Evaluation and referral for child maltreatment in pediatric poisoning victims

Wood, Joanne N.; Pecker, Lydia H.; Russo, Michael E; Henretig, Fred M.; Christian, Cindy W.

doi:10.1016/j.chiabu.2012.01.001

Cited by 37 publications

(27 citation statements)

References 14 publications

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“…Given child abuse is often observed in the intra‐family context, only few papers have been published about paediatric drug‐facilitated observations . In front of recent neuropsychological disturbances in a child, such an issue has to be considered.…”

Section: Discussionmentioning

confidence: 99%

“…Given child abuse is often observed in the intra-family context, only few papers have been published about paediatric drug-facilitated observations. [8][9][10][11][12][13] In front of recent neuropsychological disturbances in a child, such an issue has to be considered. The quality of sampling, the use of ultra-sensitive and specific toxicological methods, and a clinical-biological collaboration allow the recognition of this form of delinquency whose consequences are both medical and legal.…”

Section: Drug Testing and Analysismentioning

confidence: 99%

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Interpretation of hair findings in children: about a case involving carbamazepine

Kintz¹

2013

Drug Testing and Analysis

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This office has been recently involved in a case dealing with child custody, where the final outcome was difficult to establish. The following concentrations were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in the hair of a 21-month-old girl: 154 (0-1 cm), 198 (1-2 cm), 247 (2-3 cm), and 368 pg/mg (3-4 cm) after decontamination.Obviously, the concentrations measured in the hair were much lower than those observed in patients under daily treatment. In this sense, the frequency of exposures appears as infrequent (low level of exposure), with marked decrease in the more recent period. However, the girl was never prescribed carbamazepine and the mother, who was under carbamazepine therapy, denied any administration. The Judge asked if this could result from a single exposure and at which period. At least, three possible interpretations of the measured carbamazepine concentrations were addressed: (1) decrease in administration in the more recent period; (2) increase of body weight due to growing, so the same dosage will result in lower concentrations in hair; and (3) sweat contamination from the mother at the time the girl is with her in bed, the older hair being in contact longer with the bedding. In this case, it was impossible to conclude that the child was deliberately administered carbamazepine. The results of the analysis of hair could indicate that she was in an environment where carbamazepine was being used and where the drug was not being handled and stored with appropriate care. There are many differences between the hair from children and those from adults: hair from children is thinner and more porous, the ratio anagen and catagen phases are not maintained, and the growth rate can be different, at some periods, from the usual 1 cm/month. These differences, together with the influence of PK-PD parameters are reviewed in this paper, as a basis for suitable interpretation. In view of these results it is proposed that a single hair analysis should not be used firmly to discriminate long-term exposure to a drug when dealing with children.

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Section: Discussionmentioning

confidence: 99%

Section: Drug Testing and Analysismentioning

confidence: 99%

Interpretation of hair findings in children: about a case involving carbamazepine

Kintz¹

2013

Drug Testing and Analysis

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“…16 This may explain the high rate of referrals in our series. Referral to CPS was high because 9 of 11 children were referred (data for 1 child were missing).…”

Section: Emergency Managementmentioning

confidence: 74%

“…10,11 Increased availability of cannabis may lead to it becoming a more frequent cause of accidental ingestion in children. 16 Cannabis is illicit in France. 12 Moreover, parental drug or alcohol problems seem to be linked with child abuse by decreasing the ability to parent effectively, increasing parents' level of punitiveness toward their children and the risk of perpetrating child abuse or neglect.…”

mentioning

confidence: 99%

“…12 Moreover, parental drug or alcohol problems seem to be linked with child abuse by decreasing the ability to parent effectively, increasing parents' level of punitiveness toward their children and the risk of perpetrating child abuse or neglect. 16 To ensure a coordinated response to child abuse and neglect, several possibilities are open to doctors in France: reporting to the public prosecutor, reporting to child protectives services (CPS), or continued hospitalization of the child against the parents' wishes while awaiting an emergency enquiry. 14 More recently, some evidence has linked parental use of cannabis with child abuse.…”

mentioning

confidence: 99%

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Parental Cannabis Abuse and Accidental Intoxications in Children

Pélissier¹,

Claudet²,

Pélissier-Alicot³

et al. 2014

Pediatric Emergency Care

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Child Protection System Interactions for Children With Positive Urine Screens for Illicit Drugs

Rebbe,

Malicki,

Siddiqi

et al. 2024

JAMA Netw Open

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ImportanceYoung children are ingesting illicit drugs at increased rates, but it is unknown what the associated child protection system (CPS) responses are when a child tests positive.ObjectiveTo document the child protection system involvement and the characteristics of children who test positive for illicit substances.Design, Setting, and ParticipantsThis retrospective cross-sectional study linked medical discharge and child protection system administrative data. The setting was Rady Children’s Hospital San Diego, a free-standing pediatric hospital in California. Participants included all emergency department and inpatient medical encounters involving children aged 12 years or younger with a positive urine drug test between 2016 and 2021. Statistical analysis was performed from February 2023 to January 2024.ExposureDrug type, including amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, fentanyl, opiates, and phencyclidine.Main Measures and OutcomesCPS responses associated with the medical encounter including reports, substantiations, case openings, and out-of-home placements.ResultsA total of 511 emergency department and inpatient medical encounters involving children had a positive drug test (262 [51.3%] were female; 309 [60.5%] were age 6 years or younger; fewer than 10 [&lt;3.0%] were American Indian or Alaska Native; 252 [49.3%] were Hispanic [any race], 20 [3.9%] were non-Hispanic Asian, 56 [11.0%] were non-Hispanic Black, 143 [28.0%] were non-Hispanic White, 36 [7.0%] had other or unknown race and ethnicity; 233 [43.6%] had a CPS report prior to the medical encounter). Following the positive screen, 244 (47.7%) were reported to child protection, and 61 (11.9%) were placed out-of-home within 30 days. Mean (SD) quarterly counts of encounters with positive drug tests doubled after the COVID-19 pandemic onset (32.9 [9.8]) compared with prior to the pandemic onset (16.5 [4.7]); for encounters positive for cannabis, mean (SD) quarterly counts were 3 times as high after the pandemic onset than prior (16.6 [4.7] vs 5.7 [2.9]). Encounters for children under age 1 were significantly more likely to have associated child protection reports (relative risk [RR], 2.91 [95% CI, 2.21-3.83]) and child protection case openings (RR, 1.71 [95% CI, 1.07-2.72]) than encounters involving older children.Conclusions and RelevanceIn this cross-sectional study of emergency department and inpatient medical encounters, less than half of children with positive urine drug screens were reported to CPS; out-of-home placements were uncommon. With increased encounters for positive drug tests, it is unclear what services these children and families are receiving.

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Evaluation and referral for child maltreatment in pediatric poisoning victims

Cited by 37 publications

References 14 publications

Interpretation of hair findings in children: about a case involving carbamazepine

Interpretation of hair findings in children: about a case involving carbamazepine

Parental Cannabis Abuse and Accidental Intoxications in Children

Child Protection System Interactions for Children With Positive Urine Screens for Illicit Drugs

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