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Previous studies have indicated that childhood sexual abuse (CSA) and other forms of child maltreatment (CM), as well as their subsequent posttraumatic symptoms, are significant risk factors for the development of disordered eating behaviors and attitudes and eating disorders (EDs). However, there are no known reports of CM based on forensic interview and assessment that have been linked to disordered eating behaviors and attitudes, or eating disorders (EDs), especially in children and adolescents. We, therefore, examined the hypothesis that ED-related symptoms would be significantly associated with trauma-related symptoms in children with reported maltreatment. Girls (n = 179, 11.9 ± 2.4 years) and boys (n = 99, 11.7 ± 2.8 years) referred for forensic assessment of alleged maltreatment completed the Kids' Eating Disorders Survey, the Eating Disorders Inventory for Children (EDI-C), the Trauma Symptom Checklist for Children, and the Adolescent Dissociative Experiences Scale, among others. Significant positive correlations between most EDI-C subscale scores and most TSC-C subscale scores (PTSD, dissociation, anxiety, depression, sexual concerns) were found (p ≤.001) in the total sample and girls alone. Participants with credible, substantiated disclosures had significantly higher scores on several ED-related measures than those with non-credible, non-substantiated disclosures. Linear regression analysis indicated that PTSD and dissociative symptoms were significant predictors of EDI-C scores in those with substantiated disclosures (p ≤.001). Findings support the hypothesis that ED-related symptoms are significantly linked to authenticated CM.

[This corrects the article DOI: 10.1371/journal.pone.0197769.].

Importance: A simple, reliable tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available to healthcare professionals including first-response providers., Objective: To test the accuracy and precision of an existing weight estimation tool based on patient height and mid-upper arm circumference (MUAC) in children between six months and five years of age in low-to-middle income countries., Design: Data were collected in 2,434 nutritional surveys during 1992-2017 using a modified Expanded Program of Immunization two-stage cluster design., Setting: Locations in 51 low-to-middle income countries with high prevalence of acute and chronic malnutrition., Participants: Of 1,848,979 children enrolled in the surveys, a total of 1,800,322 children met inclusion criteria (age 6-59 months; weight ≤ 25 kg; MUAC 80-200 mm) and exclusion criterion (bilateral pitting edema and biologically implausible measurements based on WHO flagging criteria)., Exposures: Weight was estimated by a regression procedure using database height and MUAC., Main Outcomes and Measures: Mean percentage difference between true and estimated weight (MPD), proportion of estimates accurate to within ± 10% and ± 20% of true weight (PW10 and PW20), weighted Kappa statistic, and Bland-Altman bias (bias) were reported as measures of tool accuracy. Standard deviation (SD) of the MPD and Bland-Altman 95% limits of agreement (LOA) were reported as measures of tool precision., Results: The height model fitted for MUAC classes was accurate and precise. MPD was +0.67% (SD = 9.95%); PW10/PW20 were 68.31% (95% CI 68.24%, 68.38%)/94.73% (95% CI 94.69%, 94.76%); and bias (LOA) were +0.06 kg (-1.97 kg; +2.10 kg). For MUAC < 115 mm, PW10/PW20 were 63.91% (95% CI 63.42%, 64.40%)/90.72% (95% CI 90.42%, 91.01%); and bias (LOA) were +0.14 kg (-1.29 kg; +1.56 kg). For 115 mm ≤ MUAC < 125 mm, PW10/PW20 were 76.27% (95% CI 76.03%, 76.51%)/96.36% (95% CI 96.25%, 96.46%); and bias (LOA) were +0.06 kg (-1.20 kg; +1.33 kg). For MUAC > 125 mm, PW10/PW20 were 69.93% (95% CI 69.86%, 70.00%)/95.27% (95% CI 95.24%, 95.30%); and bias (LOA) were +0.05 kg (-2.04 kg; +2.13 kg)., Conclusions and Relevance: An updated model estimating weight from height and MUAC in a large database of children aged 6 to 59 months across a wide range of low-to-middle income countries with high prevalence of acute and chronic malnutrition was confirmed to be accurate and precise. A height-based weight estimation tape stratified according to MUAC classes is proposed for children aged 6-59 months in limited-resource settings., Competing Interests: The authors have declared that no competing interests exist.

