Infant head trauma no more common in military families

By Veronica Hackethal, MD

NEW YORK | Fri Sep 6, 2013 3:37pm EDT

NEW YORK (Reuters Health) - Infants in military families have about the same risk of suffering head trauma from violent shaking, known as shaken baby syndrome, as civilian babies, a new study suggests.

Researchers looking at U.S. Department of Defense records found between 26 and 34 out of every 100,000 babies born into military families had substantiated abusive head trauma in the first year of life, similar to civilian rates during the same period.

However, "Within the military there are some children who are particularly at higher risk, including the children of enlisted men," said Dr. Desmond Runyan, director of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect at the University of Colorado School of Medicine in Aurora.

Baby boys, as well as those born early or with birth defects, were also at increased risk for shaken baby syndrome. So were infants with young mothers, parents in lower pay grades or mothers in the military.

Babies between two and four months old are at the highest risk of shaken baby syndrome, which can cause seizures and permanent brain damage. One in four children with the condition dies as a result.

In general, shaken baby syndrome is most common among families who are poor, have little social support and are under stress, Runyan and his colleagues said. Inconsolable crying is one of the main triggers for shaking.

"These risk factors for shaken baby syndrome can get magnified a little bit due to the stresses of being in the military," Runyan told Reuters Health.

Many military families are removed from their extended families, live in lower-quality housing and earn relatively low wages, all of which could make child abuse more likely, he said. On the other hand, being in the military may protect against some forms of abuse, like neglect, since members of the military have to pass an aptitude test, have steady employment and have access to family support programs.

Past studies on the topic have been inconsistent: some showed an increased risk for shaken baby syndrome among military babies, while others failed to show a link.

One issue, Runyan said, is that some of those studies were done on military training bases where there are a lot of young families - so the results may represent the experience of mostly higher-risk infants.

For the new study, the researchers looked at Department of Defense medical records for 676,827 infants born between 1998 and 2005 and linked them to investigative findings from military family advocacy programs confirming cases of abuse.

Of those infants, 230 had substantiated shaken baby syndrome and 73 had probable or possible shaken baby syndrome.

Using U.S. Centers for Disease Control and Prevention criteria for a diagnosis of shaken baby syndrome, the researchers calculated there were 34 substantiated cases in the first year of life for every 100,000 military babies during the study period.

They then did the same analysis with criteria that have been used to study shaken baby syndrome among civilians, which produced a rate of about 26 cases per 100,000 babies. That is similar to the 28 cases per 100,000 infants found in a past study of civilian babies in 2000, the researchers write in Pediatrics.

Gia Gumbs, who led the study at the Naval Health Research Center in San Diego, California, told Reuters Health in an email that studies of civilian families "may underestimate the number of cases" of shaken baby syndrome if they use less sensitive criteria for diagnosis.

The researchers note that higher-risk military families should be provided additional support through screening and prevention programs for shaken baby syndrome, something the military strongly supports, according to the authors.

"The military has been very responsive and active to the concerns raised about shaken baby syndrome in infants," Runyan said.

SOURCE: bit.ly/15tWduU Pediatrics, online September 2, 2013

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Fetal alcohol disorders common in adopted, foster kids

By Genevra Pittman

NEW YORK | Mon Sep 9, 2013 12:34am EDT

NEW YORK (Reuters Health) - Children adopted from orphanages or in foster care have a high rate of fetal alcohol syndrome and other physical, mental and behavioral problems related to alcohol exposure before birth, according to a new review of past studies.

Among those children, researchers found that rates of alcohol-related problems - which can include deformities, mental retardation and learning disabilities - were anywhere from nine to 60 times higher than in the general population.

"It's increasingly well recognized that this is a very high-risk population and one that we should really be paying attention to," Phil Fisher, a psychologist who studies foster and adopted children at the University of Oregon in Eugene, said.

"We know that one of the main reasons that kids end up in foster care or being made eligible for adoption is because their parents have substance abuse problems," added Fisher, who wasn't involved in the new research.

The findings are based on a review of 33 studies of children in the care of child welfare agencies or foster parents, as well as kids before and after their adoption from orphanages. Most of the studies were conducted in Russia or the United States.

Compiling the studies with the most accurate reporting techniques, Dr. Svetlana Popova from the Center for Addiction and Mental Health in Toronto and her colleagues found six percent of children in those settings had fetal alcohol syndrome.

The condition includes a distinctive set of facial features, including a small head, jaw and eyes, and other physical developmental defects, especially of the heart. Slow growth and delayed development after birth are also typical of fetal alcohol syndrome.

Close to 17 percent of the children had a more loosely-defined fetal alcohol spectrum disorder, which covers any physical, mental or behavioral issues caused by prenatal alcohol exposure.

The highest rates of fetal alcohol syndrome were seen among children in a Russian orphanage for kids with special needs and among those adopted from Eastern Europe by families in Sweden. In those studies, anywhere from 29 percent to 68 percent of children showed severe alcohol-related damage.

In other cases, such as a study of Chinese children adopted and brought to the United States, there were no reported instances of fetal alcohol syndrome, the study team reported Monday in Pediatrics.

Fisher said it's important to know that although problems related to alcohol exposure are common among adopted and foster children, not all kids have been exposed - and some with prenatal exposure are "quite resilient" and do fine.

"I don't think anyone wants to create the impression that every child in the foster care system … and every child who's adopted has very severe problems," he told Reuters Health.

Still, he said there is a need for more recognition of the challenges faced by children who have been exposed to drugs and alcohol in the womb. Rather than focusing only on their obvious current symptoms, he said fetal alcohol disorders should be treated as chronic diseases, like diabetes.

"The supports need to be available in an ongoing way," Fisher said.

He also pointed to the importance of identifying children who have some of the effects of drug and alcohol exposure - but not ones as obvious as the distinct facial features seen with fetal alcohol syndrome - and getting them support as soon as they enter the child welfare system or are adopted.

"If we don't do the early screening and detection … then I think we're in a much more challenging position," he said.

"We hope that the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure," Popova told Reuters Health in an email.

She agreed that spotting problems as soon as possible is important.

"Early screening may lead to early diagnosis, which can lead to early participation in developmental interventions, which can in turn, improve the quality of life for children with a (fetal alcohol spectrum disorder)," she said.

Early intervention, Popova added, may also help prevent future mental health problems and trouble in school.

SOURCE: bit.ly/cxXOG Pediatrics, online September 9, 2013.

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