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NCJ Number: 48226 Find in a Library
Title: NON-ACCIDENTAL POISONING - AN EXTENDED SYNDROME OF CHILD ABUSE
Journal: BRITISH MEDICAL JOURNAL  Issue:1  Dated:(1976)  Pages:793-796
Author(s): D ROGERS; J TRIPP; A BENTOVIM; A ROBINSON; D BERRY; R GOULDING
Corporate Author: British Medical Assoc
United Kingdom
Date Published: 1976
Page Count: 4
Sponsoring Agency: British Medical Assoc
London, WC1 H9JR, England
Type: Report (Study/Research)
Format: Article
Language: English
Country: United Kingdom
Annotation: SIX CASES ARE REPORTED WHICH ILLUSTRATE THE MANIFESTATIONS, DIAGNOSES, AND MANAGEMENT OF NONACCIDENTAL POISONING AS AN EXTENDED SYNDROME OF CHILD ABUSE.
Abstract: WHILE STUDIES OF CHILD ABUSE HAVE CONCENTRATED LARGELY ON PHYSICAL VIOLENCE, NUTRITIONAL NEGLECT, AND EMOTIONAL DEPRIVATION, THE CHILD ABUSE SYNDROME MAY EXTEND TO THE LESS OBVIOUSLY PARENTALLY INFLICTED CHILD MORBIDITY AND MORTALITY RESULTING FROM INTENTIONAL POISONING. AS CAN BE SEEN IN THE CASES REPORTED, THE FIRST MANIFESTATION OF POSSIBLE POISONING INVOLVES THE APPEARANCE OF OFTEN BIZARRE SYMPTOMS WITH NO APPARENT PATHOLOGICAL EXPLANATION. IN THE CASE OF BARBITURATE POISONING, PHYSICAL SIGNS AT THE TIME OF FIRST PRESENTATION MAY GIVE AN INDICATION OF DRUG POISONING. IN THE CASES PRESENTED INVOLVING DIURETIC AND SALT POISONING, OTHERWISE INEXPLICABLE ELECTROLYTE VALUES PROVIDED THE FIRST INDICATION OF THE CAUSE OF ILLNESS. ADDITIONAL FEATURES IN CASES OF NONACCIDENTAL CHILD POISONING WHICH MAY AID IN ITS DIAGNOSIS INCLUDE NEUROLOGICAL PRESENTATION SUCH AS FAINTING; A PARENTAL HISTORY OF DRUG ABUSE OR OVERDOSE; THE AVAILABILITY OF DRUGS IN THE HOME; PSYCHOSOCIAL STRESS IN THE FAMILY, SUCH AS MARITAL CONFLICT OR PARENTAL PSYCHIATRIC DISTURBANCE; PREVIOUS CONSPICUOUS ILLNESS, INJURY, OR DEATH IN THE FAMILY; EPISODIC NATURE OF THE SYMPTOMS; EPISODES RELATED TO PARENTAL VISITS TO THE HOSPITALIZED CHILD; A RECURRENCE OF SYMPTOMS AFTER DISCHARGE TO THE PARENTAL HOME; AND DETECTION OF A DRUG IN THE URINE, BLOOD, OR GASTRIC CONTENTS. WHEN A DIAGNOSIS OF NONACCIDENTAL POISONING IS SUSPECTED, A COMPLETE SOCIAL AND MEDICAL HISTORY SHOULD BE TAKEN AND CAREFUL BIOCHEMICAL TESTING AND TOXICOLOGICAL ANALYSIS OF THE BLOOD AND URINE SHOULD BE CARRIED OUT. ONCE NONACCIDENTAL POISONING HAS BEEN PROVEN, A CASE CONFERENCE SHOULD BE SCHEDULED, AND A CONSIDERATION OF THE NEED FOR PROTECTIVE PLACEMENT OF THE CHILD SHOULD BE UNDERTAKEN. BOTH PARENTS SHOULD BE FRANKLY INFORMED OF THE CAUSE OF THE ILLNESS AND SUGGESTED SOURCE OF DRUGS. A PSYCHIATRIC INVESTIGATION OF THE WHOLE FAMILY IS RECOMMENDED, AND IF VOLUNTARY SEPARATION FROM THE CHILD IS NOT ACCEPTED BY THE PARENTS, A PLACEMENT ORDER SHOULD BE EFFECTED UNTIL SUCH A TIME WHEN IT IS MOST PROBABLE THAT FURTHER POISONING EPISODES WILL NOT OCCUR. FOLLOWING COURT HEARING OR FURTHER CASE CONFERENCE, LONG TERM MANAGEMENT DECISIONS MAY BE MADE. POSSIBLE PSYCHIATRIC BASES FOR NONACCIDENTAL CHILD POISONING MAY INCLUDE THE PROJECTION OF PARENTAL PROBLEMS ONTO THE CHILD AS A MEANS OF ESCAPING FROM THEM, AND OVER-INVOLVEMENT BETWEEN PARENT AND CHILD WITH SUBSEQUENT FAILURE TO EMOTIONALLY DIFFERENTIATE BETWEEN THE SELF AND THE CHILD. PARENTAL DENIAL OF THE POISONING IS FREQUENT, BUT TREATMENT WILL REQUIRE PARENTAL ACCEPTANCE OF RESPONSIBILITY BEFORE DYSFUNCTIONAL CHILD/PARENT RELATIONSHIPS OR PARENTAL DYSFUNCTIONS CAN BE TREATED. REFERENCES ARE PROVIDED. (JAP)
Index Term(s): Case studies; Child abuse; Emotional disorders; Family counseling; Home environment; Poisons and poison analysis; Psychiatric services; Psychological evaluation; Toxic reactions
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http://www.ncjrs.gov/App/publications/abstract.aspx?ID=48226

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