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The cost of child abuse

When it comes to child abuse, Halifax pediatrician Dr. Brett Taylor says there is a lot of emotion and precious little logic, in our approach. Just over two children per 100 in Canada are investigated for signs of possible child abuse or neglect each year, according to the Canadian Incidence Study published in 2005. Taylor wonders why — as a country — we're not taking action to dramatically decrease the number of children hurt.

In the United States, a study in 2001 found that child abuse and maltreatment costs as much as $258 million per day. That includes direct costs such as hospitalization, chronic health problems, increased burden on child welfare systems and indirect costs such as juvenile delinquency and adult criminality.

What do you think shoud be done to decrease incidences of child abuse?

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Disease, risk and community

It is just before midnight. The ambulance is five minutes out, carrying a four-year-old with a known history of asthma who awoke with marked respiratory distress. The ambulance personnel have reported that the child is alert but breathing 50 to 60 times per minute, working hard, and that the O2Sat (the amount of oxygen in her blood stream) is abnormally low.

The charge nurse has cleared a bed and another nurse has been pre-assigned.

Sounds like a good opening for a TV show, right? Except that, like a TV show, it's a construct, a fabrication. There really isn't much of an emergency here.

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Diagnosing illness

Halifax paediatrician Brett Taylor says figuring out what ails is you can be an art. Imagine, he says, that you are an emergency paediatrician, seeing a six-year old child with a fever and a sore, red throat. What do you do?

Most of these children have viral illnesses, but about five per cent have strep throat; you might consider doing a throat swab to find out. Unfortunately, about 10 per cent of all children, including those with a viral infection, carry strep as a "colonizing bacteria". That is, the strep is causing no illness — but a throat swab will say the child has strep.

The combination of fever, sore throat and a positive throat swab means the odds are two to one against the child having strep throat. Now, experienced emergency docs don't swab every kid with a red throat.

They use their clinical skills to weed out those likely to be viral, and swab the rest. There are limits to how well they can do this

When you go to the doctor, are you looking for a confirmation of a diagnosis you have already made?

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