Biomedical subjects
E H Newberger
Publications and source records attributed to E H Newberger.
Understanding of child abuse and neglect.
Explore the source record for details and available documents.
Mothers of sexually abused children: trauma and repair in longitudinal perspective.
Mothers whose children had been sexually abused reported experiencing serious psychological symptoms following disclosure of the abuse. Over a one-year period, their emotional status improved. Strong relationships between mothers' reports of their own and their children's symptoms were accompanied by persistent discrepancies between maternal and direct assessments of the children's emotional states. Findings suggest that addressing maternal distress is important to the study and treatment of child sexual abuse.
Child physical abuse.
Child abuse is an age-old problem for which we have had documentary records for as long as we have had recorded history. This article reviews the ethical dilemmas, diagnosis, interviewing guidelines, physical examination, and treatment for child physical abuse. Also discussed are unusual manifestations and differential diagnosis.
Abuse of pregnant women and adverse birth outcome. Current knowledge and implications for practice.
Explore the source record for details and available documents.
Pediatric interview assessment of child abuse. Challenges and opportunities.
The assessment of child abuse is a professionally and personally challenging task. Here as elsewhere in medicine success often is linked with the informed intelligence, mature attitude, and professional demeanor of the clinician. If one can maintain a thoughtful and skeptical approach to the data; display warmth, calm, and respect to everyone involved in the case; and express one's views with care and parsimony, good information will be forthcoming and, it is hoped, excellent management will follow.
Child abuse and failure to thrive: individual, familial, and environmental characteristics.
Similar theories of etiology have been postulated for child abuse and nonorganic failure to thrive (FTT). This study compared individual, familial, and environmental conditions in cases of child abuse to cases of FTT. Assessment of the mother's childhood home, supports, current living situation, attitudes toward her child, and child characteristics (such as temperament, social maturity, and complicating medical conditons) showed the groups to be remarkably alike. The major significant difference was that although both groups were poor, the abuse group was even more impoverished and lived in more crowded conditions than the families with a child with FTT. These data suggest a common etiologic context for different pediatric social illnesses and the need for a broad collaborative approach by pediatricians and colleagues in related disciplines.
Victimization of mothers of abused children: a controlled study.
To search for indicators of violence against mothers of child abuse victims by husbands or boyfriends, the women's medical records were reviewed and compared to records of mothers of a nontraumatized child comparison group. Of the 32 children ascertained in a 6-month interval, the records of mothers of 19 (59.4%) were diagnostic or highly suggestive of current or previous victimization. Although the prevalence of documented violence against the mothers of children in the comparison group was an unexpectedly high 16%, the case-control difference was highly significant (P less than .001). Although differences were found in the (younger) ages and (higher) parity of mothers of abused children, these differences did not predict risk of mothers' exposures to violence in a multivariate analysis. The rate of violence against single mothers of child abuse victims, however, was four times the rate against mothers who were married (P = .022). These findings suggest a need to broaden the diagnostic conceptualization of child abuse to include maternal victimization and argue for including data concerning maternal risk in formulating diagnoses and disposition plans for abused children.
The changing American family.
The increase in single-parent families, step-families, maternal employment, and young children in substitute care are among several important changes in the American family in recent decades. Although it is not clear that these changes necessarily lead to negative outcomes in children, it is apparent that a variety of potential risks and challenges confront many families today. Pediatricians can play a valuable role by helping families to adjust and cope with certain difficulties, such as divorce. However, in other areas such as child care, changes in public policies and programs are needed to better support families to optimally nurture their children.
Child and family attributes of failure-to-thrive.
