Polysarcia adiposa: morbid obesity

From October 1988 to March 2005, there were at least 92 autopsy cases where morbid obesity was present and/or where it was attributed to the cause of death in the coronial district of Auckland, New Zealand, a city with a population of over 1 million people. Obesity has been researched internationally, and much is known about associated comorbidities such as atherosclerotic disease, hypertension, and diabetes, to name a few. However, in the morbidly obese (body mass index>or=40 kg/m2), only 14 of 92 cases were found to have ischemic heart disease due to coronary atherosclerosis as the principal cause of death, and slightly over half (48/92) have some degree (mild, moderate, severe) of coronary atheroma. There is a strong positive correlation between heart weight and body weight. Only 8 livers were normal, all others showing some form of steatosis, venous congestion, and fibrosis/cirrhosis. The mean weights of the heart, lungs, and liver were above the normal reference range in almost all cases. In conclusion, the study did not follow the widely published finding of the positive correlation between morbid obesity and ischemic heart disease in terms of mortality, but the study was consistent with other studies on the organ manifestations of morbid obesity, particularly for the heart, lungs, and liver.     

THE FOSTER CARE OMBUDSMAN: APPLYING AN INTERNATIONAL CONCEPT TO HELP PREVENT INSTITUTIONAL ABUSE OF AMERICA'S FOSTER YOUTH

Children today are often abused while in foster care, undermining the theoretical goal of the modern foster care system: to create a temporary, safe, homelike setting to protect and nurture children who are unable to live with their biological parents due to various reasons such as abuse, neglect, or abandonment. Often this abuse is worse than the type for which they were removed from their parents’ care in the first place. First examining the reasons why this complex problem exists, this Note recommends an internationally based, innovative concept as a partial solution: the foster care ombudsman. This Note explains the concept of an ombudsman and demonstrates how it can be particularly helpful to foster children, highlighting existing child welfare ombudsman offices in California, Rhode Island, and New Jersey, as well as international approaches. It also illustrates how a foster care ombudsman can complement class action litigation of foster care abuse claims.     

Providing Interdisciplinary Services to At‐Risk Families to Prevent the Placement of Children In Foster Care

Grandparents need support to take on the responsibility of children whose parents cannot care for them due to drug addiction, mental health issues, HIV illness, or other health problems. Without support and assistance, these families and children are likely to end up enmeshed in the already overburdened child abuse and neglect system. The University of Maryland has created a model program providing social work and legal services to at‐risk grandparent families to help avoid the unnecessary placement of these children in foster care. In this new program, student attorneys and student social workers worked with the grandparent client to help stabilize the family, providing representation or advice on housing, public benefits, custody, and school‐related issues. Joint education of student attorneys and student social workers in a clinical experience enhances their understanding of their roles and those of the other profession and prepares them for a more thoughtful and informed approach to family law, child welfare cases, and at‐risk children.     

STATE CHILD EMOTIONAL ABUSE LAWS: THEIR FAILURE TO PROTECT CHILDREN WITH GENDER IDENTITY DISORDER

Emotional abuse of children with Gender Identity Disorder by parents is very difficult to identify and prevent. State investigators of abuse and neglect often have a hard time determining if the reasons for mental illness and psychological harm in children are due to the actions of their parents, or if they stem from other sources. Once identified, it becomes even harder to prove in court for purposes of ordering services or removing the child from the home if the abuse is severe enough. With children who are gender non‐conforming, this task becomes exponentially more difficult due to the low prevalence rate, discrimination, stereotypes, and a parent's right to bring up their child as they choose. These youth face discrimination and violence in school, work, their communities, and also within their own families. Emotional abuse statutes are too vague to protect youth who are gender non‐conforming. The vague and unclear laws lead to inconsistency in the application of the law and lack of protection of the children because judges and investigators are not aware of how parent's actions harms youth with gender identity disorder. Therefore, states should adopt the model statute within this Note which defines specific actions by parents which would not qualify as abuse when involving gender conforming youth but qualifies as abuse for children with gender identity disorder. Many states already have statutes which define physical abuse, sexual abuse and abandonment by specific actions by parents towards their children. This proposal will enable both the state and the judges to properly identify victims with gender identity disorder of emotional abuse and provide for their protection.     

