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Biomedical subjects

Howard Dubowitz

Publications and source records attributed to Howard Dubowitz.

9 recordsLinked to original sources
PubMed2003

Failure to thrive.

Failure to thrive is a condition commonly seen by primary care physicians. Prompt diagnosis and intervention are important for preventing malnutrition and developmental sequelae. Medical and social factors often contribute to failure to thrive. Either extreme of parental attention (neglect or hypervigilance) can lead to failure to thrive. About 25 percent of normal infants will shift to a lower growth percentile in the first two years of life and then follow that percentile; this should not be diagnosed as failure to thrive. Infants with Down syndrome, intrauterine growth retardation, or premature birth follow different growth patterns than normal infants. Many infants with failure to thrive are not identified unless careful attention is paid to plotting growth parameters at routine checkups. A thorough history is the best guide to establishing the etiology of the failure to thrive and directing further evaluation and management. All children with failure to thrive need additional calories for catch-up growth (typically 150 percent of the caloric requirement for their expected, not actual, weight). Few need laboratory evaluation. Hospitalization is rarely required and is indicated only for severe failure to thrive and for those whose safety is a concern. A multidisciplinary approach is recommended when failure to thrive persists despite intervention or when it is severe.

Child↗
PubMed2002

The neglect scale: confirmatory factor analyses in a low-income sample.

The Neglect Scale is an easy-to-administer, retrospective, self-report measure of neglect. Research conducted by Straus and colleagues with college students indicates that this scale has a high level of internal consistency reliability and moderate construct validity. The purpose of this article is to examine the reliability and validity of the Neglect Scale when used with a low-income, inner-city sample. The sample included 151 women who were participating in a neglect prevention demonstration project. The Neglect Scale was completed as part of a computer-administered baseline interview before services were provided. To assess whether the 20-item, four-factor structure reported by Straus et al. fit the data from this sample, a confirmatory factor analysis was performed; the model did not fit the data well. Additional analyses identified a model that did fit the data well and suggest that the Neglect Scale is a promising self-report measure.

Child↗
PubMed2002

Behavior problems among preschool children born to adolescent mothers: effects of maternal depression and perceptions of partner relationships.

Investigated how maternal depression influenced the relation between mothers' perceptions of the quality of their partner interactions and behavior problems among their preschool children. Participants included 194 low-income families from 4 sites. Approximately three fourths of the mothers (72%, n = 139) identified a male partner and comprised the analysis sample. Mothers were adolescents (< or = age 19) at delivery, and data were gathered when children were 4 to 5 years of age. In this high-risk sample, 42.4% of the children had been maltreated, 36% had externalizing scores in the clinical range, and 10.8% had internalizing scores in the clinical range. Multiple regression analyses revealed (a) maternal perceptions of negative partner interactions were associated with more internalizing behavior problems among the children, adjusting for the effects of maltreatment; (b) maternal depression mediated the relation between the maternal perceptions of the quality of partner interactions and children's internalizing and externalizing behavior problems; and (c) maternal perceptions of positive partner interactions did not protect children from internalizing or externalizing behavior problems associated with maltreatment. Programs for adolescent mothers should provide screening and treatment for depressive symptoms and help partners negotiate caregiving roles and mutually satisfying relationships.

Adolescent↗
PubMed2002

Behavior and development of preschool children born to adolescent mothers: risk and 3-generation households.

