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Biomedical subjects

K W Feldman

Publications and source records attributed to K W Feldman.

31 records · Page 2Linked to original sources
PubMed1988

Diagnostic and surgical implications of child abuse.

One hundred fifty-six children younger than 13 years of age with blunt abdominal injuries were reviewed, and those injured in accidents (89%) were compared with those injured by child abuse (11%). Abused children were younger (mean age, 2 1/2 years) and all presented late to medical attention with a history that was inconsistent with their physical findings. Only 65% of abused children had physical or roentgenographic signs of prior abuse, while 35% had no signs of prior abuse. The abdominal organs injured were different; 61% of accidentally injured children suffered injuries to a single, solid organ, and only 8% had hollow viscus injuries, while 65% of abused children had hollow viscus injuries. Physicians should suspect child abuse when children have unexplained injuries (especially young children with hollow viscus injuries) even when other signs of child abuse are absent, and they should suspect hollow viscus injury in abused children.

Abdominal Injuries↗
PubMed1984

Pseudoabusive burns in Asian refugees.

Six Southeast Asian refugee children had cigarettelike burn scars on the lower trunk and abdomen. Questioning of the families disclosed that the burns had been the result of therapeutic burning by folk medical healers for prior illnesses. Pediatric practitioners should recognize the therapeutic intent of these injuries to avoid inappropriate accusations of child abuse. They can likewise encourage families to seek less harmful alternative treatments.

Asia, Southeastern↗
PubMed1984

Child abuse, cardiopulmonary resuscitation, and rib fractures.

Rib fractures have occasionally been described in children receiving cardiopulmonary resuscitation (CPR). Because child abuse is sometimes suspected in these cases, it is both medically and legally important to establish whether the rib fractures are secondary to abuse or CPR. One hundred thirteen children, including 41 victims of child abuse, 50 patients who had CPR, and 22 patients who had rib fractures, were studied. Twenty-nine patients had rib fractures; 14/29 (48%) were abusive. Other causes of fracture were: motor vehicle accidents (four), rickets/osteoporosis (five), surgery (five), and osteogenesis imperfecta (one). In spite of prolonged resuscitation performed with variable degrees of skill, no fractures could be attributed to CPR. On the other hand, rib fractures occurred frequently in abused children (6/41 or 15%). Abusive fractures were often multiple, of different ages, and affected multiple adjacent ribs. Patients with abusive rib fracture also had other physical and radiologic signs of abuse or neglect.

Adult↗
PubMed1980

Strangulation in childhood: epidemiology and clinical course.

A review of 233 cases of childhood strangulation was made to determine injury epidemiology. Consistent patterns of injury were observed. Crib and playground equipment strangulations are already the subject of Consumer Product Safety Commission (CPSC) preventative regulations. High chair-, playpen mesh-, pacifier cord-, and clothing-related injuries would be amenable to prevention by improved product safety regulation. The CPSC has been petitioned to remedy the first two of these hazards. Many crib and rope strangulations can only be prevented by direct patient counseling. Although Congress empowered and required the CPSC to recognize and correct unsafe products, its surveillance systems may obscure the very design defects that cause injury. Likewise, political considerations may slow enactment of new design regulations. Physicians who treat childhood accident victims are in a position to recognize hazardous products and lobby for their improvement. Of the 233 cases 38 were further evaluated to delineate the clinical course of childhood strangulation. Victims who fail to resume normal cardiopulmonary function by the time of hospitalization have a poor prognosis for neurologic recovery with current modes of therapy. Improved treatment of hypoxic and ischemic cerebral injury might prevent some of the deaths and handicaps resulting from strangulation.

Accident Prevention↗
PubMed1978

Tap water scald burns in children.

Tap water scald burns account for 7% to 17% of all childhood scald burns that require hospitalization. Often the burns are severe and disabling. Toddlers and preschool children are the most frequent victims. In 45% of the injuries, the unsupervised victim or peer turned on the tap water; in 28% the cause was abuse. Eighty percent of the homes tested had unsafe bathtub water temperatures of 54 C (130 F) or greater, exposing the occupants to the risk of full-thickness scald with 30-second exposure to hot water. Such burns may be prevented passively by limiting household water temperatures to less than 52 C (125 F). New water heaters could be preset at this temperature and families could be taught to turn down the temperature on existing units.

Accidents, Home↗
PubMed1975

Fetal phallic growth and penile standards for newborn male infants.

No appreciable difference in size of the fetal clitoris versus the fetal penis was noted until 14 weeks' gestation, which is after the period of masculine differentiation of the external genitals. However, significant differences in the rate of penile and clitoral growth were evident in second trimester fetuses. The majority of the prenatal growth of the penis occurs after 14 weeks gestation at an almost linear rate. The penile stretched length of the full-term infant was 3.5 cm plus or minus 0.7 cm and the diameter was 1.1 cm plus or minus 0.2 cm.

Clitoris↗
PubMedDate not supplied

When is childhood drowning neglect?

Concern that drowning is frequently considered neglectful and referred to Children's Protective Services (CPS) led us to review the frequency and associations of referral. Records of 95 childhood drowning and near drowning victims hospitalized between 1981 and 1987 were reviewed. Reactions of 14 nurses, 27 physicians, and 13 social workers to 4 case scenarios were solicited. Only 8 drownings were reported to CPS. Reporting was significantly more likely if the child was younger or nonwhite, the family poor, the injury in the bathtub, social work involved, a prior CPS report recognized or consideration of neglect documented in the chart. Reporting was not related to the child's sex or clinical outcome, the parent's marital status or drug/alcohol history, type of child supervision, or time until discovery or history of prior accidents. Only 28% of the cases had social service evaluation. Intensive care staff were least likely and emergency room staff most likely to consider drowning scenarios neglectful. Profession, age, sex, years in practice and whether one was a parent did not affect the referral decision. Judgment that scenarios were neglectful correlated closely with the decision to report. Lapse in supervision by an intoxicated father, was thought most neglectful. Judgment was split whether poor families letting infants bathe alone or with siblings were neglectful or the result of poor knowledge of hazard and infant development. A 4-year-old who wandered into a lake at a picnic was felt a victim of an unfortunate accident. Clinicians found decisions about referral stressful.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Abuse↗