Obesity,Body Mass Index,and Homicide

The body mass indexes (BMIs) of 100 randomly selected homicide cases from the files of Forensic Science SA were compared to the Australian and South Australian populations. There were 70 males and 30 females (M:F = 2.3:1; age range 18–84 years; mean 42.3 years). There was a substantially lower proportion of obese individuals in the homicide population compared to the general Australian and South Australian populations (19% [vs.] 27.9% and 30%, respectively). A second group of 144 randomly selected autopsy cases where the BMI was ≥40 kg/m² was analyzed. There were 77 males and 67 females (M:F = 1.2:1; age range 23–78 years; mean 46.7 years). The majority of deaths were natural (N = 108), with no homicides. A negative association between obesity and homicide has, therefore, been demonstrated. Reasons for the lower numbers of obese/morbidly obese individuals among homicide victims are unclear, but may include physical protection afforded by fat padding from sharp force injuries, and relative sociodemographic isolation.     

Childhood panhypopituitarism presenting as child abuse: a case report and review of the literature

Childhood panhypopituitarism may be acquired or congenital. Children with panhypopituitarism can present clinically with diabetes, growth failure, decreased bone density, and morbid obesity. In the forensic setting without the proper history, it can be misdiagnosed as child abuse or neglect. We report a case of a 3-year-old black girl who was admitted to the emergency room with apnea and subsequently died. While at the emergency department, it was discovered that the child had a fractured left hip and was severely growth retarded for age. The coroner wanted to rule out child abuse and/or neglect and requested an autopsy based on the physical findings identified by hospital staff. Significant findings at autopsy included small for age (15th percentile for age), hypoplastic brain/pituitary gland/adrenal gland/thyroid gland, abnormally formed skull with an occipital protuberance, a fractured left hip with decreased bone density, and central adiposity. Subsequent to the autopsy, it was discovered that at 6 weeks of age the child suffered from group B streptococci meningitis that resulted in panhypopituitarism. The panhypopituitarism then resulted in seizure activity, diabetes insipidus, and growth retardation. The authors hope this case report and review of the literature will assist investigators, pathologists, and clinicians in making a distinction between neglect or inflicted injury of child abuse and panhypopituitarism that can present with similar signs and symptoms.     

Assessing the Influence of Familial Paternalism on Child Neglect Sentencing Decisions

Familial responsibilities have been found to significantly reduce the severity of sentencing outcomes of defendants in the criminal court. Additional research also has suggested that this leniency might be contingent on the type of offense, with defendants who commit crimes which imply that they are unfit parents (e.g., drug offenses) not receiving a significant reduction in their likelihood of incarceration. Utilizing familial paternalism as the theoretical basis, the current study examines whether having children influences the sentences of defendants charged with forms of criminal child neglect. The findings indicate that having children does result in significantly reduced odds of incarceration for defendants charged with child neglect. These findings support the arguments set forth by familial paternalism. However, they do not support the inference that defendants convicted of child neglect are presumed to be unfit parents. Implication of these results and directions for future research are discussed.     

Training Parents Reported for or at Risk for Child Abuse and Neglect to Identify and Treat Their Children's Illnesses

Parents at-risk or reported for child abuse or neglect may demonstrate deficits in infant and child health care skills, placing their children at greater risk for health problems. Research assistants, caseworkers, and a nurse provided health care skills training to parents at risk or reported for child abuse or neglect. A health reference guide and other training materials were validated by health care professionals. Training involved teaching parents to follow a series of steps to identify symptoms, use reference and record-keeping materials, determine the best form of treatment, and either treat the illness at home, consult a physician, or seek emergency treatment. Skill acquisition was assessed through observations of parent behavior in simulated health care scenarios. A series of multiple baselines across parents demonstrated effectiveness of this training in the context of these scenarios. Six out of seven parents met the 100% mastery criterion. All parents provided positive ratings of the content of the training program, the training strategies, and the counselors who provided training.     

