Demographic and clinical features of child abuse and neglect cases: one year experience of The Hospital Based Child Protection Team of Ege University Turkey

Abstract

Aim: Glazmann thrombasthenia is a rare autosomal recessive disease characterized by a defect in platelet aggregation Here we report the management of children with Glazmann thrombasthenia followed up at Cerrahpasa Medical Faculty Pediatric Hematology Department Material and Method: The files of nineteen patients 42 girls 58 boys; median age: 10 months were retrospectively reviewed Results: The median age of onset of bleeding symptoms was 9 months 2 weeks 24 months All patients presented with easy bruising and mucosal bleeding Fourteen patients rsquo; parents were consanguineous In 15 patients flow cytometry was performed According to this seven patients had type I six patients had type II and two patients had type III disease Nine patients were treated with thrombocyte transfusion tranexamic acid recombinant active factor VII and fibrin glue as a single or combined therapy; none of them had a major bleeding complication Conclusions: Bleeding control during invasive procedures may be challenging in children with Glazmann thrombasthenia; local treatments desmopressin steroid and antifibrinolytics may be used with success Turk Arch Ped 2012; 47: 104 6

Keywords

• -

Çocuk istismarı ve ihmali olgularımızın demografik ve klinik özellikleri: Ege Üniversitesi Çocuk Koruma Birimi’nin bir yıllık deneyimi

Öz

Amaç: Çocuk istismarı olgularının tanınmasında ve yönetilmesinde en uygun yaklaşım çok merkezli bir ekip çalışması ile sağlanabilir Bu çalışmada çocuk istismarı tanısı alan olgularımızın demografik ve klinik özelliklerinin değerlendirilmesi amaçlandı Gereç ve Yöntem: Ağustos 2009 2010 yılları arasında Ege Üniversitesi Çocuk Koruma Birimi rsquo;ne yönlendirilip çocuk istismarı tanısı alan olguların demografik ve klinik özellikleri geriye dönük olarak değerlendirildi.

Bulgular: Bu çalışmada çocuk istismarı tanısı alan yaşları 1 17 yaş arasında değişen 46 rsquo;sı 51 7 kız 48 rsquo;i 48 3 erkek toplam 89 çocuk değerlendirildi Cinsel fiziksel duygusal istismar ve ihmal oranları sırasıyla 49 25 11 14 bulundu İstismarı gerçekleştiren kişi fiziksel istismar olgularının 67 rsquo;sinde baba iken cinsel istismar olgularının 59 rsquo;unda yabancı birisinin olduğu saptandı Fiziksel istismar kız ve erkek cinsiyette eşit sıklıkta iken cinsel istismar olgularının çoğunluğunu 56 8 kız çocukları oluşturmaktaydı.

Çıkarımlar: Ülkemizde çocuk istismarı ve ihmaline ilgi ve duyarlılığın artması ile birlikte tanı alan olgu sayısında artış olmuştur ve pek çok hastanede çocuk koruma birimleri ldquo;multidisipliner rdquo; olarak hizmet vermeye başlamıştır Bütün bunlar olumlu gelişmeler olsa da ülkemizde çocuk istismarı olgularının tanınması ve doğru yönlendirilmesi konusunda daha alınacak çok yol vardır.

Anahtar Kelimeler

• Çocuk
• istismar
• multidisipliner

Kaynakça

1. Runyan D, Corrine W, Ikeda R, et al. Child abuse and neglect by parents and other caregivers. In: World report on violence and health. World Health Organization, Genova, 2002;57-86.
2. Caffey J. Multiple fractures of long bones of children suffering from subdural hematoma. AJR 1946;56:163.
3. US Department of Health and Human Services study findings: Study of national incidence and prevalance of child abuse and neglect. Washington, DC. Children’s Bareau, National Center on Child Abuse, 1988.
4. Child Maltreatment, Ağustos 2010. http://www.who.int/topics/child_abuse/en/. Erişim tarihi: Mayıs 2011.
5. Beyazova U, Şahin F. Çocuk istismarı ve ihmaline yaklaşımda hastane çocuk koruma birimleri. Türk Ped Arş 2007;42:16-8.
6. Brown J, Cohen P, Johnson JG, Salzinger S. A longitudinal analyzis of risk factors for child maltreatment: findings of a 17 year prospective study of officially recorded and self- reported child abuse and neglect. Child Abuse Negl 1998;22:1065-78.
7. Cengel-Kültür E, Cuhadaroğlu-Cetin F, Gökler B. Demographic and clinical features of child abuse and neglect cases. Turk J Pediatr 2007;49:256-62.
8. Oral R, Can D, Kaplan S, et al. Child abuse in Turkey: an experience in overcoming denial and a description of 50 cases. Child Abuse Negl 2001;25:279-90.

9. US Department of Health and Human Services, National Center on Child Abuse and Neglect, National Child Abuse and Neglect Data System. Child maltreatment 1995; Reports from the states to the national center on child abuse and neglect. Washington, DC: US Goverment Printing Office;1997.
10. Sahin F, Cepik-Kuruoglu A, Demirel B, et al. Six-year experience of a hospital-based child protection team in Turkey. Turk J Pediatr 2009;51:336-43.
11. Alexandre GC, Nadanovsky P, Moraes CL, Reichenheim M. The presence of a stepfather and child physical abuse, as reported by a sample of Brazilian mothers in Rio de Janeio. Child Abuse Negl 2010;34:959-66.
12. Bahali K, Akçan R, Tahiroglu AY, Avcı A. Child sexual abuse: seven years in practice. J Forensic Sci 2010;55:633-6.
13. Vargas NA, López D, Pérez P, Zşñiga P, Toro G, Ciocca P. Parental attitude and practice regarding physical punishment of schoolchildren in Santiago de Chile. Child Abuse Negl 1995;19:1077-82.
14. Orhon FS, Ulukol B, Bingoler B, Gülnar SB. Attitudes of Turkish parents, pediatric residents, and medical students toward child disciplinary practices. Child Abuse Negl 2006;30:1081-92.
15. Maguire S. Which injuries may indicate child abuse? Arch Dis Child Educ Pract Ed 2010;95:170-7.
16. Pierce MC, Smith S, Kaczor K. Brusing in infants: those with bruise may be abused. Pediatr Emerg Care 2009;25:845-7.
17. Akbarnia BA. The role of the orthopedic surgeon in children abuse. In: Morrissy RT, Weinstein SL, (eds). Pediatric orthopedics. Philadelphia, PA: Lipincott-Raven; 1990:1315-34.
18. Showers J, Garrison KM. Burn abuse: a four-year study. J Trauma1988;28:1581–3.
19. Maguire S, Moynihan S, Mann M, Potokar T, Kemp AM. A systematic review of the features that indicate intentional scalds in children. Burns 2008;34:1072-81.
20. Agirtan CA, Akar T, Akbas S, et al. Establishment of interdisciplinary child protection teams in Turkey 2002-2006: identifying the strongest link can make a difference Child Abuse Negl 2009;33:247-55.
21. Oral R, Blum KL, Johnson C. Fractures in young children: Are physicians in the emergency department and orthopedic clinics adequately screening for possible abuse? Pediatr Emerg Care 2003;19:148-53.