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Jonathan Tobin: Defending the Right to a Jewish State

Heather Hale: Compliment your kids without giving them big heads

Megan Shauri: 10 ways you are ruining your own happiness

Carolyn Bigda: 8 Best Dividend Stocks for 2015

Kiplinger's Personal Finance editors: 7 Things You Didn't Know About Paying Off Student Loans

Samantha Olson: The Crucial Mistake 55% Of Parents Are Making At Their Baby's Bedtime

Densie Well, Ph.D., R.D. Open your eyes to yellow vegetables

The Kosher Gourmet by Megan Gordon With its colorful cache of purples and oranges and reds, COLLARD GREEN SLAW is a marvelous mood booster --- not to mention just downright delish
April 18, 2014

Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology

Caroline B. Glick: The disappearance of US will

Megan Wallgren: 10 things I've learned from my teenagers

Lizette Borreli: Green Tea Boosts Brain Power, May Help Treat Dementia

John Ericson: Trying hard to be 'positive' but never succeeding? Blame Your Brain

The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious

April 14, 2014

Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time

Greg Crosby: Passing Over Religion

Eric Schulzke: First degree: How America really recovered from a murder epidemic

Georgia Lee: When love is not enough: Teaching your kids about the realities of adult relationships

Cameron Huddleston: Freebies for Your Lawn and Garden

Gordon Pape: How you can tell if your financial adviser is setting you up for potential ruin

Dana Dovey: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate

Justin Caba: Eating Watermelon Can Help Control High Blood Pressure

The Kosher Gourmet by Joshua E. London and Lou Marmon Don't dare pass over these Pesach picks for Manischewitz!

April 11, 2014

Rabbi Hillel Goldberg: Silence is much more than golden

Caroline B. Glick: Forgetting freedom at Passover

Susan Swann: How to value a child for who he is, not just what he does

Cameron Huddleston: 7 Financial Tasks You Should Tackle Right Now

Sandra Block and Lisa Gerstner: How to Profit From Your Passion

Susan Scutti: A Simple Blood Test Might Soon Diagnose Cancer

Chris Weller: Have A Slow Metabolism? Let Science Speed It Up For You

The Kosher Gourmet by Diane Rossen Worthington Whitefish Terrine: A French take on gefilte fish

April 9, 2014

Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?

Samuel G. Freedman: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Jessica Ivins: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau

Kim Giles: Asking for help is not weakness

Kathy Kristof and Barbara Hoch Marcus: 7 Great Growth Israeli Stocks

Matthew Mientka: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease

Sabrina Bachai: 5 At-Home Treatments For Headaches

The Kosher Gourmet by Daniel Neman Have yourself a matzo ball: The secrets bubby never told you and recipes she could have never imagined

April 8, 2014

Lori Nawyn: At Your Wit's End and Back: Finding Peace

Susan B. Garland and Rachel L. Sheedy: Strategies Married Couples Can Use to Boost Benefits

David Muhlbaum: Smart Tax Deductions Non-Itemizers Can Claim

Jill Weisenberger, M.S., R.D.N., C.D.E : Before You Lose Your Mental Edge

Dana Dovey: Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease

Chris Weller: Electric 'Thinking Cap' Puts Your Brain Power Into High Gear

The Kosher Gourmet by Marlene Parrish A gift of hazelnuts keeps giving --- for a variety of nutty recipes: Entree, side, soup, dessert

April 4, 2014

Rabbi David Gutterman: The Word for Nothing Means Everything

Charles Krauthammer: Kerry's folly, Chapter 3

Amy Peterson: A life of love: How to build lasting relationships with your children

John Ericson: Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet

John Ericson: Why 50 million Americans will still have spring allergies after taking meds

Cameron Huddleston: Best and Worst Buys of April 2014

Stacy Rapacon: Great Mutual Funds for Young Investors

Sarah Boesveld: Teacher keeps promise to mail thousands of former students letters written by their past selves

The Kosher Gourmet by Sharon Thompson Anyone can make a salad, you say. But can they make a great salad? (SECRETS, TESTED TECHNIQUES + 4 RECIPES, INCLUDING DRESSINGS)

April 2, 2014

Paul Greenberg: Death and joy in the spring

Dan Barry: Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?

Mayra Bitsko: Save me! An alien took over my child's personality

Frank Clayton: Get happy: 20 scientifically proven happiness activities

Susan Scutti: It's Genetic! Obesity and the 'Carb Breakdown' Gene

Lecia Bushak: Why Hand Sanitizer May Actually Harm Your Health

Stacy Rapacon: Great Funds You Can Own for $500 or Less

Cameron Huddleston: 7 Ways to Save on Home Decor

The Kosher Gourmet by Steve Petusevsky Exploring ingredients as edible-stuffed containers (TWO RECIPES + TIPS & TECHINQUES)

Jewish World Review Oct. 7, 2005 / 4 Tishrei, 5766

Healing Fractures, Broken Families: A Complication of an ‘Intrauterine Confinement Syndrome’

By Drs. Michael A. Glueck & Robert J. Cihak

The Medicine Men
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http://www.JewishWorldReview.com | Among the glories of modern medicine is an ever more accurate and subtle diagnostic capability. Many conditions and diseases are now treatable because we see them for what they are.

But sometimes we create a serious when we presume abnormal findings, such as fractures, to be the product of criminal assault.

