Richard Krugman

University of Colorado | UCD · Department of Pediatrics

Purpose of Review Obesity is an overwhelmingly common medical entity seen in the adult population. A growing body of research demonstrates that there is a significant relationship between child maltreatment and adult obesity. Recent Findings Emerging research demonstrates a potential dose–response relationship between various types of child abuse...

The Gary B. Melton Visiting Professorship was created to honor and celebrate the legacy of Dr. Melton and to encourage scholars and advocates to continue to build on his impressive body of interdisciplinary work on children’s rights, global approach to child health and well-being, and social frameworks of family and community. A collaboration of th...

Background Although mandatory reporting has grown substantially in scope and geographical coverage, there is limited empirical evidence to support its effectiveness in preventing harm to children. In the absence of rigorous evaluations, comparing the perspectives of individuals who work in systems with and without mandatory reporting provides impor...

The past 50 years have witnessed a dramatic change in the morbidity and mortality of many (if not most) pediatric diseases. The primary driver for this improvement has been the billions of dollars invested in research by the National Institutes of Health and hundreds of not-for-profit advocacy groups that have raised awareness and money to support...

The experience of physicians and other health care providers in child abuse pediatrics in the last six decades includes successes and failures, which can offer critical insights to inform the growing field of health care providers focusing on elder abuse clinical practice and research. Methods: We compare and contrast child abuse pediatrics and eld...

Introduction Physical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research sugges...

The 30th anniversary of the United Nations Convention on the Rights of the Child provides an opportunity to reflect on whether the approaches to date in dealing with child abuse and neglect (CAN) have been successful. Initial responsibility in most countries to address CAN has been given to Child Protective Services Agencies. Recently, there have b...

For more than fifty years, not enough has been done to tackle the national problems of child abuse and neglect.

Background: Child Protective Services (CPS) systems have not historically conducted system effectiveness research. More information is needed about the long-term outcomes of children and families served by the systems. Objective: To investigate how workers within CPS systems in Colorado and the Netherlands measure and perceive the effectiveness...

This volume provides a wide spectrum description analysis of the contemporary and well established child protection systems in a range of countries, such as Australia, Canada, Netherlands and Spain. It presents a brief orientation about the public and private systems involved in protecting children in each country. Further the book identifies curre...

Academic medicine shares the handicap of many hierarchical organizations in that it is difficult for those lower in the hierarchy to speak up when doing so requires challenging their chronologic and administrative elders. Elsewhere in this issue, Dankoski and colleagues offer specific recommendations for combating this "organizational silence," inc...

This Handbook examines core questions still remaining in the field of child maltreatment. It addresses major challenges in child maltreatment work, starting with the question of what child abuse and neglect is exactly. It then goes on to examine why maltreatment occurs and what its consequences are. Next, it turns to prevention, treatment and inter...

Every day in the United States, children and adolescents are victims of commercial sexual exploitation and sex trafficking. Despite the serious and long-term consequences for victims as well as their families, communities, and society, efforts to prevent, identify, and respond to these crimes are largely under supported, inefficient, uncoordinated,...

This chapter introduces The Battered-Child Syndrome, the paper by C. Henry Kempe and his colleagues that is the focus of this section, and summarizes the commentaries written in response to this paper.

This chapter introduces Approaches to Preventing Child Abuse: The Health Visitor’s Concept, the paper by C. Henry Kempe that is the focus of this section, and summarizes the commentaries written in response to this paper.

This chapter introduces Sexual Abuse, Another Hidden Pediatric Problem: The 1977 C. Anderson Aldrich Lecture, the paper by C. Henry Kempe that is the focus of this section, and summarizes the commentaries written in response to this paper.

This chapter introduces the orientation of the volume around four papers published by C. Henry Kempe and his colleagues. Each paper is followed by invited commentaries that consider the impact and legacy of Dr. Kempe’s work.

This volume is the first book in the new series, Child Maltreatment: Contemporary Issues in Research and Policy. This first volume focuses on the legacy of the work of C. Henry Kempe, M.D., the pediatrician widely credited with galvanizing public and private attention to abused and neglected children. 2012 marks 50 years after the appearance of the...

