Robert W. Block

Failure to Thrive as a Manifestation of Child Neglect

Failure to thrive is a common problem in infancy and childhood. It is most often multifactorial in origin. Inadequate nutrition and disturbed social interactions contribute to poor weight gain, delayed development, and abnormal behavior. The syndrome develops in a significant number of children as a consequence of child neglect. This clinical report is intended to focus the pediatrician on the consideration, evaluation, and management of failure to thrive when child neglect may be present. Child protective services agencies should be notified when the evaluation leads to a suspicion of abuse or neglect.

Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: Addressing the forensic controversies

Does an expanded subarachnoid space predispose to subdural bleeding? What does heterogeneity in the appearance of a subdural collection on CT or MRI imaging indicate? Spontaneous rebleeding? Minor re-injury? Major reinjury? In some specific cases, answers to these questions have important forensic implications. To conclude objectively that an infants intracranial hemorrhage or rebleeding resulted from inflicted injury or re-injury requires an in-depth understanding of the pathogenesis of posttraumatic subdural and subarachnoid collections. The authors present two cases of indoor, accidental, pediatric, closed-head trauma that resulted in intracranial rebleeding. Both accidental cranial impacts occurred in medical settings and were independently witnessed by medical personnel. In addition, the authors summarize the relevant medical literature regarding pediatric intracranial bleeding and rebleeding.

All adults once were children.

All adults once were children, and children exposed to unrelenting adversities or toxic stress are at risk for developing a multitude of health conditions that threaten their development and eventual adult health status. Pediatricians and their pediatric surgeon colleagues can help families and their children develop resiliency by properly addressing the needs of families and their children and by participating in advocacy opportunities related to federal, state, and local policies affecting children. Evolving neuroscience that expands our knowledge of brain health and the relatively new field of epigenetics continue to contribute scientific information that underscores the need for attention to the health and wellbeing of the developing child in order to prevent many diseases and conditions among adults that continue to escalate healthcare costs. Resiliency is needed to combat the effects of toxic stress, and physicians are urged to work with their communities to assist families who need help learning about parenting resources to promote childrens capacities for success.

No Surprise: The Rate of Fatal Child Abuse and Neglect Fatalities Is Related to Poverty

In this issue of Pediatrics , Farrell et al1 describe research linking poverty with child maltreatment fatalities. The American Academy of Pediatrics has addressed the overall issue of the effects of poverty in a recent policy statement.2 An increasing number of reports linking ecology with outcomes for both adults and children have been published describing risk factors for overall health, brain health, and lifetime health trajectories.3,4 Given the sociologic, economic, medical, and myriad other challenges related to poverty, it is not surprising that the authors report a significant increase in fatal child maltreatment related specifically to socioeconomic status. What may be surprising is that although this fact is both intuitive … Address correspondence to Robert W. Block, MD, FAAP, Department of Pediatrics, University of Oklahoma/Tulsa University School of Community Medicine, 4502 E. 41st St, Tulsa, OK 74114. E-mail: rblock{at}aap.net

Recognizing the importance of the social determinates of health.

All adults once were children. Who we are, how we function, how we think and perform, and many other traits have their beginnings in our earliest years. Although the foundation of the United States is embedded in the concept of equality, it is certainly true that not all children have similar advantages as they move through their first several years of life. Many of the inequalities that affect health in general, and brain health in particular, may be evident to astute pediatricians and their medical home team partners while they are providing primary care visits with families. In their article, “Addressing Social Determinants of Health at Well-Child Care Visits: A Cluster RCT,” Garg, Toy, and colleagues address the utility of systematically screening for unmet basic needs at well-child visits and providing “simple” referrals and follow-up. They present their data from a … Address correspondence to Robert W. Block, MD, FAAP, 256 E 27th St, Tulsa, OK 74114. E-mail: rblock{at}aap.net