Serial abuse in children who are shaken

Article Abstract:

The repeated shaking of a child can produce shaken-baby syndrome (SBS), which is characterized by intracranial injuries and retinal hemorrhages with no signs of external trauma. The fact that SBS is most frequently the result of repeated instances of shaking suggests that this may be part of a pattern of serial (repeated) abuse of the child and his siblings. A study was conducted to determine the rate of recidivism for shaking, and to determine prior abuse to the shaken child or his siblings. Of 24 children examined, 12 had sustained external head trauma in addition to the shaking. Prior abuse or neglect of the child was evident in 71 percent of cases. Out of all the patients, 33 percent had been previously shaken; this corresponds to the overall 33 percent recidivism rate for child abuse. Children who have been shaken and their siblings should be examined carefully for evidence of prior abuse. This examination may include skeletal X-rays, CT (computerized tomography) scanning, and MRI (magnetic resonance imaging). The possibility of subsequent abuse in shaken children is significant. Current estimates may be too low because not all cases of abuse are reported. Many cases of shaken children are subacute, and long-term symptoms of shaking may go undetected. By accurately assessing the possibility of future abuse, social and legal services may be called upon to intervene. Evidence of shaking as a part of a pattern of serial abuse should be brought to the attention of judges and juries in criminal prosecutions. The notion that shaking is an unintentional, isolated incident must be expelled. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Child abuse, Brain, Brain injuries

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Bacterial meningitis in older children

Article Abstract:

Bacterial meningitis is a disease primarily affecting children two years of age or younger. The condition is rare in older children, who account for approximately four percent of all cases. An ll-year study was performed to review the characteristics of the disease in 25 previously healthy children who were six years of age or older. The most significant neurological symptoms were headache, altered consciousness, and neck pain. Other symptoms included nuchal rigidity (abnormal stiffness of the neck with pain and spasm on passive motion), lethargy, somnolence (sleepiness), petechiae (skin spots); less frequently noted were stupor or coma. Eleven of the patients had no fever when they were first examined. In the 22 patients who survived, any fever that was present responded to antibiotics, either immediately or within 48 hours. The organisms primarily responsible for the disease were Haemophilus influenzae type B (10 cases); Neisseria meningitides (9 cases) and streptococcus pneumoniae (6 cases). (Consumer Summary produced by Reliance Medical Information, Inc.)

Demographic aspects, Meningitis, Central nervous system diseases

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Mediterranean spotted fever in children returning from France

Article Abstract:

Mediterranean spotted fever (MSF) is characterized by fever and rash . It is caused by the microorganism Rickettsia conorii, which is carried by the tick Rhipicephalus sanguineus. Epidemiologic studies indicate that the incidence of MSF, which is similar to Rocky Mountain spotted fever, is rising in parts of Europe, Africa, and Asia. However, the disease is rarely seen in international travelers. Cases are described of two children, who traveled in southern France and developed MSF. The children had symptoms of rash and lymphadenopathy, or swollen lymph nodes. Blood tests confirmed the diagnosis of MSF, and the children were treated with the antibiotic doxycycline. The disease is usually mild, but may be misdiagnosed as other types of fever-associated skin rash. These cases illustrate the effect of international travel on clinical practice and, also, describe the features of another type of tick-borne illness, associated with rash and fever. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Causes of, Pediatric diseases, Fever, Infection in children

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