In 1962, C. Henry Kempe and colleagues published a landmark paper in JAMA entitled “The Battered-Child Syndrome.”¹ This heavily cited paper is credited with launching a new field and the passage of legislation in every state in the United States that required the reporting of suspected cases of child abuse or neglect to designated authorities (eith...

Advocacy for children is a fundamental pediatric concern and activity. Notwithstanding achievements for children to date, pediatrics can do more in the twenty-first century to advocate for children and promote research on ways in which advocacy for children can be improved. Evidence-based advocacy should take many directions including legislation,...

This article describes a decade of major changes at an academic health center (AHC) and university. The authors describe two major changes undertaken at the University of Colorado and its AHC during the past 10 years and the effects of these changes on the organization as a whole. First, the AHC's four health professional schools and two partner ho...

The University of Colorado School of Medicine has developed an innovative 4-year undergraduate curriculum. As a strong advocate for education and curriculum reform, Dr M. Douglas Jones Jr. created an environment for pediatrics to flourish in this new curriculum. Pediatric content has increased in all years of the curriculum, and pediatric faculty h...

I appreciate the opportunity to comment on the article by Magill and colleagues,1 which describes a 7-year saga to operate a primary care network for an academic health science center. There are a number of notable things to comment on as one looks from afar. In doing so, I will compare their experience in Utah with ours in Colorado. Our approach,...

Information that can help in identifying, reporting, and treating child abuse and neglect is more readily available to the pediatrician than ever before. Family and community violence remain national public health concerns. The medical literature on the epidemiology of child abuse and violent behavior continues to expand, as does the body of knowle...

Neurosurgeons that see children and care for those with traumatic injury are highly likely to see cases of child abuse and neglect. That fact makes it inevitable that they will encounter the legal system. It is hoped that this article has demystified the legal process and systems that one encounters in day-to-day practice. Avoiding the diagnosis of...

The purpose of the study was to extend the scope of earlier research on minority physicians attending to the needs of the poor and their own ethnicity by contrasting practice characteristics of Hispanic doctors in Colorado with those of their white, non-Hispanic counterparts. It was found that Hispanic physicians spent more hours per week in direct...

In this issue of THE JOURNAL, Martin et al1 report on the prevalence of physical abuse before, during, and after pregnancy as determined from a random sample of North Carolina women (1997-1998). Women were surveyed by mail and telephone approximately 3.6 months after they delivered live infants. Reported physical abuse before and during pregnancy e...

To assess the incidence and nature of concerns about sexual abuse, with particular reference to erroneous concerns of sexual abuse made by children. A review of case notes of all child sexual abuse reports to the Denver Department of Social Services over 12 months. Cases were put into four groups: substantiated, not sexual abuse, inconclusive and e...

The objectives of this study include conducting an analysis of access to primary medical care in rural Colorado through simultaneous consideration of primary care physician-to-population and distance-to-nearest provider indices. Analyses examined the potential development and implications of excessively large, perhaps unmanageable patient caseloads...

Now, more than ever, physicians must be willing to suspect child abuse and report their concerns. New information from the past decade warns us that reports of violence against children continue to increase. We are learning that MRI imaging of the head may, in some cases, help date subdural hematomas, but long-term developmental follow-up studies o...

First published in 1968, The Battered Child quickly became a landmark work. Our awareness of child abuse today is due in no small part to the remarkable impact of its first and subsequent editions. The new edition of this classic text continues the legacy. While updating and significantly adding to previous editions, the fifth edition retains the m...

To describe sociodemographic factors pertinent to sexually abusive youths, to define common characteristics of the offending behaviors and victims, and to identify issues relevant to treatment recommendations. The Uniform Data Collection system (UDCS), developed by the National Adolescent Perpetrator Network, provided data from 90 contributors in 3...

Child abuse is an ancient problem but one that has grown alarmingly in the United States in the last few decades. Once the problem of child abuse was recognized in the 1960s, mandatory reporting was instituted to develop public health mechanisms for intervention. But the approaches taken then were inadequate, and as sexual abuse of children was ack...

