Biomedical subjects
Publications and source records attributed to R K Oates.
Three cases, one of bullous impetigo, one of a Mongolian spot, and one of constriction of the toe by a hair, were mistakenly diagnosed as cases of child abuse. The diagnosis of child abuse is not usually simple and requires a careful evaluation of the injuries and the family if cases are not to be either overlooked or overdiagnosed.
Parents of children with Down's syndrome should be interviewed with their child as soon after the birth as possible. The child should be assessed carefully by a paediatrician experienced in this field. The parents should be given ongoing practical support and a treatment programme should be provided for the child. The birth of a handicapped child is always a tragedy for a family but with sensitive care of the child, parents and other siblings, much can be done to help the family readjust and become realistically involved in the child's care and education.
A group of 39 mothers who had a physically abused child at an average of 6 years previously and a group of 14 mothers who had a child with non-organic failure to thrive (NOFTT) 13 years ago were reviewed. Each child was compared with a child matched for age and sex and for ethnic group, residential area and social class of the parents. The mothers from the NOFTT group knew less than their comparison mothers about their child's education and on a personality test were less able at intellectual and abstract concepts. The abuse group mothers were more mobile and more isolated than their comparison group. They were less likely to have been brought up by their own parents and had more negative feelings towards their fathers. They had lower self-esteem and higher expectations for their children than the comparison mothers. On a personality assessment they were more assertive, demanding and suspicious than the comparison mothers. Although child abuse and non-organic failure to thrive have been described as part of the same spectrum, the characteristics of the parents on follow-up are different. As some of the adverse characteristics of the parents persist long after the presenting incident, the need for a long term treatment programme aimed at supporting children who remain in these families is recommended.
The first case of osteosarcoma in a 13 year old boy with Rothmund-Thomson syndrome is reported. The association between these two conditions is uncertain.
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The case histories of 187 abused and neglected children, admitted to the Royal Alexandra Hospital for Children over a three-year-period, were reviewed. Multiproblem families from the lower socioeconomic groups predominated, reflecting the hospital's geographic catchment area. Eight children died and 30 were made state wards. A high proportion of mothers described problems during the pregnancy, a difficult delivery and neonatal problems. The majority of parents in this study were married and had small families. First-born male infants of young isolated mothers were found to be at greatest risk of child abuse and neglect.
One hundred children who attended a Sydney Paediatric Casualty Department with injuries, burns or ingestions of harmful substances were divided into two groups. One group (30 children) consisted of cases which were considered to be those of child abuse or neglect (CAN). In the other group (70 children) there was no suspicion of child abuse or neglect. This was regarded as the "simple accident" (SA) group. The 100 families were visited at home and interviewed about their child's health, child rearing practices, parental expectations for the child, and socioeconomic status. Factors which had a significant association with suspected child abuse and neglect were obstetric complications, prolonged stay in hospital in the first two years of life, low maternal regard for the child, unwed mother of Australian nationality, maternal social isolation, and family disruption during the parents' own childhood. These risk factors may enable the earlier identification of abused children.
The parents of 50 children with Down's syndrome were interviewed to find what sort of information they were given at the time of diagnosis and what arrangements were made for the child's future. Particular emphasis was placed upon the method and timing of giving the parents the diagnosis, the utilization of community resources to help the family and what information they would have liked to have been given in retrospect. The ages of the children ranged between three months and eight years at the time of the survey. Seventy-two per cent of parents were given the diagnosis during the first week, with an increasing proportion being dissatisfied with the timing the longer the delay in telling what was wrong with the child. The mother has been told first in 48% of cases, and both parents have been told together in only 20% of cases. Fifty-four per cent of parents were encouraged to take the baby home, 22% were encouraged to place the baby in an institution, while in 28% of cases the decision was left to them. Forty-six per cent of patients felt that an overly-pessimistic outlook had been given by the doctor. Eighty-four per cent had medical follow-up, community follow-up, or literature supplied, whereas 16% had no such arrangements made. The parents' own suggestions for better management were sought. The two most outstanding were to be placed in early contact with community facilities and to be given a chance to meet other parents of children with Down's syndrome.
Children with multiple handicaps often require the services of a team of professionals to ensure that they receive a comprehensive assessment. It is essential that the information derived from this assessment is conveyed accurately to the child's parents in language that they understand. It is also important that a member of the assessment team is made responsible for seeing that the recommendations made for the child's future are actually carried out. On hundred and twenty-nine children referred for assessment of developmental delay were found to have multiple intellectual, physical and social problems needing a team approach to their assessment, and the mobilization of a variety of community resources to provide their ongoing care.
Twenty-one children diagnosed as having nonorganic failure to thrive were reviewed at an average of 6 years 4 months after their initial presentation. Most of the children were found to be of normal height and weight but disorders in personality traits and educational attainments were common. One half of the children have abnormal personalities. Two thirds have a delayed reading age. Intelligence testing shows that one third have verbal scores significantly lower than their performance scores. Two children from the original series have died in suspicious circumstances. The families of these children have a high incidence of marital instability and economic difficulties. The traditional medical approach to nonorganic failure to thrive needs to be complemented by intensive social support for these families at the time of initial presentation in the hope that the long-term effects of this syndrome can be ameliorated.
A child with acute lymphoblastic leukaemia complicated by prolonged gastrointestinal and skin haemorrhages due to profound thrombocytopenia finally died of thrombotic occlusions of major cerebral arteries due to mucormycosis. Biopsy of any suspect lesion is needed urgently before prolonged therapy with amphotericin B is started. So far there have been no cures in childhood.
Cooling is known to prolong survival in newborn animals when used before the onset of asphyxia. It has therefore been advocated as a treatment for birth asphyxia in humans. Since it is not possible to cool a human baby before the onset of birth asphyxia, experiments were designed to test the effect of cooling after asphyxia had already started. Newborn rabbits were asphyxiated in 100% nitrogen and were cooled either quickly (drop of 1 degree C in 45 s) or slowly (drop of 1 degree C in 2 min) at varying intervals after asphyxia had started. When compared with controls, there was an increase in survival only when fast cooling was used early in asphyxia. This fast rate of cooling is impossible to obtain in a human baby weighing from 30 to 60 times more than a newborn rabbit. Further litters of rabbits were asphyxiated in utero. After deliver they were placed in environmental temperatures of either 37 degrees C, 20 degrees C, or 0 degrees C and observed for spontaneous recovery. The animals who were cooled survived less often than those kept at 37 degrees C. The results of these experiments suggest that hypothermia has little to offer in the treatment of birth asphyxia in humans.
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A survey of mothers attending infant welfare clinics showed that 26% changed their infant's milk in the first two weeks after birth and that multiple changes were common. Twenty-two per cent. were preparing a milk formula more concentrated than the recommended strength by using either heaped or packed scoops instead of level scoops of powder or by giving extra scoops. The commonest age for starting solid feeding was between 3 and 4 weeks and the practice of adding rusk or cereal to the bottle was common. There are obvious dangers of hypernatraemia from taking concentrated milk feeds and problems of obesity which may follow the early introduction of cereals.
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