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Biomedical subjects

K W Feldman

Publications and source records attributed to K W Feldman.

At least 19 recordsLinked to original sources
PubMed1992

Positional asphyxia in individuals with severe cerebral palsy.

The authors report the accidental death by positional asphyxia of three individuals with cerebral palsy occurring after they had been placed in bed for the night. During the five-year period between 1984 and 1989, 12 per cent of deaths from positional asphyxia in King County, Washington, involved individuals with cerebral palsy. Such accidents are similar to those occurring among healthy young children, perhaps because both groups have limited motor skills. Further research into accidents among disabled persons may clarify their special risks and possibly lead to modifications in bed design.

Accidents, Home↗
PubMed1991

Tap water burn prevention: the effect of legislation.

Five years after a 1983 Washington State law required new water heaters to be preset at 49 degrees C (120 degrees F), 77% of homes (84% of homes with postlaw and 70% of homes with prelaw water heaters) had tap water temperatures of less than 54 degrees C. In 1977, 80% of homes had tap water temperatures greater than 54 degrees C. Mean temperature in 1988 was 50 degrees C compared with 61 degrees C in 1977. Both changes were significant compared with 1977 temperatures. Few people increased their heater temperature after installation. Eighteen burn victims were identified from July 1979 through May 1988, for an average admission rate of 2.4 per year, compared with 5.5 per year in the 1970s. Compared with the 1970s, total body surface area burned, mortality, grafting, scarring, and length of hospital stay were all reduced, while the likelihood that scald burns were the result of child abuse increased to 50%. Both education campaigns and legislation have resulted in significantly safer water temperatures. Further, this change seems to have resulted in a reduction in frequency, morbidity, and mortality of tap water burn injuries in children. Lower water heater settings proved acceptable to the consumer.

Adolescent↗
PubMed1990

Nutritional rickets.

Nutritional rickets was diagnosed in 18 infants aged eight to 24 months. Clinical features included progressive leg bowing, poor linear growth, a diet deficient in vitamin D, seizures, and abnormal serum calcium, phosphate and alkaline phosphatase levels. Wrist radiographs and serum alkaline phosphatase levels were the most useful confirmatory tests. Breast milk may not contain enough vitamin D to protect infants, particularly dark-skinned children and those living in cloudy, northern U.S. cities, from rickets after six months of age. As breast feeding becomes more widely practiced, care is required to ensure that infants at high risk for rickets receive appropriate vitamin D supplementation.

Breast Feeding↗
PubMed1989

Psychologic morbidity of children subjected to Munchausen syndrome by proxy.

Munchausen syndrome by proxy is being recognized and reported with increasing frequency, which suggests that it is more common and occurs with a wider spectrum of severity than was previously suspected. In past reports, the difficulties of detecting and documenting the syndrome have been emphasized, as well as its physical morbidity and mortality. The psychologic morbidity of Munchausen syndrome by proxy in six children is described. The children reacted with developmentally appropriate behavior problems ranging from feeding disorders in infants, withdrawal and hyperactivity in preschool-aged children, to hysterical disorders and personal adoption of Munchausen syndrome behavior in adolescents. Parental psychologic and behavioral styles, family dynamics, and responses from legal and children's protective services systems make protection of the child within the home difficult, if not impossible. Even with protection from further physical injury, severe psychologic trauma remains likely. Extreme caution is suggested in allowing these children to remain in the family.

Adolescent↗
PubMed1988

Diagnostic and surgical implications of child abuse.

One hundred fifty-six children younger than 13 years of age with blunt abdominal injuries were reviewed, and those injured in accidents (89%) were compared with those injured by child abuse (11%). Abused children were younger (mean age, 2 1/2 years) and all presented late to medical attention with a history that was inconsistent with their physical findings. Only 65% of abused children had physical or roentgenographic signs of prior abuse, while 35% had no signs of prior abuse. The abdominal organs injured were different; 61% of accidentally injured children suffered injuries to a single, solid organ, and only 8% had hollow viscus injuries, while 65% of abused children had hollow viscus injuries. Physicians should suspect child abuse when children have unexplained injuries (especially young children with hollow viscus injuries) even when other signs of child abuse are absent, and they should suspect hollow viscus injury in abused children.

Abdominal Injuries↗
PubMed1984

Pseudoabusive burns in Asian refugees.

Six Southeast Asian refugee children had cigarettelike burn scars on the lower trunk and abdomen. Questioning of the families disclosed that the burns had been the result of therapeutic burning by folk medical healers for prior illnesses. Pediatric practitioners should recognize the therapeutic intent of these injuries to avoid inappropriate accusations of child abuse. They can likewise encourage families to seek less harmful alternative treatments.

Asia, Southeastern↗
PubMed1984

Child abuse, cardiopulmonary resuscitation, and rib fractures.

Rib fractures have occasionally been described in children receiving cardiopulmonary resuscitation (CPR). Because child abuse is sometimes suspected in these cases, it is both medically and legally important to establish whether the rib fractures are secondary to abuse or CPR. One hundred thirteen children, including 41 victims of child abuse, 50 patients who had CPR, and 22 patients who had rib fractures, were studied. Twenty-nine patients had rib fractures; 14/29 (48%) were abusive. Other causes of fracture were: motor vehicle accidents (four), rickets/osteoporosis (five), surgery (five), and osteogenesis imperfecta (one). In spite of prolonged resuscitation performed with variable degrees of skill, no fractures could be attributed to CPR. On the other hand, rib fractures occurred frequently in abused children (6/41 or 15%). Abusive fractures were often multiple, of different ages, and affected multiple adjacent ribs. Patients with abusive rib fracture also had other physical and radiologic signs of abuse or neglect.

Adult↗
PubMed1980

Strangulation in childhood: epidemiology and clinical course.

A review of 233 cases of childhood strangulation was made to determine injury epidemiology. Consistent patterns of injury were observed. Crib and playground equipment strangulations are already the subject of Consumer Product Safety Commission (CPSC) preventative regulations. High chair-, playpen mesh-, pacifier cord-, and clothing-related injuries would be amenable to prevention by improved product safety regulation. The CPSC has been petitioned to remedy the first two of these hazards. Many crib and rope strangulations can only be prevented by direct patient counseling. Although Congress empowered and required the CPSC to recognize and correct unsafe products, its surveillance systems may obscure the very design defects that cause injury. Likewise, political considerations may slow enactment of new design regulations. Physicians who treat childhood accident victims are in a position to recognize hazardous products and lobby for their improvement. Of the 233 cases 38 were further evaluated to delineate the clinical course of childhood strangulation. Victims who fail to resume normal cardiopulmonary function by the time of hospitalization have a poor prognosis for neurologic recovery with current modes of therapy. Improved treatment of hypoxic and ischemic cerebral injury might prevent some of the deaths and handicaps resulting from strangulation.

Accident Prevention↗
PubMed1978

Tap water scald burns in children.

Tap water scald burns account for 7% to 17% of all childhood scald burns that require hospitalization. Often the burns are severe and disabling. Toddlers and preschool children are the most frequent victims. In 45% of the injuries, the unsupervised victim or peer turned on the tap water; in 28% the cause was abuse. Eighty percent of the homes tested had unsafe bathtub water temperatures of 54 C (130 F) or greater, exposing the occupants to the risk of full-thickness scald with 30-second exposure to hot water. Such burns may be prevented passively by limiting household water temperatures to less than 52 C (125 F). New water heaters could be preset at this temperature and families could be taught to turn down the temperature on existing units.

Accidents, Home↗