Background. Child abuse, neglect, and other adverse childhood experiences (ACE) can have a severe impact on physical and mental health. They can cause lifelong problems ranging from psychiatric disorders to physical problems, such as diabetes, heart conditions and even cancer. Therefore, ACE factors are a pressing topic but so far it has received little attention in medical care over the whole life span and needs to be addressed in all patients. Aims. How are ACE factors and other potentially traumatic experiences manifested in children and how can healthcare providers identify patients in need? How can they intervene to reduce harm and prevent future risk? Material andmethods. Introduction to and explanation of the complex associations between traumatic experiences, physical sequelae, and lifelong changes in the chronic stress system. Special consideration of the seminal work of Felitti and colleagues on how early childhood adversities relate to lifelong negative consequences (known as the ACE study). Further analysis using the example of children whose parents have a psychiatric disorder or substance abuse. Information about prevention programs and intervention according to the 2019 Association of the Scientific Medical Societies in Germany (AWMF) child protection S3(+) guidelines. Results. Chronic stress seems to cause chronic health impairment and early death of individuals with a history of ACE. The permanent state of a fight or flight reaction seems to induce epigenetic changes, which enable a fast adaptation to a critical environment. Abused and neglected children often suffer from a multitude of ACE factors. Therefore, to prevent the lifelong negative health outcomes associated with these factors, early intervention is needed including general improvement of the living conditions of children and parents. Conclusion. An early intervention system is needed to prevent ACE and the resulting mental and physical health problems. Healthcare providers need to be able to identify red flags and respond to them. A multidisciplinary approach shows the most promising results when working with traumatized children and malfunctioning families.

BACKGROUND:Early childhood interventions positively contribute to health related child development. For these interventions, networks are a necessary prerequisite as they promote interdisciplinary and interprofessional cooperation. This holds especially true for the integration of health system protagonists.METHODS:In a cross-sectional survey local paediatrists, gynaecologists, general practitioners, and psychotherapists were asked about their knowledge, experiences, desires, and reservations regarding cooperation in early childhood intervention networks.RESULTS:64 out of 1747 (3.7%) eligible clinicians answered the survey. On average they estimated that 10.1% of the families they are treating would benefit from early childhood interventions. Participants rated themselves as competent to offer appropriate early childhood interventions. The youth welfare service was judged as the most important institution for their own professional practice by 84.4%. Additionally to an applicable agenda, a fair group moderation of network meetings was seen as a substantial requirement in order to take part in network meetings.CONCLUSION:Health professionals are important protagonists in early childhood interventions. Clinicians should assess relevant problems in families and offer appropriate support on a regular basis. Alongside clearly defined regional contacts, interprofessional continuing education seems mandatory.

Die unterschiedlichen Erscheinungsformen und Tatumstände der Kindesmisshandlung können in Deutschland verschiedene Tatbestände des Strafgesetzbuchs (StGB) erfüllen, die mit erheblichen rechtlichen Sanktionen bedroht sind. Demgegenüber sind tatsächliche strafrechtliche Konsequenzen nur selten anzutreffen.

Background: Interdisciplinary cooperation and networking determine the success of activities for supporting families at risk for early childhood abuse. The integration of the healthcare sector might be important.Methods: The medical standard of perinatal care at the University hospital includes information exchange about family risk factors which may contribute to an increased risk of child abuse within the first year of life. As a result, the pediatrician offered supporting services for the families at the time of the second examination during the official childhood health screening program (U2). A team of family-sponsorship was established and evaluated.Results: In 281 of 1 238 risk-factor questionnaires at least one stress factor was detected and 97 families had high-impact family stress. Families under the supervision of a family midwife or youth services had a significantly higher number of risk factors. The family-sponsorship program was institutionalized and positively evaluated by the families.Conclusions: The time of a hospital delivery is an excellent opportunity for the evaluation of familial risk factors and for the provision of supporting services. To increase the acceptance of such services by the families at risk repeated assessment of risk factors and support offers are required.

Der Medizinische Kinderschutz beinhaltet die interdisziplinäre Diagnostik und Therapie physischer und psychischer Symptome sowie die Diskussion juristischer Konsequenzen. Retrospektive Analyse der Fälle mit Verdacht einer Kindesmisshandlung und Einleitung eines strafprozessualen Verfahrens (Untersuchungszeitraum 2 Jahre). Die Schwere der Verletzungen wird den strafrechtlichen Konsequenzen gegenübergestellt. Von 21 Strafverfahren wurden 7 bereits von der Staatsanwaltschaft eingestellt. In 4 von 8 Fällen mit Gerichtsurteil erfolgte eine rechtskräftige Verurteilung. In den 4 Fällen mit Freispruch war das Gericht zwar von einer Misshandlung überzeugt, konnte jedoch die Täterschaft nicht eindeutig zuordnen. Eine Korrelation zwischen der Verletzungsschwere und dem Ausgang des strafprozessualen Verfahrens war nicht feststellbar. Bei der Diagnostik und Therapie im Rahmen des Medizinischen Kinderschutzes ist stets die Frage nach den möglichen juristischen Folgen einzubeziehen. Die rechtliche Aufarbeitung von schwerwiegenden Kindesmisshandlungen verlangt eine hohe Qualität des medizinischen Sachverstandes. Entscheidend sind die möglichst valide Einschätzung des Entstehungszeitraums von Verletzungen und die exakte Dokumentation der Befunde. Die Studie zeigt auch, dass die medizinische Begutachtung nur einen Teilaspekt in der juristischen Bewertung der Kindesmisshandlung darstellt.

Background: Medical child protection includes besides interdisciplinary diagnostics and treatment of physical and psychological symptoms also a discussion that looks at the ensuing legal consequences. Method: This study analyses 21 criminally investigated cases of suspected child abuse from a 2 year study period and compares severity of injury to legal outcome. Results: 7 of those 21 criminal proceedings were already dropped by the prosecution and never went to trial. 4 of the 8 cases that led to a trial ended with a conviction. In all of the 4 cases that resulted in an acquittal the judges had been convinced that the child had been abused but found themselves unable to exactly identify the perpetrator. Our study's cases did not show a positive correlation between severity of injury and legal outcome. Conclusion: Diagnosing and treating children and minors within the context of medical child protection should always also include the question of possible legal consequences. The judicial process in cases of serious child abuse requires high medical expertise. Such expertise particularly includes the ability to determine the time of injury as exactly as possible and to provide precise written documentation of any medical findings. However, our study also shows that medical assessment is only one of many aspects in the legal response to child abuse.

A sensitive and simple liquid chromatography/mass spectrometry (LC/MS) method was developed for the determination of terephthalic acid isopropylamide, the final metabolite of procarbazine in human urine. A solid-phase extraction with C(18) cartridges was used followed by LC/MS with a single mass spectrometer (SSQ 7000 from Finnigan). Terephthalic acid isobutylamide was the internal standard. The quantification limit was 30 ng/mL in urine (6 x noise). This assay was applied for drug monitoring of terephthalic acid isopropylamide in urine after oral administration of procarbazine in children and adolescents with Hodgkin lymphomas.