Forty-one Boston children hospitalized with non-organic failure-to-thrive (FTT) were matched with 41 control subjects on age, socioeconomic status (SES), sex, and race. A precoded maternal interview was used to evaluate family stress, isolation, infant health, and the temperament and social maturity of the child. A regression analysis was performed with 27 variables thought to be potentially associated with the FTT diagnosis. Ten variables explained 81% of the between group variance on F-tests. The most significant distinctions were poor child health (p less than 0.001), high reactivity to visual and auditory stimuli (p less than 0.001), and disordered feeding interaction (p less than 0.005). Other case-comparison differences included social isolation, few maternal opportunities to escape caregiving, the presence of a male adult in the family, fewer available extended family, fewer violent disagreements between parents, greater number of maternal unmarried years. Children with FTT appeared to have developmental idiosyncrasies. These conspire with social and familial factors to yield the current profile of non-organic FTT. This study questions whether such findings are the cause of FTT or are better understood as a result.
Scarring for life: abuse with electric cords.
Explore the source record for details and available documents.
The American family in crisis: implications for children.
Explore the source record for details and available documents.
Consensus and difference among hospital professionals in evaluating child maltreatment.
The decision-making process in suspected cases of child maltreatment involves reaching interprofessional consensus. Interprofessional consensus in seriousness ratings of maltreatment incidents for the welfare of the child was examined by surveying 39 case vignette ratings by 295 pediatric hospital professionals from five occupations. The survey instrument was derived from research by Giovannoni and Becerrra (1979). An exploratory factor analysis yielded five categories of maltreatment: physical abuse, sexual abuse, general failures in care, minor neglect/discipline, and lifestyles/values. A sixth category, parental sexual preference, was rated not very serious and did not appear to belong in the maltreatment domain. Nurses and social workers rated incidents as most serious, differing significantly from psychiatrists and, often, from physicians and psychologists. Professions agreed on rank ordering of categories by seriousness. Variables such as sex, parenthood status, years of experience, and medical specialty showed some relationship to ratings within some professional groups.
Childhood ingestions as symptoms of family distress.
Familial, child developmental, and demographic concomitants of serious ingestions in preschool children were measured in 23 hospitalized children and controls matched on age, race, and socioeconomic status. A precoded maternal interview focused on family stress, parental discipline, parental emotional history, as well as childhood temperament and social maturity. A regression analysis was performed on variables that discriminated between ingestion cases and controls. Sixteen variables from the regression equation were entered into a stepwise discriminant function analysis. Significant descriptors of ingestion victims included the following: lack of extended family low Vineland Social Maturity quotient, few maternal opportunities to escape caregiving, good health, a high frequency of physical punishment in the mother's childhood, and increased current advocacy needs. Using these six variables as a screening device, the discriminant function correctly classified 87% of the subjects as either cases or controls. These data suggest that ingestions are symptoms of familial and, especially of maternal, distress. These healthy, active, but delayed children appear to overwhelm their caregivers.
Child abuse incidence and reporting by hospitals: significance of severity, class, and race.
Estimates from the National Study of the Incidence and Severity of Child Abuse and Neglect suggest that hospitals recognized over 77,000 cases of child abuse between May 3, 1979, and April 30, 1980. Compared to other agencies in the sample, hospitals identified children who were younger, Black, lived in urban areas, and had more serious injuries. Hospitals failed to report to child protection agencies almost half of the cases that met the study's definition of abuse. Discriminant analysis revealed that income, mother's role in abuse, emotional abuse, race, maternal employment, and sexual abuse distinguished the reported from the unreported cases. Disproportionate numbers of unreported cases were victims of emotional abuse and came from families of higher income. Their mothers were more often White and more often alleged to be responsible for the injuries.
Child abuse: the current theory base and future research needs.
Explore the source record for details and available documents.
Failure to thrive: a controlled study of familial characteristics.
Explore the source record for details and available documents.
Child abuse and accidents in black families: a controlled comparative study.
Families of child abuse and accident victims were evaluated in a study of 402 families with children up to four years of age. Children were matched on a one-to-one basis with a control according to race, socioeconomic status, and age. Socioeconomic factors that play a significant role in imposing undue stress upon many families are identified, and implications for prevention and for practice are offered.