Providing Care for Non-Accidental Pediatric Injuries

Author: 
Rosauro Dalope, MD, FAAP

Every year, 2.9 million incidences of child abuse are reported in the United States. More than 25 percent of maltreated children are under the age of 3. The Infant/Toddler Abuse Recovery Program at the Good Shepherd Rehabilitation Hospital Pediatric Unit is designed to treat infants and toddlers who have experienced non-accidental injuries (NAI) and who require inpatient care to address complex medical needs that resulted from physical abuse or trauma, shaken baby syndrome or medical neglect. The therapeutic program takes place in a secure, developmentally appropriate inpatient environment and is led by a pediatrician and a pediatric physiatrist. Services include:

  • Care by a multidisciplinary team of pediatric professionals, including: physicians, pediatric specialty nurses, pediatric dieticians, speech, physical, occupational and recreational therapists and behavioral counselor
  • Feeding therapy, when appropriate, with staff members who have advanced training and expertise in feeding techniques and strategies
  • Comprehensive medical care
  • Nutrition support from a dedicated pediatric dietician to optimize growth
  • Developmental facilitation working towards age appropriate developmental skills.
  • Interventions to improve autoregulation and sleep-wake cycles
  • Community reintegration to facilitate access to medical care, school services and social services

Case Study

Patient: Admitted to GSRH Pediatric Unit at 4 years old

Length of Stay: 34 days

The child was initially brought to the emergency department of a local hospital by Children and Youth Services (CYS) after reports of neglect. After a six-day admission in the acute-care hospital, the patient was transferred to the Good Shepherd Rehabilitation Hospital Pediatric Unit.

Upon admission, the patient was malnourished and weighed 20 pounds. His teeth were severely decayed. He was profoundly developmentally delayed. The patient engaged in repetitive movements, demonstrating an inability to play. He could only drink from a bottle and was fearful of people. The 4-year-old had never been out of a crib.

During his 34-day inpatient stay, the patient received occupational, physical, speech and recreational therapy. Slowly, he began making eye contact with the staff and started playing with toys. He began bearing weight through his legs and learned to pull himself up and stand in the crib. He learned a few simple gestures and allowed others to provide hand-over-hand assistance to learn sign language.

The pediatric care manager worked closely with CYS to locate a foster family for the patient. Once the family was identified, the foster parents visited the patient and received training from the team to support his growth and development.

Outcomes:

  • Gained almost 7 pounds and learned how to walk and play
  • Improved oral intake (eating pureed foods)
  • Improved communication skills (imitating words)
  • Able to make eye contact with all caregivers
  • Referred to outpatient therapy as well as Early Intervention services in a classroom setting (arranged through the Intermediate Unit)
  • Referred to a pediatrician and a dentist