Lang Cathleen A, Cox Matthew J, Flores Glenn
Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA; Children's Medical Center Dallas, 1935 Medical District Dr., Dallas, TX 75235, USA.
Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA; Children's Medical Center Dallas, 1935 Medical District Dr., Dallas, TX 75235, USA; Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA.
Child Abuse Negl. 2013 Dec;37(12):1109-13. doi: 10.1016/j.chiabu.2013.03.002. Epub 2013 Apr 24.
The rate of multiple births has increased over the last two decades. In 1982, an increased frequency of injuries among this patient population was noted, but few studies have evaluated the increased incidence of maltreatment in twins. The study aim was to evaluate the features of all multiple-birth children with substantiated physical abuse and/or neglect over a four-year period at a major children's hospital.
A Retrospective chart review was conducted of multiple-gestation children in which at least one child in the multiple set experienced child maltreatment from January 2006 to December 2009. Data regarding the child, injuries, family, and perpetrators were abstracted. We evaluated whether family and child characteristics were associated with maltreatment, and whether types of injuries were similar within multiple sets. For comparison, data from the same time period for single-birth maltreated children also were abstracted, including child age, gestational age at birth, and injury type.
There were 19 sets of multiple births in which at least one child had abusive injuries and/or neglect. In 10 of 19 sets (53%), all multiples were found to have a form of maltreatment, and all children in these multiple sets shared at least one injury type. Parents lived together in 63% of cases. Fathers and mothers were the alleged perpetrator in 42% of the cases. Multiple-gestation-birth maltreated children were significantly more likely than single-birth maltreated children to have abdominal trauma (13% vs. 1%, respectively; p<.01), fractures (83% vs. 39%; p<.01), and to be injured at a younger mean age (12.8 months vs. 34.8 months; p<.01).
Siblings of maltreated, multiple-gestation children often, but not always, were abused. In sets with two maltreated children, children usually shared the same modes of maltreatment. Multiples are significantly more likely than singletons to be younger and experience fractures and abdominal trauma. The findings support the current standard practice of evaluating all children in a multiple set when one is found to be abused or neglected.
在过去二十年中，多胞胎出生率有所上升。1982年，人们注意到这类患者群体中受伤频率增加，但很少有研究评估双胞胎中虐待发生率的上升情况。本研究的目的是评估一家大型儿童医院在四年期间所有被证实遭受身体虐待和/或忽视的多胞胎儿童的特征。
对2006年1月至2009年12月期间多胎妊娠儿童进行回顾性病历审查，其中多胎组中至少有一名儿童遭受虐待。提取有关儿童、伤害、家庭和施暴者的数据。我们评估了家庭和儿童特征是否与虐待有关，以及多胎组内伤害类型是否相似。为了进行比较，还提取了同一时期单胎受虐儿童的数据，包括儿童年龄、出生时的孕周和伤害类型。
有19组多胞胎，其中至少有一名儿童遭受虐待性伤害和/或忽视。在19组中的10组（53%）中，发现所有多胞胎都遭受了某种形式的虐待，并且这些多胎组中的所有儿童至少有一种共同的伤害类型。父母同住的情况占63%。在42%的案例中，父亲和母亲被指控为施暴者。多胎妊娠受虐儿童比单胎受虐儿童更有可能遭受腹部创伤（分别为13%和1%；p<0.01）、骨折（83%和39%；p<0.01），且平均受伤年龄更小（12.8个月和34.8个月；p<0.01）。
多胎妊娠受虐儿童的兄弟姐妹经常（但并非总是）遭受虐待。在有两名受虐儿童的多胎组中，儿童通常遭受相同的虐待方式。多胞胎比单胞胎更有可能年龄更小，且遭受骨折和腹部创伤。这些发现支持了当前的标准做法，即当发现多胎组中的一名儿童受到虐待或忽视时，对该组中的所有儿童进行评估。
