The author begins with an accurate observation that the discourse about “Abusive Head Trauma” (AHT) and “Shaken Baby Syndrome” (SBS) has become clouded by harsh rhetoric and that a dialectical approach to resolution is missing and necessary. The controversy has reached the Supreme Court in Cavazos v. Smith and confused some justices. The author also calls for “transdisciplinary” research about medical histories given to doctors in child injury cases and confessions of inflicted injuries with or without plea bargains given to law enforcement officers or prosecutors. Unfortunately, there is no existing authority capable of imposing a rational dialectic process on the combatants in this conflict, and they themselves may see little value in attempts to engage the “other side” in a rational dialectical process. The “medical experts”who hold that the diagnoses are unscientific are not so much motivated by science as by economic considerations. Persons threatened with prolonged imprisonment for crimes are often willing and able to recruit large sums to compensate the expert witnesses who may assist them in securing better outcomes and the defense attorneys who organize the defenses welcome the “agnostic” stances the “experts” bring since they inject “reasonable doubt.” Medical Examiners who are public employees charged with determining causes of death in injury cases are often underpaid by myopic political entities, and a few have been lured to assist defendants in fatal child abuse cases. Once they “cross the line” to “the other side” they tend to stay connected to the defense. The prosecutors often cast them out. The author correctly observes that the “agnostic position” is not widely supported. Narang (Narang 2011) notes that both individual medical doctors and medical societies heavily favor the view that both AHT and SBS are valid diagnostic constructs. In a later article, Narang (awaiting publication) comments on the literature cited by the confused justices:

Objective: The authors' objective is to describe the disparity between the case-fatality rates for inflicted versus unintentional injuries of children, and to emphasize its utility as a way of estimating the effectiveness of the ascertainment of inflicted injuries of children.Method: Determination, comparison, and explanation of the case-fatality-rate disparity in four injury databases were derived from hospitalized injury cases.Results: The CFR disparity is 6-14-fold in the 4 injury databases. The CFR disparity varies strongly and inversely with the observed incidence of inflicted injuries in the databases.Conclusions: A large disparity between the case fatality rates (CFRs) of inflicted and unintentional injuries exists in a number of injury databases. Inflicted injuries have much higher CFRs than unintentional injuries. The disparity can be accounted for by "missed" (incorrectly diagnosed) and "missing" (unseen) cases.Practice implications: Present diagnostic criteria for physically abusive (inflicted) injuries are forensically-driven and too conservative for public health purposes. New public-health-oriented case definitions for "inflicted injury" are needed. Programs to reduce injury recidivism in young children should be a part of overall injury prevention. (C) 2010 Elsevier Ltd. All rights reserved.

OBJECTIVE. The objective of the work was to develop an estimate of the risk of death resulting from short falls of < 1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday. METHODS. A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed. RESULTS. The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers. CONCLUSIONS. The best current estimate of the mortality rate for short falls affecting infants and young children is < 0.48 deaths per 1 million young children per year. Additional research is suggested.

This article draws on international evidence to propose a solution to a key problem affecting UK paediatricians and child protection. Disciplinary actions brought by the General Medical Council against doctors for their testimony in, and or reporting of, cases of suspected child abuse, have caused damaging consequences for the profession and, worse, for child protection. Because of these cases and mounting numbers of complaints, paediatricians are less likely to report suspected child abuse, and are less willing to accept leading child protection roles. This problem demands a solution. Informed by a comparative analysis, this article suggests that enacting a legislative immunity for paediatricians from legal and administrative proceedings where a report of suspected child abuse is made in good faith, is required to restore paediatricians’ willingness to report suspected child abuse and engage in child protection work.

The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday.A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed.The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers.The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.

junction 402 Cricket ball 204 Cricopharyngeus 71 Crochet needle 493 Cutaneous lesions 360 Cyst 344 -wall excision 465 Cysticercus cyst 118 Dengue 490 -hemorrhagic fever 490 Dense-array EEG 474 Desmoplastic infantile ganglioglioma 422 Developmental abnormality 360 Diabetic ketoacidosis 496 Dialysis 65 Diastematomyelia 418 Diffuse pontine glioma 208 Direct cortical stimulation 313 Disseminated hemangioma 344 Distal catheter migration 49 Distraction osteogenesis 216 Distractor breakage 216 Dural arteriovenous fistula 172 Dysembryoplastic neuroepithelial tumor 333

In this article we address the recent actions of the General Medical Council in the United Kingdom affecting 2 pediatricians who are major contributors to pediatric knowledge about the intentional suffocation of infants. The General Medical Council struck one of them from the register of licensed medical practitioners, but the decision was appealed successfully. The council restricted the practice of the other pediatrician. After a review of the transcripts of the hearings, we conclude that the opinions given by both doctors were responsible, and the transcripts suggest that the conduct of the hearings was unfair. Licensing boards may have difficulty in competently regulating doctors' expert testimony, at least in cases involving child maltreatment.

Medical expert witnesses need legal protection too, to use the evidence effectively I n this week's BMJ Gornall points out some of the problems associated with the presentation of medical evidence of child abuse in the United Kingdom. He focuses on the omission from the Royal College of Paediatrics and Child Health's new handbook, Child Protection Companion , of research evidence gathered by two controversial paediatricians—David Southall and Sir Roy Meadow.1 A well developed evidence base exists for child abuse medicine that is suitable for use in litigation for child protection. The published evidence on the abuse and neglect of children begins with a descriptive article by Tardieu (the father of forensic medicine) in 1860.2 He pointed out how medical conditions that he had observed in 32 children defined the abusive nature of the events that had occurred. In 1962 Kempe and colleagues reiterated that doctors could and should infer abuse on the basis of certain medical findings of injury. The “battered child syndrome” that they defined is still a valid concept based on observational …

The first important monograph describing the battered child syndrome was written in 1860 by Ambroise Tardieu, a French forensic physician. Here is a translation of his article, published in the Annales d'hygiene publique et de medecine legale, with the title "Etude medico-legale sur les sevices et mauvais traitements exerces sur des enfants." The first part of his article is entirely translated. A brief summary of the 32 cases report described by Tardieu in the second part of his article is presented. (c) 2005 Elsevier Ltd. All rights reserved.

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2–62% of women and 3–16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.

This chapter focuses on child abuse in the United States, how it is defined and measured, and its behavioral and social consequences. Throughout, the discussion is guided by concern with the organizations involved in confronting child abuse, from identifying its diverse forms and documenting their prevalence to policy formation and programmatic response. Major topics examined include the cycle of violence thesis, prevention and treatment, and problems and issues related to conceptual ambiguity (in particular, the absence of a generally accepted operational definition of child abuse) such as theoretical fragmentation and important knowledge gaps. Chief among the conclusions is the absence of the organizational unity and financial support necessary to facilitate the acquisition of the knowledge prerequisite to developing informed social policy and devising effective action programs.