Evaluation and referral for child maltreatment in pediatric poisoning victims
Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA Child abuse & neglect
(Impact Factor: 2.34).
05/2012; 36(4):362-9. DOI: 10.1016/j.chiabu.2012.01.001
Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS.
Retrospective study of poisoning victims<6 years old seen at an urban children's hospital from 2006 to 2008. Logistic regression was performed to evaluate the associations between the outcomes (evaluation for maltreatment by hospital team and/or referral to CPS) and predictor variables (demographics and circumstances, type and severity of poisoning).
Among 928 poisonings, 41% were from household products, 20% from over-the-counter drugs, 7% from prescription narcotics/sedatives, 29% from other prescription drugs, and ≤ 1% each from ethanol, illicit drugs, or other substances. Most children were asymptomatic (69%) or stable (28%); 3% were critically ill. Only 13% were evaluated by the hospital team and 4% were referred to CPS. Demographic characteristics were not associated with referral to CPS. Higher clinical severity was associated with increased referral (p<0.001). Compared to poisonings with over-the-counter drugs, referrals were more likely for poisonings with ethanol and prescription narcotics/sedatives, but not other prescription drugs or household products (p<0.001). All illicit drug poisonings and 44% of ethanol poisonings were referred. The majority of referrals to CPS were for concerns for illicit drugs, poor supervision or multiple forms of maltreatment; 6% were secondary to concerns for intentional poisoning.
Evaluations and referrals to CPS for maltreatment are uncommon in young poisoning victims. Referrals occurred consistently for illicit drugs but not ethanol. Although referrals were more likely for higher severity poisonings, it is unclear if the severity of poisoning is associated with the level of supervisory neglect or a marker of ongoing risk to the child. These findings suggest the need to identify risk factors for ongoing harm and the development of clinical guidelines used to determine which poisoning victims should be referred to Child Protective Services.
Available from: Jiri Patocka
- "Pokud budete postupovat poctivě, budete se divit, v jak nebezpečném prostředí ukládáte hlavu ke spánku. Mějte na paměti, že zdravý dospělý jedinec si celou řadu hrozeb nepřipouští, ale v domácnostech přebývají i zranitelnější osoby, jako například malé děti, těhotné ženy, staří lidé, alergici nebo astmatici (Meyer et al., 2007; Presgrave rde et al., 2008; Wood et al., 2012). Chorvatští pracovníci Institutu pro lékařský výzkum a pracovní lékařství v Záhřebu publikovali práci (Klepac et al., 2000), ve které shrnují četnost otrav za období od roku 1985 do roku 1999. "
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ABSTRACT: The curiosity and the natural tendency to explore the environment put young children at an increased risk of poisoning over older children and adults. Poisonings are a significant area of concern from 1 year of age and progressively contribute more to overall rates of morbidity and mortality until children reach adulthood. Particularly, the abuse of children by poisoning is also highly common with thousands of fatalities. A practical strategy is presented that aims to alert health, forensic, and law enforcement professionals to this problem and to demystify the preconception that it is a rare form of abuse or neglect. Compounds that are foreign to a living organism (xenobiotics) and those present within body (endobiotics), mainly involved in children intoxications and contextual examples related to exposure are also reviewed. Particular concern is given to concepts in the field of children poisoning. The described history and the clinical and toxicological evaluation are discussed, and harmonized protocols regarding correct procedures for sample collection to forensic toxicological analysis are proposed. Since children are particularly vulnerable to the toxic effects of high doses of xenobiotics and endobiotics, special consideration on the preparation of the environment that surrounds children in order minimize all possible risks will be also considered.
Available from: Nadia Fucci
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We are describing a case of pediatric maltreatment. A 3-year-old boy was brought to the emergency room because of drowsiness that was caused by what his parents described as an 'accidental' intake of a powder contained in a plastic wrapper that was found in a park.
Urine immunochemical screening for drugs of abuse showed a positive result for opiate exposure. Despite the described 'accident,' the physician suspected abuse and ordered a hair analysis to verify possible intake of drugs of abuse. The child's hair was analyzed along its whole length for drugs of abuse using gas chromatography mass spectrometry in accordance with international guidelines.
Results and discussion:
Morphine and 6-acetylmorphine were identified, and the doctor informed the city's juvenile court. The boy's family was involved with social services for a period of observation to confirm suspected prolonged abuse. Hair analysis proves to be a useful tool for periodical examination of drug exposure to protect children from significant health and social risks.
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