Pediatric Social Illness: Toward an Etiologic Classification

The significance of ecological stress factors for understanding the etiology and interrelationships among the pediatric social illnesses was explored in a case-control study of 560 children under 4 years of age. Cases of child abuse and neglect, failure to thrive, accidents, and poisonings were matched on age, socioeconomic status, and ethnic group with children who had comparably acute medical conditions. Data were ascertained from the children's medical records and from an extensive maternal interview which probed historical and contemporary familial, environmental, and child developmental realities. The findings support the basic hypothesis that the occurrence of pediatric social illness is associated with increased family stress. Child abuse is associated with more extreme stresses in all categories studied; failure to thrive with maternal historical stresses, perceived sickness of the index child, and contemporary social isolation; and accidents with contemporary household crises. An additive mode of pathogenesis of the more severe symptom manifestations is suggested by these data. Specific at-risk items were also noted. Although child abuse separated sharply from the other entities in a discriminant function regression analysis of the data, the insufficient predictive power of the principal discrimination features suggests that proposed programs to screen for risk of child abuse are of questionable accuracy and social utility.