PubMed · 9616636
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K Spicknell. Shaking babies.. https://pubmed.ncbi.nlm.nih.gov/9616636/
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The mother is usually the one who narrates the patient's history to the pediatrician. Listening and eliciting the parent's story is an art. One of the essential attributes of a good pediatrician is the readiness to believe the parent's story. Mothers are good historians and careful observers. The axiom that the mother is always right is true in most instances. However, occasionally the clinician is deliberately misled by the storyteller, resulting in numerous and potentially dangerous diagnostic investigations. We describe a boy with recurrent hypoglycemic coma in whom the diagnosis of factitious hypoglycemia was delayed as it is believed to be nonexistent in our community. We emphasize that in all patients with recurrent hypoglycemia, estimation of C-peptide and insulin should be performed even when the clinical settings are not in favor of the diagnosis of Munchausen syndrome by proxy. Munchausen syndrome by proxy, hypoglycemia.
OBJECTIVE: To assess the catch-up growth of abused infants who stayed in foster care for 1 year. PATIENTS AND METHODS: Longitudinal study over an 8 year period (1992-1999). All infants were aged between 5 and 7 months at the time of entry into foster care. Weight, length, and arm circumference were established on entry and were reassessed 3,6, and 12 months after initial placement. Results were compared with normal regional longitudinal standards of reference(Zscore). Student's t-test was used to assess statistically significant differences. RESULTS: Sixty-four infants (34 boys and 30 girls) entered foster care during the study period. Mean age was 6 months (boys: 0.69 SDU/girls 0.70 SDU). At placement, the analyzed parameters were below the normal standards (boys: weight Z = -1.98 SDU, length Z = -2.09 SDU, arm circumference Z = -1.34 SDU; girls: weight Z = -1.86 SDU, length Z = -1.61 SDU, arm circumference Z = -1.22 SDU) and showed statistically significant differences (p < 0.05). Catch-up growth during the first 3 months after placement was considerable (improvement in boys: weight Z = +1.20 SDU, length Z = + 1.18 SDU, arm circumference Z = +0.95 SDU; improvement in girls: weight Z = +0.82 SDU, length Z = +.63 SDU, arm circumference Z = +0.77 SDU). Differences were no longer statistically significant but still remained below normal standards. Six months after initial placement, there was no significant catchup growth for length (improvement in boys = + 0.34 SDU; improvement in girls = +0.05 SDU) and growth impairment for weight and arm circumference was minimal. Twelve months after initial placement, impairment of catch-up growth for all parameters was mild. No statistically significant differences compared with normal standards were found (boys: weight Z = -0.84 SDU, length Z = -0.74 SDU, arm circumference Z = - 0.56 SDU; girls: weight Z = -1.09 SDU, length Z = -1.04 SDU, arm circumference Z = -0.52 SDU). CONCLUSIONS: In 6 month old infants of both sexes, catch-up growth was significant during the first 3months after placement into foster care. A stay of more than 6 months did not produce improvement in catch-up growth.
We looked at the incidence and demography of nonaccidental head injury in children in a prospective population-based study of paediatric units in Scotland during 1998-99. Shaken impact syndrome occurs with an annual incidence of 24.6 per 100000 children younger than 1 year (95% CI 14.9-38.5). Cases are more common in urban regions, and during autumn and winter months. The risk of a child suffering non-accidental head injury by age 1 year is one in 4065. These brain injuries occur almost exclusively in young infants (median age 2.2 months).