OBJECTIVE: To investigate whether living in a 3-generation household (grandmother-mother-child) is associated with fewer behavior problems and better cognitive development among preschool children of mothers who gave birth during adolescence and whether it protects children from the behavior and developmental problems associated with maltreatment and maternal depression. DESIGN: Cohort study. SETTING: Participants included low-income families recruited from 4 sites: East, Northwest, Midwest, and South, who are part of LONGSCAN, a longitudinal study of children's health, development, and maltreatment. PARTICIPANTS: One hundred ninety-four mothers who were adolescents (less than age 19) at delivery. Data were gathered when children were 4 to 5 years of age. Twenty-six percent of the children lived in 3-generation households, 39% had a history of maltreatment, and 32% of the mothers had depression scores in the clinical range. MAIN OUTCOME MEASURES: Child behavioral problems were measured with the Child Behavior Checklist, completed by the mother, and child developmental status was assessed with the Battelle Developmental Inventory Screening Test, administered by research assistants. RESULTS: Multiple regression analyses revealed that children who had been reported for maltreatment and had mothers with depressive symptoms had more externalizing behavior problems, compared with children who experienced neither risk or only 1 risk. However, when residential status was considered, children with the greatest number of externalizing behavior problems were those who experienced both maltreatment and maternal depressive symptoms and lived in 3-generation households. Children who had been reported for maltreatment or had mothers with depressive symptoms were more likely to have internalizing problems, compared with children with neither risk. Residential status was not related to children's internalizing behavior problems or cognitive development. CONCLUSIONS: Living in a 3-generation household did not protect preschool children from the behavior problems associated with maltreatment and depression. In contrast, living in a 3-generation household was associated with more behavior problems among the highest risk group of children--those who had been maltreated and had mothers with symptoms of depression. Although 3-generation families may provide an important source of support and stability for adolescent mothers and their infants early in the parenting process, it may not be advisable to rely on 3-generation households as young mothers enter adulthood, particularly among those with a history of maltreatment or depression. Children with the fewest number of behavior problems were living with their mothers in their own household (often with the father), had not been maltreated, and had mothers with few symptoms of depression.

Adolescent↗
PubMed2002

Child neglect: outcomes in high-risk urban preschoolers.

BACKGROUND: Limited longitudinal research has been conducted on the impact of neglect on children's health and well-being. There is a need to consider the impact of specific subtypes of neglect on children's functioning. In addition, there is interest in examining the cumulative effect of experiencing >1 subtype of neglect. OBJECTIVE: To examine the individual and cumulative relationships among physical, psychological, and environmental neglect and children's behavior and development at age 3, and the impact on changes in children's behavior and development between ages 3 and 5. METHODS: One hundred thirty-six children and their primary caregivers participating in a prospective longitudinal study of children's development and maltreatment were assessed when the children were aged 3 and 5 years. The children were recruited from primary care clinics because of failure to thrive, risk for human immunodeficiency virus, or as a comparison group. Evaluations were conducted in laboratory and home settings using observations, maternal self-report, and standardized testing of the children. Scores on physical, psychological, and environmental neglect were combined into a Cumulative Neglect Index. Regression analyses were run to examine the association of specific subtypes of neglect and of cumulative neglect with children's functioning at age 3, controlling for group, sociodemographic risk, and maternal depression. The analyses were repeated examining the impact on child outcomes at age 5, controlling for the above 3 variables as well as the children's cognitive development and behavior at age 3. RESULTS: Of the subtypes of neglect at age 3, only psychological neglect was significantly associated with increased internalizing and externalizing behavior problems at age 3; the Cumulative Neglect Index was associated with internalizing problems. None of the neglect subtypes or cumulative neglect were predictive of changes in children's behavior and development between ages 3 and 5. Cognitive development of the entire sample was impaired at age 5, averaging 0.85 standard deviations below the norm, and their average externalizing behavior score was significantly problematic with an average of 0.60 standard deviations above the norm. CONCLUSIONS: In the context of poverty where many preschool children have poor cognitive development and increased behavior problems, psychological neglect is significantly related to reported behavior problems. Children who experienced multiple types of neglect had increased internalizing problems. Neglect did not explain changes in children's behavior or development between ages 3 and 5. There is a need for pediatricians to identify and address child neglect, particularly psychological neglect, as early as possible. Pediatricians should also screen for maternal depression.

Adult↗
PubMed1987

Inflicted and noninflicted injuries: differences in child and familial characteristics.

Clinicians involved in child protection work are frequently confronted with decisions as to whether a child's injury is inflicted or accidental. This study examines child, parental, familial, and environmental characteristics in a group of 25 abused children compared to a group of 90 children with accidents. Significant differences and commonalities are discussed.

Accidents↗