The account of these patients documents the necessity for critical attention to the entire environment, including cultural factors believed to be especially important in the care and development of the injured child. It further documents the necessity for early intervention when abuse is suspected. Drastic management by removal from the home, the only method of intervention referred to in this paper, is indicated when the caretaker cannot respond to milder measures designed to improve his relations with the infant. Other methods such as home helps, intensive psychotherapy, or day care for the infant should be carefully tried if the child is considered safe from further assault. Of course, ongoing evaluation should be part of any attempt at intervention.

No abstract

Observations were made of 146 children who were accidentally injured or abused, and 113 children were studied in detail. The injuries of the abused group tended to be more severe and to be followed by serious sequelae more often than those of the accidentally injured, but the two groups, accident and abuse, were difficult to differentiate on the basis of history alone. Other findings such as developmental retardation, patient's ordinal position, family density, and ability to cope with stress were more useful. The physician must be aware that any infant accident or injury reflects a lapse in child care and requires more than emergency treatment.