Suchergebnisse

Pediatric primary care provides a unique opportunity to tackle child abuse and neglect. In the United States in particular, primary care is a well-established system, and most children have multiple visits, especially in the first few years. There is typically a very good relationship between parents and health professionals, who are respected experts on children. The interested pediatrician, thus, has a remarkable entrée into the workings of a family, its shortcomings, and its strengths. With some knowledge and skill, pediatricians can play a pivotal role, even in a few strategic minutes. We know, however, that some professionals feel very uncomfortable becoming involved in this unpleasant area and may be deterred from taking any action. Understandable as this may be, it can jeopardize a child's health and safety. Hopefully, this issue of Pediatric Clinics of North America will help make this work a bit easier, albeit not easy. With training and support, pediatricians can equip themselves to be competent and more comfortable addressing child maltreatment. Aside from the possible forensic implications, the heart of this work is primarily about helping families take adequate or good care of their children. Indeed, helping address child abuse and neglect also helps promote children's health, development, and safety, and it is central to the rich mandate of Pediatrics.

Many ethical dilemmas confront professionals in the field of child maltreatment. These include (a) moving from a minimal standard of what is adequate to a higher standard of good care; (b) weighing the needs and interests of children and parents; (c) determining what should be disclosed to families, for research and clinical purposes; (d) handling information that may be considered confidential; (e) establishing children's right to protection; (f) intervening with drug-exposed new-borns; (g) reporting maltreatment to agencies one might not have confidence in; and (h) considering child care practices of different religious and cultural groups. This article briefly raises ethical issues involved in these areas and suggests approaches based on clinical experience and the literature in medicine. As we aim to provide optimal care, there is a need for continuing examination of these complex ethical issues.

Family Connections was a demonstration program specifically designed to prevent child neglect. This article describes the development of prevention strategies and the assessment of outcomes for families who received two versions of the intervention. The sample included 154 families (473 children) in a poor, urban neighborhood who met risk criteria for child neglect and who were randomly assigned to receive either a 3- or 9-month intervention. Self-report and observational data were analyzed using analyses of variance (ANOVA) with repeated measures. Results for the entire sample indicated positive changes in protective factors (parenting attitudes, parenting competence, social support); diminished risk factors (parental depressive symptoms, parenting stress, life stress); and improved child safety (physical and psychological care of children) and behavior (decreased externalizing and internalizing behavior). Results further reflected no advantage of the 9-month intervention for improving parenting adequacy. Further testing of the intervention with other target populations is being conducted.