Extreme obesity and associated cardiovascular disease verified at autopsy: time trends over 3 decades

Extreme obesity is a strong predictor of premature death, but the prevalence of cardiovascular disease in morbidly obese populations is largely unknown. The aim of the present study was to find out whether there has been an increase in extreme obesity with body mass index 40.0 kg/m(2) or greater in medicolegal autopsy material in a known geographical area in Finland during a period of 3 decades and to examine the prevalence and time trends of associated cardiovascular disease in this obesity category. Autopsy reports of 235 cases examined in 1975 to 2006 were analyzed. The number of extremely obese individuals increased from 0.6% of the yearly amount of autopsies in the 1970s and 1980s to 2.8% and 2.5% in 2005 and 2006, respectively. The most frequent cause of death was cardiomyopathy or cardiomegaly (28.9%), followed by coronary heart disease (24.3%). Either coronary arteries were lesion-free, or only fatty streaks had been observed in 46.8% of the women and in 43.1% of the men. No significant changes in the average body mass index or severity of coronary atherosclerosis were observed. Younger individuals younger than 40 years began to appear more often after 1995. An increased trend of extreme obesity in a region where autopsy frequency is high may refer to a general increase of this obesity category. A large number of extremely obese people are resistant to coronary atherosclerosis, but cardiac hypertrophy may be accompanied by several mechanisms leading to sudden death even among the youngest extremely obese individuals.     

Breaking The Cycle Of Intergenerational Child Maltreatment: A Case For Active Efforts For Dependent Minor Parents And Their Children In State Custody

Dependent minor parents placed in foster care with their children often face significant hurdles. These parents are responsible to make caregiving decisions for their children, while they themselves fall under the caregiving responsibility of the state child welfare system. As such, dependent minor parents live in a “twilight zone” – they hold full parental rights, but limited rights as teenagers. For a number of reasons, the children of minor parents in foster care often come into state custody. When two generations are in foster care at the same time, states must balance the safety and best interests of the children with the rights of minor parents to care for their own children. Currently, the state child welfare system is only required to provide “reasonable efforts” to reunify parents with children when they have been removed from their care for abuse, neglect, or dependency. However, dependent minor parents in state custody often require more supportive services in order to successfully reunify with their children than in a typical child welfare case. This article places the circumstance just described in the context of dependent minor parents’ constitutionally protected rights, and advocates for a higher standard which would require states to provide “active efforts” to protect and preserve these young families.     

INTERCOUNTRY ADOPTIONS: INSTITUTING EDUCATIONAL PROGRAMS IN THE ADOPTION PROCESS TO FACILITATE AWARENESS OF CULTURAL IDENTITY ISSUES

In 1995, China first claimed the designation as the number one location for parents from the United States seeking to adopt children. The children, for the most part girls, are between 6 and 20 months old, when they are adopted. Most of the girls that were adopted in 1995 are now entering into their preteen years, and if they have not already confronted the issue of who they are, they will soon be forced to. Adoption is a complicated and emotional process that affects the entire family. Traditionally, parents who adopt have been able to consciously choose when and how they will first tell their child that they are adopted. However, when the adopted child is a member of a transracial family, where the parents and adoptive child are obviously of a different race, this decision can sometimes be taken out of their hands by a stranger thoughtlessly asking, “Is she yours?” The parents who choose to adopt from a foreign country should be prepared to answer this question and numerous others before they bring their adopted child home. This note will explore the concept of incorporating educational programs into the intercountry adoption process as an effective method of educating prospective parents on the challenges that transracial families will confront.     

