Sample Reviews

Cortical hypoxic-ischemic brain damage in shaken-baby (shaken impact) syndrome: Value of diffusion-weighted MRI. Paul M Parizel, Berten Ceulemans, Annick Laridon et al. Pediatr Radiol 2003;33:868-871. (from Edegem, Belgium)

Diffusion-weighted magnetic resonance imaging (MRI) is a technique that measures restricted (Brownian) motion of water indicating cytotoxic edema. As the name implies, cytotoxic edema is a form of edema associated with cell death.

 

Computerized tomography (CT) has long been recognized as relatively insensitive in detecting the early changes of cytotoxic edema. Fluid attenuated inversion recovery sequences (FLAIR) magnetic resonance (MR) is considerably more sensitive for the detection of intercerebral edema but the changes are not reliably exhibited until a period of time after the injury. Diffusion-weighted imaging allows detection of the changes owing to cytotoxic edema almost immediately after the injury. 

 

The authors report a case of a two-month-old with cytotoxic edema owing to severe shaking. The diffusion-weighted imaging characterized the extent of injury much more accurately then standard MR sequences or CT. While this is not surprising, it does again emphasize the tremendous value of MR in the imaging of children with abusive head injury. 

             Reviewed by Wilbur L. Smith, M.D., Spring 2004 issue

 

The legacy of the clergy abuse scandal. David Finkelhor. Child Abuse Negl 2003;27:1225-1229. (from Durham, NH)

 

In this commentary, Finkelhor discusses the positive and negative impacts the clergy sex abuse scandal has had on child protection. The scandal has sustained the public interest in child sexual abuse, a phenomenon that “never fails to amaze.” It has overridden the negative media attention given to “overzealous prosecutors, mendacious children and a child protection system threatening the integrity of families.” But there are helpful and harmful aspects to this current attitude.

 

On the positive side, parents are again aware that they should talk to their children about sexual abuse and how to protect themselves against it. There has also been a destigmatization of having been abused, and the barriers to disclosure have been lowered. Finally, institutions and mandated reporting laws are in a stronger position than formerly.

 

Negative effects have also been seen. The scandal has raised the importance of sexual abuse, once more, above all the other forms of child maltreatment despite the fact that religious officials have also engaged in caning, closeting, verbal threats, cursing with eternal damnation, or discouraging children or their parents from seeking medical care. A second problem is that the scandal has reinforced offender stereotypes by referring to them as pedophiles when, in fact, the majority were not pedophiles but represented a spectrum of abuse types. It has also reinforced the public perception about the threat and incorrigibility of sex offenders, based mainly on a few egregious cases. Finkelhor says, “It does not help the child maltreatment field or the public and policy-makers to see child molesters as simply incorrigible, compulsive fiends who cannot be stopped. It is factually incorrect, it makes investigations more difficult, it deters confessions and cooperation from offenders, it confuses victims in some cases, and it undermines the work of colleagues who are trying to succeed at offender treatment and sensible corrections management.”

 

Another negative impact is that the scandal has reinforced the erroneous idea that homosexuals are to blame for child molesting. Homosexuality may not be completely irrelevant in that “the priesthood provides an attractive lifestyle for …men who are experiencing extreme conflicts over conscious or denied homosexual feelings and that, in the absence of opportunities to deal openly with such feelings and overcome the accompanying shame and confusion, it creates vulnerability for the kind of acting out and exploitation that occurred in the Church context.” 

 

The last problem Finkelhor discusses is that of the role of litigation in the field of child maltreatment. Despite the fact that plaintiffs’ attorneys have played an heroic role in advocating for victims in this set of cases, the investigations have not received the same degree of scrutiny that police, child welfare investigators or mental health providers provide. . He asks, “How are plaintiffs recruited? What kinds of informed consent procedures are undertaken with them? What are the traumatizing portions of the litigation process and how are these stresses managed and mitigated?”  It signals the need, he says, for more scrutiny of the process and best practice standards for civil litigation.                 

                                       Reviewed by Robert M. Reece, M.D., Spring 2004 issue

 

Editor’s Note: 

This article should be read by all professionals in the Child Protection field, no matter what your discipline.  As usual, Dr. Finkelhor has articulated the central issues of concern for all of us.