Johnson, Katie L.

AbstractBackgroundRecognizable skin findings of child physical abuse include bruises, abrasions, lacerations, bite marks, burns, and oral injuries. Self‐induced skin picking, or neurotic excoriation, can correspond to emotional stress, underlying psychiatric illness, or substance abuse. Parental neurotic excoriation injury of children has not been reported previously as a form of physical abuse.MethodsWe present a case series of five children abused via parental excoriation. All affected children were three years of age or younger and otherwise healthy. Each child presented with wounds determined to be consistent with chronic picking. Patient age, injury location, and in some cases, witness accounts confirmed the lesions were not self‐inflicted.ResultsIn three cases, caregivers reported methamphetamine use. In these cases, caregivers repeatedly picked or wiped the infants’ skin. In two cases, the caregiver demonstrated personal neurotic excoriation behavior, which was imposed upon her children resulting in similar lesions. One affected child died at 14 days of age from abusive head trauma, while the other four children were placed in foster care by Child Protective Services.ConclusionExcoriation injury places children at risk for significant scarring and other long‐term effects. We report examples demonstrating that repetitive skin injury by caregivers is a diagnostic consideration for abuse in young children.

Abstract Background Adverse childhood experiences ( ACE s) are associated with adult high‐risk behaviors and diseases. There is value in screening parents for ACE s given the repercussions parental ACE s may have on parenting behaviors and child development. The primary aim of this study was to assess the feasibility of parental ACE screening in the home setting. A secondary aim was to evaluate whether or not maternal ACE s correlated with maternal mental health measures. Methods Two home visiting programs that support early childhood development and conduct parental mental health screening implemented ACE screening for parents of infants <1 year of age. Descriptive statistics were produced for population surveillance of ACE s as well as standard practice screens for depression, anxiety, substance use, and intimate partner violence. Logistic models were used to examine associations between ACE score and mental health measures. Results A total of 110 parents completed the ACE screen. All possible ACE score outcomes were represented (0–10). A trend toward association of positive prenatal maternal depression screen with ACE score was identified ( p = .05). Conclusion This novel prospective home‐based screening program for parental ACE s was feasible and identified a trend toward increasing ACE score association with positive prenatal maternal depression screen.