Imagine you're a pediatrician. The parents of three of your patients bring in their youngest child, a 3-month-old baby boy. They tell you that after they changed his diaper, he wasn't moving his left leg normally. X-rays show an acute fracture of the leg, plus multiple healing fractures of the ribs and the bones about both knees. The radiologist says the healing fractures are about three weeks to three months old and that the pattern is consistent with (or even diagnostic of) child abuse.

The parents are devastated and deny mistreating the baby. The baby's previous visits to your office were routine. You hadn't seen any signs of trauma or identified any sign of the fractures the radiologist says were present the last two times you examined the baby. The parents' two older children are also your patients and haven't shown any sign of child abuse.

On your physical examination and on lab tests, you don't find any other evidence of injury, such as bruises or internal organ damage. No dietary deficiencies, no genetic abnormalities, no abnormal blood tests, no signs of any other problem or neglect. The social worker says the parents fit a low-risk profile for child abuse.

You can't find any medical reason why the bones are broken. You wonder how you could have missed so many fractures when the baby seemed normal to you at the times the radiologist said multiple fractures were already present. What do you do?

You might be required by law to report every patient the least bit suspicious for child abuse to government authorities. Your report could provoke drastic criminal justice interventions, such as forcibly taking the infant out of the home and jail time for the parents.

This has been happening to parents and other child caretakers ever since the "battered child syndrome" became a popular diagnosis over 40 years ago and the criminal legal system got in gear to prosecute the presumed-guilty parents. If doctors could not find a known disease or other cause for healing fractures or other injuries, the parents or others in contact with the child were automatically suspected of having injured the baby.

Doctors were making a purportedly medical diagnosis of intentional child abuse, based on flimsy X-ray film evidence. We radiologists forgot that we cannot see or diagnose human intent on our X-rays.

But in 1993, Dr. Colin R. Paterson, a Scottish physician at the University of Dundee, reported babies with a condition he called temporary brittle bone disease (TBBD). He saw and reported babies up to 1 year old with multiple unexplained bone fractures of different ages who didn't have a history of significant trauma, bruises or internal organ injuries.

On lab and X-ray tests, they also didn't have one of the rare diseases that cause weak bones. The parents denied injuring these babies; further, after the babies returned home and the fractures healed, they didn't show any signs of subsequent child abuse. Paterson's initial observations were not universally accepted, and were often derided or ignored.

Dr. Marvin Miller, Director of the Department of Medical Genetics and Professor of Pediatrics and Obstetrics at the Wright State University School of Medicine in Dayton, Ohio, reported his own personal observations and research at the 2005 annual meeting of the Association of American Physicians and Surgeons.

Dr. Miller confirmed the reality of temporary brittle bone disease, based on his personal experience with 65 babies with the condition. His involvement started eleven years ago when a mother asked Dr. Miller if there were other ways to diagnose brittle bones susceptible to easy fracture if the usual tests didn't make a diagnosis.

Because he knew that standard X-rays can diagnose lower bone density only after it's decreased by at least one-third, he used new and more sensitive techniques. He confirmed lowered bone density in these babies' bones, indicating that they were indeed weaker than normal. Both full-term and premature babies showed low bone density.

Dr. Miller outlined a plausible theory to account for the condition. In the full-term babies, about half the mothers had prior pregnancies; all these mothers reported that the baby was not as active in the womb as prior babies. He related this limited fetal movement to bone-strength factors identified by Dr. Harold Frost.

Dr. Frost showed that the development of bone strength and size depend on exercise and use. We consider this similar to development of muscle strength that also requires exercise for strength and development.

Put simply: Full-term babies with temporarily brittle bones didn't kick, wiggle and poke around enough while in the womb to develop strong bones. Uterine deformities or a twin cramped the full-term babies; they didn't have enough wiggle room.

The preemies didn't have enough "wiggle time" in the womb to develop normal bone strength. But preemies given daily physical therapy for a month have 75 percent higher bone density than preemies not given therapy, implying a comparable increase in bone strength. In addition, recent research shows that babies lay down 80 percent of bone calcium and density in the last trimester.

Because the bones of a baby with TBBD are weak, they break easily with normal handling, such as during diaper changing, fondling, hugging and medical exams. Fortunately, they do not seem to suffer a great deal of pain from most of these fractures. They also grow out of the condition after they're 6 to 12 months old. The cure seems to be supportive treatment and exercise.

We think of these healing bones as a sign of what might be called an "intrauterine confinement syndrome" in full-term babies; low levels of fetal movement should alert doctors and parents to the possibility that these babies need special care to stimulate normal bone strength and avoid fractures.

In preemies, easily broken bones should probably be expected to be part of the premature-birth condition. Based on these initial scientific findings, delicate handling and physical therapy should be considered.

Fortunately, more and more doctors are considering temporary brittle bone disease when they evaluate babies with multiple unexplained fractures and testify at legal hearings. This testimony often causes rejection of a child abuse verdict.

For these babies and their parents, common sense and scientific advances are starting to overcome the presumption of "guilty until proven innocent."

Related Article: New Scientific Evidence Refutes Existence of Shaken Baby Syndrome (https://www.jewishworldreview.com/1004/medicine.men1.asp)

Editor's Note: Robert J. Cihak wrote this week's column.

Every weekday JewishWorldReview.com publishes what many in in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here.

Michael Arnold Glueck, M.D., is a multiple award winning writer who comments on medical-legal issues. Robert J. Cihak, M.D., is a Discovery Institute Senior Fellow and a past president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists. Comment by clicking here.

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