Kempe Foundation

Computed tomography (CT) is commonly used for children when there is concern for traumatic brain injury (TBI) and is a significant source of ionizing radiation. Our objective was to determine the feasibility and accuracy of fast MRI (motion-tolerant MRI sequences performed without sedation) in young children. In this prospective cohort study, we attempted fast MRI in children <6 years old who had head CT performed and were seen in the emergency department of a single, level 1 pediatric trauma center. Fast MRI sequences included 3T axial and sagittal T2 single-shot turbo spin echo, axial T1 turbo field echo, axial fluid-attenuated inversion recovery, axial gradient echo, and axial diffusion-weighted single-shot turbo spin echo planar imaging. Feasibility was assessed by completion rate and imaging time. Fast MRI accuracy was measured against CT findings of TBI, including skull fracture, intracranial hemorrhage, or parenchymal injury. Among 299 participants, fast MRI was available and attempted in 225 (75%) and completed in 223 (99%). Median imaging time was 59 seconds (interquartile range 52-78) for CT and 365 seconds (interquartile range 340-392) for fast MRI. TBI was identified by CT in 111 (50%) participants, including 81 skull fractures, 27 subdural hematomas, 24 subarachnoid hemorrhages, and 35 other injuries. Fast MRI identified TBI in 103 of these (sensitivity 92.8%; 95% confidence interval 86.3-96.8), missing 6 participants with isolated skull fractures and 2 with subarachnoid hemorrhage. Fast MRI is feasible and accurate relative to CT in clinically stable children with concern for TBI.

Coping strategies are believed to protect against the harmful effects of maltreatment on children's psychosocial outcomes. Caregivers are thought to be critical in helping children develop adaptive coping strategies, yet many maltreated children have poor and/or insecure relationships with their parents. A quality relationship with a caring, non-parental adult (e.g., a mentor), however, may be one strategy to promote healthy coping among maltreated children. Children (N=154) in this study participated in a mentoring and skill-based program for maltreated preadolescents placed in foster care. Hierarchical regression was used to assess the association between children's reports of their relationship with their mentor at the end of the intervention and four coping strategies (i.e., Active, Support-seeking, Avoidance, and Distraction) 6months following the intervention, while accounting for baseline coping strategies and other demographic factors. Above and beyond the covariates, better mentoring relationship quality was associated with children's greater use of Active and Distraction coping 6-month post-intervention. Mentoring relationship quality was not significantly associated with children's Avoidance or Support-seeking coping. The findings suggest that mentoring programs may be a fruitful approach to improving vulnerable children's coping skills. Healthy coping is hypothesized to protect against the harmful effects of maltreatment and to promote resilience in the face of multiple stressors (Banyard & Williams, ; Boxer & Sloan-Power, 2013; Cicchetti & Rogosch, 2009). It remains unclear, however, how best to promote positive coping among maltreated children, who are disproportionately exposed to numerous adverse childhood experiences (Raviv, Taussig, Culhane & Garrido, 2010). Theories of coping emphasize the importance of coping socialization through quality parent-child relationships (Kliewer etal., 2006; Skinner & Wellborn, ). Unfortunately, many maltreated children are exposed to poor quality and/or inadequate caregiving (Baer & Martinez, 2006), which may place them at risk for engaging in unhealthy or inappropriate forms of coping. It is reasonable to expect that positive relationships with other non-parental adults (e.g., mentors) would affect coping behaviors given the positive impact that quality relationships have on a myriad of emotional and behavioral child outcomes (DuBois, Portillo, Rhodes, Silverthorn & Valentine, 2011; Keller & Pryce, 2012; Thomson & Zand, ). Because children in foster care often transition in and out of schools and home environments, a quality relationship with a mentor (a consistent presence in the child's life) may be well suited to promote healthy coping strategies.