description The mission of foster care is to provide for the health, safety, and well-being of children while assisting their
families with services to promote reunification. Children entering foster care have frequently experienced early childhood trauma.
More than 70% have a history of abuse, neglect, or both. Only about 50% of children achieve reunification. In the USA, the
Adoption and Safe Families Act (P.L. 105-89) passed in 1997 requires that a permanency plan be made for eachchild no
later than 12 mo after entry to foster careandthatapetition to terminateparental rights typicallymust be filed when a child has
been in foster care for at least 15 of the previous 22 mo. (See Chapter 35, page 134, and e35-1.)
2. A 4 yr old girl is admitted to the hospital for her third evaluation for vaginal bleeding. The
mother noted bright red blood on the child's underwear. Previous examinations revealed a
normal 4 yr old girl, Tanner stage 1, with normal external genitalia. Pelvic ultrasound results were
normal, as was the serum estradiol level. The hemoglobin and platelet counts were normal, as
were the bleeding time and coagulation studies. Findings on pelvic examination conducted
under anesthesia also were normal. The next step in the examination is to:
■ Determine the blood type of the blood on the underwear
□Interrogate the father
□Isolate the parents and child
□Determine von Willebrand factor levels
, □Measure fibronectin in thevagina
description Consideration of factitious disorder by proxy should be triggered when the reported symptoms are repeatedly
notedbyonlyoneparent,appropriatetesting failstoconfirmadiagnosis,andseeminglyappropriatetreatmentis ineffective.
Attimes,thechild'ssymptoms,theircourse, ortheresponseto treatmentmaybeincompatiblewith anyrecognizeddisease.
Preverbalchildrenareusuallyinvolved.Bleedingisaparticularlycommonpresentation.Thismaybecausedbyaddingdyes to
samples, adding blood (e.g., from the mother) to the child's sample, or giving the child an anticoagulant (e.g., warfarin). (See
Chapter 37, page 146.)
3. Munchausen syndrome by proxy is characterized by all of the following EXCEPT:
□Mother who appears devoted and wins over members of care team
□Multiple hospitalizations and investigations without diagnosis
□Symptomsonhistorybutnotwitnessedbymedicalteam
■ Symptomsoccurring in presence ofdifferent caregivers (e.g., while motherisout of town)
□Use of medications or toxins
description Symptoms in young children are mostly associated with proximity of the offending caregiver to the child. The
mother may present as a devoted or even model parent who forms close relationships with members of the health care
team. While appearing very interested in her child's condition, she may be relatively distant emotionally. (See Chapter 37, page
146.)
4. Which statement is false?
■ Malnutrition is the second leading cause of acquired immune deficiency worldwide behind HIV infection
□Zinc is important in immune function and linear growth
□Kwashiorkor and marasmus are rare in developed countries
□The Western diet is associated with increased noncommunicable disease
descriptionThesignificantglobalburdenofmalnutritionandundernutritionistheleadingworldwidecauseofacquired
immunodeficiencyandthemajorunderlyingfactorformorbidityandmortalitygloballyforchildren <5 yr ofage. Zincisa
micronutrientthatsupportsmultiplemetabolicfunctionsinthebody,isessentialfornormalimmunefunctioning,andis required
tosupportlineargrowth;zincdeficiencyisassociatedwithimpairedimmunefunctioningandpoorlineargrowth.In parallelto
theriskfornutrientandenergydeficiencies,issuesrelatingto excessesposeimportantchallengesbecauseoftheir negative
healtheffects, such as obesity or cardiovascular disease risk factors. The nutrition transition under way in the
, developing world from traditional diets to the Western diet has been associated with increases in noncommunicable diseases,
often coexisting with undernutrition and malnutrition, observed sometimes in the same communities or even the same families.
(See e41-1.)
5. Components of energy expenditure in children include:
□Thermal effect offood
□Basal metabolic rate
□Energy for physical activity
□Energy to support growth
■ All of the above
description The 3 components of energy expenditure in adults are the basal metabolic rate, the thermal effect of food
(energy required for digestion and absorption), and energy for physical activity. Additional energy intake and expenditure are
required to support growth and development for children. (See e41-4.)
6. Which of the following clinical scenarios increases the risk of vitamin A deficiency?
□Vegetarian diet
□Chronic intestinal disorders
□Zinc deficiency
■ B and C
□All of the above
description Vitamin A is an essential micronutrient because it cannot be biogenerated de novo by animals. It must be
obtained from plants in the form of provitamin-A carotenoids. In the USA, grains and vegetables supply approximately 55%
and dairy and meat products supply approximately 30% of vitamin A intake from food. Vitamin A and the provitamins-A
arefatsoluble, andtheirabsorptiondepends onthepresenceof adequatelipidandproteinwithinthemeal.
Chronic intestinal disorders or lipid malabsorption syndromes can result in vitamin A deficiency. In developing countries,
subclinical orclinical zincdeficiencycanincreasetherisk ofvitamin Adeficiency. Thereis also someevidenceof marginal zinc
intakes in children in the USA. (See Chapter 45, page 188.)
7. Which statement about vitamin A toxicity is NOT true?
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