Reviews and Notes: Pediatrics: Child Abuse: Medical Diagnosis and Management

Child Abuse: Medical Diagnosis and Management

Robert M. Reece; ed. 466 pages. Philadelphia: Lea & Febiger; 1993. $69.50.

In his preface, the editor points out that "in all other areas of medical effort, the concept of differential diagnosis has been employed to assure that premature decisions about a diagnosis are avoided. This same rigor must be applied in cases presenting as child abuse." This text deals with the important questions to ask as well as the new diagnostic techniques. Physicians who do not routinely deal with suspected child abuse may be astounded and depressed to learn that "abusive head trauma" is the leading cause of death in abused children, that homicide now causes 7 times as many deaths in children as meningitis, and that 5000 deaths annually are attributed to child abuse. Sexual abuse of children is allegedly more common than pneumonia, affecting from 10% to 28% of children. The chapter "Fatal Child Abuse and Sudden Infant Death Syndrome" is particularly recommended. It includes a Table titled"Criteria for Distinguishing SIDS from Fatal Child Abuse and Other Medical Conditions" that lists factors such as history and age at death as consistent with, less consistent with, highly suggestive of, or diagnostic of child abuse.