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      Lyme Disease Misinterpreted as Child Abuse

      case-report

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          Abstract

          Child abuse is one of the most common causes for child fatality in the United States. Inaccurate reporting of child abuse combined with scarcity of resources for child abuse evaluations can lead to unintended consequences for children and their families. The differential diagnosis of child abuse is varied. To our knowledge, there are no reports in the literature on Lyme disease mimicking child abuse. The current study presents the case of a child from an endemic area for Lyme disease presenting with skin bruising, fracture, and swollen knee. The child was reported for child abuse by the pediatrician and then referred to the orthopaedic surgeon for fracture care.

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          Most cited references35

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          The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America.

          Evidence-based guidelines for the management of patients with Lyme disease, human granulocytic anaplasmosis (formerly known as human granulocytic ehrlichiosis), and babesiosis were prepared by an expert panel of the Infectious Diseases Society of America. These updated guidelines replace the previous treatment guidelines published in 2000 (Clin Infect Dis 2000; 31[Suppl 1]:1-14). The guidelines are intended for use by health care providers who care for patients who either have these infections or may be at risk for them. For each of these Ixodes tickborne infections, information is provided about prevention, epidemiology, clinical manifestations, diagnosis, and treatment. Tables list the doses and durations of antimicrobial therapy recommended for treatment and prevention of Lyme disease and provide a partial list of therapies to be avoided. A definition of post-Lyme disease syndrome is proposed.
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            The prevalence of confirmed maltreatment among US children, 2004 to 2011.

            Child maltreatment is a risk factor for poor health throughout the life course. Existing estimates of the proportion of the US population maltreated during childhood are based on retrospective self-reports. Records of officially confirmed maltreatment have been used to produce annual rather than cumulative counts of maltreated individuals. To estimate the proportion of US children with a report of maltreatment (abuse or neglect) that was indicated or substantiated by Child Protective Services (referred to as confirmed maltreatment) by 18 years of age. The National Child Abuse and Neglect Data System (NCANDS) Child File includes information on all US children with a confirmed report of maltreatment, totaling 5,689,900 children (2004-2011). We developed synthetic cohort life tables to estimate the cumulative prevalence of confirmed childhood maltreatment by 18 years of age. The cumulative prevalence of confirmed child maltreatment by race/ethnicity, sex, and year. At 2011 rates, 12.5% (95% CI, 12.5%-12.6%) of US children will experience a confirmed case of maltreatment by 18 years of age. Girls have a higher cumulative prevalence (13.0% [95% CI, 12.9%-13.0%]) than boys (12.0% [12.0%-12.1%]). Black (20.9% [95% CI, 20.8%-21.1%]), Native American (14.5% [14.2%-14.9%]), and Hispanic (13.0% [12.9%-13.1%]) children have higher prevalences than white (10.7% [10.6%-10.8%]) or Asian/Pacific Islander (3.8% [3.7%-3.8%]) children. The risk for maltreatment is highest in the first few years of life; 2.1% (95% CI, 2.1%-2.1%) of children have confirmed maltreatment by 1 year of age, and 5.8% (5.8%-5.9%), by 5 years of age. Estimates from 2011 were consistent with those from 2004 through 2010. Annual rates of confirmed child maltreatment dramatically understate the cumulative number of children confirmed to be maltreated during childhood. Our findings indicate that maltreatment will be confirmed for 1 in 8 US children by 18 years of age, far greater than the 1 in 100 children whose maltreatment is confirmed annually. For black children, the cumulative prevalence is 1 in 5; for Native American children, 1 in 7.
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              Overreporting and underreporting of child abuse: teachers' use of professional discretion.

              According to mandatory reporting laws for professionals, the relationship between initial recognition that a child may have been abused and the subsequent reporting of that suspected case of child abuse to the responsible agency would, at first glance, appear to be clear. However, this relationship has developed into one of the major social policy controversies of the recent past. Our major goal is to present research findings that address this social policy debate concerning the problems of underreporting and overreporting, focusing specifically on teachers. A factorial survey design, that combines the advantages of the factorial experiment with those of surveys, was employed in a probability sample of teachers (N=480) who responded to vignettes in which case characteristics were systematically manipulated. Teachers responded with judgments about whether the vignette was child abuse and the likelihood that they would report this suspected case. Characteristics of the teachers and their work setting (school) were also measured. When comparing the teachers' recognition and reporting scores, we found that they gave the same score for 63% of the vignettes they judged, gave higher reporting than recognition scores (overreporting) for 4% of the vignettes, and gave higher recognition than reporting scores (underreporting) for 33% of the vignettes. Discrepancies between recognition and reporting (over and under reporting) were related to characteristics of the case, teacher, and school where the teacher was employed. Teachers in our Ohio sample evidence the use of professional discretion in making judgments about the recognition and reporting of child abuse and do not appear to make these judgments with equal certainty. Their use of discretion is more likely to result in underreporting than overreporting.
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                Author and article information

                Contributors
                Journal
                Case Rep Orthop
                Case Rep Orthop
                CRIOR
                Case Reports in Orthopedics
                Hindawi
                2090-6749
                2090-6757
                2021
                1 February 2021
                : 2021
                : 6665935
                Affiliations
                1Penn State College of Medicine, Hershey, PA 17033, USA
                2Yale School of Medicine, New Haven, CT 06510, USA
                3UCLA College of Medicine, Los Angeles, CA 90095, USA
                4Penn State Hershey Medical Center, Bone and Joint Institute, Hershey, PA 17033, USA
                Author notes

                Academic Editor: Werner Kolb

                Author information
                https://orcid.org/0000-0002-6112-8206
                https://orcid.org/0000-0002-9724-7629
                https://orcid.org/0000-0002-3002-1764
                https://orcid.org/0000-0002-2754-6455
                Article
                10.1155/2021/6665935
                7880705
                51a080e2-76ed-45b4-8c3e-c45cc0df2ca0
                Copyright © 2021 Tommy Pan et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 November 2020
                : 23 January 2021
                : 27 January 2021
                Categories
                Case Report

                Orthopedics
                Orthopedics

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