated reporter under the states child protection statute, Martha has no choice but to inform the authorities; she tells the caller, who immediately hangs up. Suddenly, Martha realizes that she does not have the name or any other identifying information about the caller. A call to Dr. Williams results in a response that the internist does not want to get involved. Commentators on this case are Richard Bourne, JD, PhD, one of whose special areas of expertise is child protection and related professional obligations; Eli H. Newberger, MD, a pediatrician with a special interest in child maltreatment; and C. Sue White, PhD, one of whose primary interests is how clinicians may inappropriately use techniques to interview children suspected of child sexual abuse, causing contaminating influences to interfere with childrens memories for their own experiences.

Family Intervention in the Pediatric Clinic: A Necessary Approach to the Vulnerable Child

an outpatient setting that would serve several functions: 1) to provide continuing pediatric ambulatorv services after hospitalization to victims of child abuse and neglect and other children with social problems whose physical conditions had warranted inpatient treatment, and to keep systematic records of their pro~ ~ess; 2) to avert hospital admission of children who, despite urgent Family crises, could be sustained safely in their