The study examined a new child report measure of maternal support following child sexual abuse. One hundred and forty-six mother-child dyads presenting for a forensic evaluation completed assessments including standardized measures of adjustment. Child participants also responded to 32 items considered for inclusion in a new measure, the Maternal Support Questionnaire-Child Report (MSQ-CR). Exploratory factor analysis of the Maternal Support Questionnaire-Child Report resulted in a three factor, 20-item solution: Emotional Support (9 items), Skeptical Preoccupation (5 items), and Protection/Retaliation (6 items). Each factor demonstrated adequate internal consistency. Construct and concurrent validity of the new measure were supported in comparison to other trauma-specific measures. The Maternal Support Questionnaire-Child Report demonstrated sound psychometric properties. Future research is needed to determine whether the Maternal Support Questionnaire-Child Report provides a more sensitive approximation of maternal support following disclosure of sexual abuse, relative to measures of global parent-child relations and to contextualize discrepancies between mother and child ratings of maternal support.

Of the estimated 6.3 million global annual deaths in children younger than the age of 5 years, nearly all (99%) occur in low- to middle-income countries (LMIC). Existing management guidelines for children with emergency conditions as taught in a variety of current pediatric life support courses are mostly applicable to high-income countries with a different disease range and full resources compared with LMIC. A revised curriculum with evidence-based application to limited-resource settings would expand their potential for reducing pediatric mortality worldwide. This review provides a supplemental curriculum of standards for selected pediatric emergency conditions with attention to the context of disease range and level-specific resources in LMIC. During training sessions, contextualized management guidelines create the framework for realistic and fruitful case simulations.

Importance: A simple, reliable anthropometric tool for rapid estimation of weight in children would be useful in limited-resource settings where current weight estimation tools are not uniformly reliable, nearly all global under-five mortality occurs, severe acute malnutrition is a significant contributor in approximately one-third of under-five mortality, and a weight scale may not be immediately available in emergencies to first-response providers., Objective: To determine the accuracy and precision of mid-upper arm circumference (MUAC) and height as weight estimation tools in children under five years of age in low-to-middle income countries., Design: This was a retrospective observational study. Data were collected in 560 nutritional surveys during 1992-2006 using a modified Expanded Program of Immunization two-stage cluster sample design., Setting: Locations with high prevalence of acute and chronic malnutrition., Participants: A total of 453,990 children met inclusion criteria (age 6-59 months; weight ≤ 25 kg; MUAC 80-200 mm) and exclusion criteria (bilateral pitting edema; biologically implausible weight-for-height z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ) values)., Exposures: Weight was estimated using Broselow Tape, Hong Kong formula, and database MUAC alone, height alone, and height and MUAC combined., Main Outcomes and Measures: Mean percentage difference between true and estimated weight, proportion of estimates accurate to within ± 25% and ± 10% of true weight, weighted Kappa statistic, and Bland-Altman bias were reported as measures of tool accuracy. Standard deviation of mean percentage difference and Bland-Altman 95% limits of agreement were reported as measures of tool precision., Results: Database height was a more accurate and precise predictor of weight compared to Broselow Tape 2007 [B], Broselow Tape 2011 [A], and MUAC. Mean percentage difference between true and estimated weight was +0.49% (SD = 10.33%); proportion of estimates accurate to within ± 25% of true weight was 97.36% (95% CI 97.40%, 97.46%); and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-2.15 kg; 2.24 kg). The height model fitted for MUAC classes was accurate and precise. For MUAC < 115 mm, the proportion of estimates accurate to within ± 25% of true weight was 97.15% (95% CI 96.90%, 97.42%) and the Bland-Altman bias and 95% limits of agreement were 0.08 kg and (-1.21 kg; 1.37 kg). For MUAC between 115 and 125 mm, the proportion of estimates accurate to within ± 25% of true weight was 98.93% (95% CI 98.82%, 99.03%) and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-1.15 kg; 1.24 kg). For MUAC > 125 mm, the proportion of estimates accurate to within ± 25% of true weight was 98.33% (95% CI 98.29%, 98.37%) and Bland-Altman bias and 95% limits of agreement were 0.05 kg and (-2.08 kg; 2.19 kg)., Conclusions and Relevance: Models estimating weight from height alone and height with MUAC class in children aged 6-59 months in a database from low-to-middle income countries were more accurate and precise than previous weight estimation tools. A height-based weight estimation tape stratified according to MUAC classes is proposed for children aged 6-59 months in limited-resource settings.