Crimes against children in nineteenth-century France

Abuse of children is not entirely a modern phenomenon but the definition and classification of abusive practices has changed. Modern concepts of child abuse date only from the 1880s in France. Child abuse in twentieth-century terms of emotional and physical assault, neglect, abandonment, and sexual molestation was not considered a crime during most of the past century. Prior to the 1880s, only two acts, abortion and infanticide, constituted crimes against children. Child abandonment, rather than a crime, was the state supported, societally acceptable alternative to abortion and infanticide. After abandonment, malnourishment and neglect of these children, even to the point of death, likewise were not crimes. With changes in attitudes of the 1880s, parental neglect, assault, and starvation of children became defined as child abuse as did perceived immoral behavior of the parents such as habitual drunkenness and debauchery. Under these new definitions of abuse, state officials could deprive parents of their legal rights and make the children wards of the state for their own protection. The state becamein loco parentis. This essay explores the changing perceptions of child abuse, and the increasing state intervention for the care of abused children after the 1880s.     

Off the Grid: Vaccinations Among Homeschooled Children

To protect public health, states require that parents have their children immunized before they are permitted to attend public or private school. But for homeschooled children, the rules vary. With the spectacular growth in the number of homeschooled students, it is becoming more difficult to reach these youth to ensure that they are immunized at all. These children are frequently unvaccinated, leaving them open to infection with diseases that are all but stamped out in the United States with immunization requirements. States should encourage parents to get their homeschooled students vaccinated through enacting the same laws as those used for public school students. This could be done by enforcing current laws through neglect petitions or by requiring that children be immunized before participating in school sponsored programs. As most states require some filing to allow parents to homeschool their children, it would be easy to enact laws requiring that homeschooled children be immunized or exempted before completing registration.     

Parent-Child Agreement on Parent-to-Child Maltreatment

Parent-child agreement on child maltreatment was examined in a multigenerational study. Questionnaires on perpetrated and experienced child maltreatment were completed by 138 parent-child pairs. Multi-level analyses were conducted to explore whether parents and children agreed about levels of parent-to-child maltreatment (convergence), and to examine whether parents and children reported equal levels of child maltreatment (absolute differences). Direct and moderating effects of age and gender were examined as potential factors explaining differences between parent and child report. The associations between parent- and child-reported maltreatment were significant for all subtypes, but the strength of the associations was low to moderate. Moreover, children reported more parent-to-child neglect than parents did. Older participants reported more experienced maltreatment than younger participants, without evidence for differences in actual exposure. These findings support the value of multi-informant assessment of child maltreatment to improve accuracy, but also reveal the divergent perspectives of parents and children on child maltreatment.     

ARE WE REALLY LOOKING OUT FOR THE BEST INTERESTS OF THE CHILD? APPLYING THE NEW ZEALAND MODEL OF FAMILY GROUP CONFERENCES TO CASES OF CHILD NEGLECT IN THE UNITED STATES

This Note advocates for state laws to be amended to implement family group conferencing (FGC) as the first step in cases of alleged child neglect. FGC was developed in New Zealand nearly twenty years ago and have since become a realistic method of balancing the best interests of the children, families, agencies, courts, and communities involved in the child welfare system. A FGC is a meeting among family members and professionals that is conducted in order to develop a plan for a child who is the victim of neglect. FGC places the family at the center of the welfare proceedings and empowers them to reach a solution without having to resort to the often lengthy and expensive adversarial court system. If FGC is incorporated into the child welfare systems throughout the United States, communication between the parents, social services, and the courts could increase, helping families adequately address the problem of neglect and getting the children out of the child welfare system quickly and more efficiently.     

