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We evaluated the relationship between neighborhood sociodemographic factors, community resources, and homicides involving young children. We performed spatial analysis of children under age five murdered in Harris County, Texas, from 1997 to 2003. Data on county population, household, socioeconomic, and residential mobility characteristics were allocated to census block groups. Age-adjusted spatial clusters of the homicides were identified. A Markov Chain Monte Carlo negative binomial regression risk model tested the relationship of age-adjusted number of child homicides to block group characteristics and distance of victim’s residence to community resources. Child maltreatment accounted for 94% of 125 homicides. In all, 64% were concentrated in 12 age-adjusted spatial clusters involving 3% of county area. Predictors for number of homicides were a larger number of single-parent households (male and female) and lower median household income. Distance to nearest community resources was not significant. Spatial clusters of child homicides were associated with low-income neighborhoods and single-parent (male and female) households. No association between the spatial clusters of child homicides and their proximity to community resources was observed. A high percentage of child homicides were concentrated in a small area of the county, which offers the potential for targeted, cost-effective interventions.

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Lichen sclerosus in young females can present as traumatic injuries on the vulva which can mimic sexual abuse. The case of an unconscious 6-year-old girl presenting in a reported inflicted drug overdose and with a clinical picture of ecchymosis and abrasions of the anogenital area is presented and discussed. The following case underscores the need for clinicians evaluating children for suspected abuse, to consider alternate conditions and causes that may not be related to sexual abuse.