Maternal support has been widely cited as an important predictor of children's adjustment following disclosure of sexual abuse. However, few studies have examined these effects longitudinally. The current study examines the relationships between a multidimensional assessment of maternal support rated by both mothers and children and children's adjustment in various domains (internalizing, externalizing, anger, depression, and posttraumatic stress disorder symptoms) concurrently and longitudinally. Participants were 118 mother-child dyads recruited from a Child Advocacy Center where children were determined through a forensic evaluation to be victims of sexual abuse. Child and mother ratings of maternal support and child adjustment were collected shortly after the forensic evaluation and at 9-month follow-up. Results were consistent with findings from past studies that maternal support is significantly related to children's post-disclosure adjustment and extends these findings longitudinally. Additionally, the study sheds light on differential relations between dimensions of maternal support (Emotional Support, Blame/Doubt, Vengeful Arousal, and Skeptical Preoccupation) and child adjustment and suggests the importance of using both child and mother ratings of maternal support in future research., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

This study examined the convergence and divergence in mothers' and children's reports of maternal support following disclosures of childhood sexual abuse (CSA). One hundred and twenty mothers and their children (ages 7-17 years) reported on two aspects of support following CSA disclosures: mothers' belief in the child's disclosure and parent-child discussion of the abuse incident. Whereas 62% of mothers' and children's reports on mothers' belief of the disclosure positively converged (i.e., both reported that mothers "completely believed" the child's disclosure), 37% of mothers' and children's reports diverged, and the remaining 1% negatively converged (i.e., both reported that the mother only believed the child "somewhat"). Positively convergent responses were associated with youths' lower risk for tobacco and illicit drug use. Forty-four percent of mothers' and children's reports on whether details of the CSA were discussed positively converged (i.e., both reported that details were discussed), 33% diverged, and 23% negatively converged (i.e., both reported that details were not discussed). Relative to other patterns of reporting, negatively convergent responses were associated with higher levels of trauma symptoms. Findings have implications for identifying high-risk mother-child dyads based on patterns of informant reporting following CSA., (Published by Elsevier Ltd.)

Nearly all global mortality in children younger than 5 years (99%) occurs in developing countries. The leading causes of mortality in children younger than 5 years worldwide, pneumonia and diarrhoeal illness, account for 1·396 and 0·801 million annual deaths, respectively. Although important advances in prevention are being made, advanced life support management in children in developing countries is often incomplete because of limited resources. Existing advanced life support management guidelines for children in limited-resource settings are mainly empirical, rather than evidence-based, written for the hospital setting, not standardised with a systematic approach to patient assessment and categorisation of illness, and taught in current paediatric advanced life support training courses from the perspective of full-resource settings. In this Review, we focus on extension of higher quality emergency and critical care services to children in developing countries. When integrated into existing primary care programmes, simple inexpensive advanced life support management can improve child survival worldwide., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: Maternal support is an important factor in predicting outcomes following disclosure of child sexual abuse; however, definition of the construct has been unclear and existing measures of maternal support are utilized inconsistently and have limited psychometric data. The purpose of this study was to develop a reliable and valid mother-report measure for assessing maternal support following the disclosure of child sexual abuse., Methods: Data from 2 very similar samples of mother-child pairs seeking forensic evaluation following the discovery of child sexual abuse were combined, resulting in a final sample of 246., Results: Exploratory factor analysis resulted in two reliable 7-item factors labeled "Emotional Support" and "Blame/Doubt," each of which had acceptable internal consistency. Analyses with a child-report measure of general maternal support the construct validity of the MSSQ. Concurrent validity analyses revealed unique relations with maternal ratings of child behavior problems and case characteristic data., Conclusions: The study resulted in the development of a brief, easily scored self-report measure of maternal support with reasonable preliminary psychometric properties that could easily be utilized in other studies of sexually abused children., Practice Implications: Adoption of this promising measure in future research will reduce the lack of cross-study measurement comparability that has characterized the maternal support literature to date, increase the feasibility of expanding upon current literature on maternal support, and may produce important information leading to clinical and theoretical innovation., (Copyright © 2010. Published by Elsevier Ltd.)

The ideal first response to a life-threatening pediatric emergency includes early recognition of the emergency, activation of the appropriate emergency response system, performance of basic life support (cardiopulmonary resuscitation/automated external defibrillator treatment), and initiation of advanced life support, but the extent of resuscitation training among health care providers likely to be first at the side of a critically ill or injured child is often deficient. In the past, resuscitation courses beyond basic life support focused on training advanced providers. The Pediatric Emergency Assessment, Recognition, and Stabilization course was developed by the American Heart Association to target a broad range of health care providers who are likely to be first at the side of a child requiring resuscitation. It is hoped that training of health care providers through the Pediatric Emergency Assessment, Recognition, and Stabilization course will translate into early recognition of life-threatening pediatric emergencies and greater resuscitation success, but results will depend on the availability of instruction and the maintenance of skills.