JOINT CUSTODY AND THE PRESCHOOL CHILD

A longitudinal study of 25 families, with children aged 14 months—5 years, in joint custody, is reported. Varying motivations that lead divorcing parents to undertake and sustain joint custody are discussed, together with the stresses and gratifications of these arrangements for the parents and children. Findings are that where both parents are motivated primarily by interest in the child, where the parenting is sensitive and where the child is shielded from interparental conflict, young children do well. Such families were not the majority in this study. Significant differences emerged in the adjustment of the 1–3 age group as compared with the 3–5 age group which point to greater difficulties for the 3–5 year-olds.     

Parental problem-solving skills and child behavior problems: A comparison of physically abusive,neglectful, clinic,and community families

Failure to solve problems related to parenting and other aspects of daily living is hypothesized to result in frustration or inability to cope, and lead to deviant parental behavior such as aggression or neglect. The present investigation provided support for a procedure for measuring parental problem-solving skill and compared the problem-solving abilities and child behavior problems of maltreating and nonmaltreating parents. Subjects were 40 parents with at least one child between the ages of three and twelve. Subjects were assigned to one of four groups: (a) physically abusive parents (n = 9); (b) neglectful parents (n = 9); (c) nonmaltreating clinic parents seeking help for child behavior problems (n = 11); and (d) nonmaltreating, non-help-seeking community parents (n = 11). Abusive and neglectful parents were deficient in problem-solving skill as compared to clinic and community parents, yet there were many similarities in parental reports of child behavior problems for maltreating and nonmaltreating parents. Parental problem-solving skill did not correlate significantly with parental ratings of child behavior problems.     

Advisability of substance abuse testing in parents who severely maltreat their children: the issue of drug testing before the juvenile/family courts

The authors discuss the advisability of juvenile courts requiring urine testing for parents who severely maltreat (abuse and/or neglect) their children. While urine testing for substance abuse is not sufficient to ensure adequate treatment, it is important as part of the overall substance abuse treatment in a selected group of parents. An objective of this article is to offer specific urine testing guidelines in the context of child maltreatment cases in which the court considers removing children from parental custody to state custody. Although potentially useful, urinalysis to detect abused substances has limitations and is appropriate only in well-defined situations. Effective treatment of the substance-abusing, child-maltreating parent must be multimodal, with treatment of substance abuse as the first and most important step.     

Fat and the law: who should take the blame?

The incidence of obesity in both adults and children is rising at a rapid rate in most developed countries, including in Australia. Some obese people are seeking to place the blame for their condition on the fast-food industry, as demonstrated by the recent litigation in the United States brought by two obese plaintiffs against McDonald's. This litigation was unsuccessful, and on existing Australian negligence principles any similar litigation commenced here is likely to suffer the same fate. Principles of personal responsibility, autonomy and free will should prevail to deny a negligence claim. The risk of obesity and concomitant health problems from eating fast food to excess is an obvious risk which the plaintiff should not have ignored and which he or she has voluntarily assumed. It is for the Australian Government, not the courts, to regulate the behaviour of the fast-food industry. The government should take action by requiring all major fast-food chains to label their products with nutritional information, and by imposing restrictions on the advertising of food to children.     

Maltreatment of handicapped children: A critical review

Despite increased interest in child abuse and neglect in the past decade, little research attention has been focused on maltreatment in handicapped populations. This is surprising given that many handicapped children display characteristics (e.g., chronic and pervasive behavioral disturbances, decreased social initiations with caregivers) that are associated with high risk for assault and neglect in nonhandicapped children. Numerous investigations have found an overrepresentation of handicapped children in maltreated samples, and results of more recent efforts reveal a high incidence of abuse and neglect in handicapped populations. Although these data underscore the high risk for maltreatment in handicapped children, a number of important issues warrant further empirical examination. Moreover, generalizations and interpretations of findings from previous research have been obfuscated by methodological shortcomings. The present paper reviews the literature concerning abuse and neglect of handicapped children. Research strategies and issues are delineated and current problems in this field are discussed. Suggestions for directions future research might take are offered.