In 1991, the U.S. Advisory Board on Child Abuse and Neglect recommended that the federal government immediately begin phasing in a national universal home visiting program for children during the neonatal period. The Board believes that such home visiting can be an effective strategy in preventing child abuse and neglect. In this article, Dr. Richa...

Now, more than ever, physicians must be willing to suspect child abuse and report their concerns. New information from the past decade warns us that reports of violence against children continue to increase. We are learning that MRI imaging of the head may, in some cases, help date subdural hematomas, but long-term developmental follow-up studies o...

The article by Jenny, Roesler, and Poyer in this issue of Pediatrics takes a look at a purported link between homosexuality and the sexual abuse of children. They find no such evidence. The study was prompted by the passage of a constitutional amendment in Colorado in 1992 that prohibited communities from enacting laws including homosexuals in anti...

The performance of area health education center (AHEC)-stimulated programs and decentralized education for medicine is not well understood. The Statewide Education Activities for Rural Colorado's Health (SEARCW/AHEC project at the University of Colorado School of Medicine was examined to determine if the program had an effect on the practice locati...

No abstract available. (C) 1993 Association of American Medical Colleges

1. Richard Krugman Several years ago, I wrote an editorial entitled "It's Time to Wave the Yellow Flag."1 The metaphor was to automobile racing, where a yellow flag is waved following a crash. Drivers are "cautioned," hold their places, but keep moving. The impetus for that editorial was the increasing criticism the child protection system was com...

Since the publication of my May 1991 article on the emergency of child abuse and neglect,1 the Secretary of Health and Human Services and Congress have been provided with the second report by the US Advisory Board on Child Abuse and Neglect that laid out the steps necessary for the federal government to improve its efforts in the area of child abus...

The shaken baby syndrome is a clearly definable medical condition. It requires integration of specific clinical management and community intervention in an interdisciplinary fashion.

To the Editor.— It has been brought to the attention of The American Academy of Pediatric Committee on Child Abuse and Neglect that some dentists continue to use the hand-over-mouth technique with airway restriction (HOMAR) for behavioral management of pediatric patients. We have received two case reports of children who were adversely affected by...

Some years ago—10 to be exact—at a 70th birthday celebration for Saul Krugman, I reviewed his impressive CV and pointed out that the field of avian biology had lost a great star. His first paper was on the use of ethylene glycol vapor to eliminate Newcastle disease virus, a pathogen of chickens.1 A further review of the Senior Krugman's CV reveals...

A sample of 497 students at the University of Costa Rica completed a survey on perceptions and experiences with various forms of punishment and experiences with sexual abuse during childhood. Spanking was shown to be the most widely accepted and most common form of discipline. The majority of the students considered most types of punishment forms o...

In Reply.— The authors, who are apparently seeing a referred population of children who are suspected or known to be sexually abused, have decided, based on their experience and the published data from other referral centers, to do cultures (presumably from at least two or three sites) for gonorrhea, chlamydia, as well as a serologic test for syphi...

In June 1990, the US Advisory Board on Child Abuse and Neglect presented its first report to the Secretary of the Department of Health and Human Services and Congress. The board had studied the status of the child protection system (broadly defined as the system, not just the child protective services (CPS) agencies involved in the multidisciplinar...

Maltreatment in childhood can result in problems that eventually present to the internist. The common somatic, psychosomatic, and psychiatric presentations in adults are reviewed. Mental health referral is often appropriate. When a case of child abuse is reported to the physician by a patient, the physician's legal responsibilities and protections...

This article reviews the recent history of responses to child abuse and the present roles of pediatricians. It outlines actions that are needed to protect children, recognizes the difficulties in effecting intervention, and concludes that pediatricians cannot afford to stand by while children continue to suffer harm.

To the Editor: The paper by Kleinman et al. (Feb. 23 issue)¹ makes excellent recommendations concerning the need for radiographic study in cases of unexplained infant death. I wonder, however, about the two infants they mention whose deaths were initially regarded as suspicious but were attributed to the sudden infant death syndrome because of nega...