Our study compared levalbuterol (LEV) to the combination of racemic albuterol (RAC) and ipratropium bromide (IB) in 140 patients aged 6-18 years presenting to a tertiary hospital Emergency Department with acute asthma and a peak expired flow rate (PEF)<80% predicted. Patients were randomized to: LEV (

Physiologic anterior subluxation is a phenomenon that is common to the upper pediatric cervical spine and characterized by the normal forward displacement of one cervical vertebra relative to the subjacent one. Physiologic anterior subluxation can be seen in children in the setting of trauma, when it must be distinguished from pathologic subluxation. Physiologic anterior subluxation has not been reported at lower cervical spinal levels (C 5 to C 6 or C 6 to C 7 ). This is a report of physiologic anterior subluxation at C 5 to C 6 and C 6 to C 7 spinal levels distinguished from pathologic subluxation in a 9-year-old child evaluated in the acute setting after cervical spine injury.

Objective: To determine the usefulness of oblique cervical spine radiography (OCSR) in the management of children who have sustained blunt cervical spine injury, particularly if OCSR is abnormal when no acute abnormalities are shown on standard cervical spine radiography (SCSR)., Methods: We carried out a blinded radiographic review of 109 patients younger than 16 years evaluated at an academic pediatric trauma center and a community hospital between July 1990 and December 1997. All patients had SCSR (anteroposterior/lateral views) and OCSR performed for a trauma-related event within 7 days of injury., Results: In 105 patients (96.3%), radiographic impression after review of SCSR and OCSR did not differ from that after SCSR review alone (95% confidence interval 90.9%, 99.0%). Radiographic impression was revised after OCSR review in 4 patients, all with equivocal findings on SCSR, to normal in three patients and abnormal in one patient (subluxation). Of 78 patients without acute abnormalities on SCSR, no patient had acute abnormalities on OCSR (95% CI, 0-3.8%)., Conclusions: In our series of 109 children who underwent acute radiographic evaluation of blunt cervical spine trauma, oblique views were unlikely to be abnormal if no acute abnormalities were evident on standard anteroposterior and lateral radiographs. Although few patients are likely to benefit from the addition of these views on a routine basis, a useful role for oblique cervical spine radiographs in detecting cervical spine injury in children cannot be excluded based on the results of this study.

Objective: One aspect of treatment for child abuse and neglect addresses the attributions that the child victim, offender, nonoffending parents, and other family members have about the occurrence of the maltreatment. This paper describes a formal approach for abuse clarification to be used with families in which maltreatment has occurred. The four primary components of the abuse clarification process are: (a) clarification of the abusive behaviors; (b) offender assumption of responsibility for the abuse; (c) offender expression of awareness of the impact of the abuse on the child victim and family; and, (d) initiation of a plan to ensure future safety. The process of abuse clarification is described and suggestions made for appropriate use of the procedure.

Aspirin overdose may result in acid-base disturbances, electrolyte abnormalities, pulmonary edema, chemical hepatitis, seizures, and mental status alteration, but myocardial depression has not been reported following aspirin overdose in children. In addition to these more typical features, the 13-month-old boy reported here developed clinical, radiographic, and echocardiographic evidence of myocardial impairment with pulmonary edema and moderately severe global left ventricular dysfunction (estimated shortening fraction of 23%). Complete resolution of the myocardial dysfunction was demonstrated on follow-up echocardiography as the child recovered from the aspirin intoxication. This case suggests that myocardial dysfunction can occur as a result of toxic aspirin ingestion, and that it may contribute to salicylate-induced pulmonary edema.

Background: Guidelines for glaucoma screening by the primary care physician have not been firmly established. Despite its limitations as a screening test, intraocular pressure measurement by tonometry remains the mainstay of glaucoma monitoring but is not widely used in the primary care setting. The purpose of this study was to compare the effectiveness of noncontact tonometry using the Pulsair instrument with that of conventional tonometry using the Goldmann applanation tonometer as a screening tool for glaucoma., Methods: Intraocular pressure was measured by non-contact and Goldmann applanation tonometry in both eyes of 50 volunteers who enrolled in a glaucoma screening program at a primary care clinic., Results: Noncontact tonometry correctly identified over 90% of the patients with intraocular pressures greater than 22 mm Hg., Conclusions: Noncontact tonometry is an easy, practical, and well-tolerated method of intraocular pressure measurement. When combined with direct ophthalmoscopy, noncontact tonometry can easily be used in routine primary care health examinations to detect glaucoma.