PEDIATRIC SOCIAL ILLNESS - TOWARD AN ETIOLOGIC CLASSIFICATION

• NCJ Number: 55648
• Journal: Pediatrics Volume: 60 Dated: (1977) Pages: 178-185
• Author(s): E H NEWBERGER; R B REED; J H DANIEL; J N HYDE; M KOTELCHUCK
• Date Published: 1977
• Length: 8 pages
• Corporate Author: California Peace Officers Assoc
• Sale Source: Childrens Hospital Medical Ctr
• Publication Type: Report (Study/Research)
• Language: English
• Country: United States of America

Annotation

THE SIGNIFICANCE OF ECOLOGICAL STRESS FACTORS FOR THE ETIOLOGY AND INTERRELATIONSHIPS AMONG THE PEDIATRIC SOCIAL ILLNESSES IS EXPLORED IN A CASE-CONTROL STUDY, AND RECOMMENDATIONS FOR CHILD-ABUSE SCREENING ARE GIVEN.

Abstract

CHILDREN UNDER 4 YEARS OF AGE AND SEEN IN EITHER INPATIENT OR OUTPATIENT DEPARTMENTS OF THE CHILDREN'S HOPSITAL MEDICAL CENTER IN BOSTON, MASS., FOR PEDIATRIC SOCIAL ILLNESS (CHILD ABUSE AND NEGLECT, FAILURE TO THRIVE, ACCIDENTS, AND POISIONINGS) WERE ELIGIBLE FOR SELECTION INTO THE STUDY AS 'CASES.' CHILDREN NOT BEARING PEDIATRIC SOCIAL ILLNESS DIAGNOSES WERE ELIGIBLE FOR SELECTION INTO THE CONTROL GROUP. THE 560 SELECTED CASES WERE MATCHED TO CONTROLS ON THE BASIS OF AGE, RACE, AND SOCIOECONOMIC STATUS. THE PRINCIPAL INSTRUMENT WAS A STRUCTURED INTERVIEW WITH THE SUBJECT'S MOTHER, FOCUSING ON CHILD DEVELOPMENT, FAMILY RELATIONSHIPS, HEALTH, FINANCES, EMPLOYMENT, AND HOUSING, AS WELL AS ON SPECIFIC LIFE EXPERIENCES OF THE MOTHER AND HER CHILD. THE FINDINGS SUPPORT THE BASIC HYPOTHESIS THAT THE OCCURRENCE OF PEDIATRIC SOCIAL ILLNESS IS ASSOCIATED WITH INCREASED FAMILY STRESS (ENVIRONMENTAL, SOCIAL, FAMILIAL, AND HEALTH PROBLEMS OCCURRING SINCE THE CONCEPTION OF THE CHILD AS WELL AS STRESS IMPOSED BY THE UNIQUE ATTRIBUTES OF THE CHILD). CHILD ABUSE IS ASSOCIATED WITH MORE EXTREME STRESSES IN ALL CATEGORIES STUDIED: FAILURE TO THRIVE WITH MATERNAL HISTORICAL STRESSES, PERCEIVED SICKNESS OF THE INDEX CHILD, AND CONTEMPORARY SOCIAL ISOLATION. ACCIDENTS WERE ASSOCIATED WITH CONTEMPORARY HOUSEHOLD CRISES. AN ADDITIVE MODE OF PATHOGENESIS OF THE MORE SEVERE SYMPTOM MANIFESTATIONS IS SUGGESTED BY THESE DATA. SPECIFIC AT-RISK ITEMS WERE ALSO NOTED. USING THOSE ITEMS WHICH ARE MOST HIGHLY DISCRIMINATING FOR CHILD ABUSE, RESEARCHERS CONSTRUCTED AN EQUATION TO ALLOW OBSERVATION OF THE EXTENT TO WHICH SUBJECTS IN THE PEDIATRIC SOCIAL ILLNESS CATEGORIES AND THE CONTROL GROUP MIGHT BE IDENTIFIED OR MISIDENTIFIED AS BEING AT RISK FOR CHILD ABUSE AT DIFFERENT LEVELS OF A SCALE; ACCURACY OF IDENTIFICATION OF CHILD ABUSE IS NOT SUFFICIENT TO PERMIT CHILD ABUSE SCREENING. TABULAR DATA AND REFERENCES ARE INCLUDED. (AUTHOR ABSTRACT MODIFIED---RCB)