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BackgroundExposure to family violence during childhood and adolescence increases the risk for experiencing or perpetrating future violence. Social distancing protocols combined with reduction in access to youth/family services during the COVID-19 pandemic may have intensified the risk of exposure to familial violence.ObjectivesThis study describes the epidemiology of violence-related injuries to 10- to 15-year-old children from family violence, including child maltreatment and physical fighting, resulting in emergency department (ED) evaluation.MethodsThis retrospective cohort study located in an urban academic pediatric ED in the mid-Atlantic region is a review of electronic medical records between January 2019 and March 2020 (prepandemic period) and March to December 2020 (pandemic period). This review focused on visits for youth aged 10 to 15 years who presented for evaluation of an injury due to a violent event involving a family member. Demographic and clinical data were abstracted, including circumstances of the event. Descriptive statistics were used to summarize data and compare prepandemic to postpandemic proportions.ResultsOf 819 youth aged 10 to 15 years evaluated for a violence-related injury, 448 (54.7%) involved a family member. Of these, most involved parents/guardians, 343 (76.6%), and occurred at home (83.9%). Most patients were girls (54.0%), Black/African American (84.4%), and were enrolled in a public insurance plan (71.2%). Most youth were transported to the hospital by police (66.7%). Overall, alcohol, drugs, and weapons were involved in 10.0%, 6.5%, and 10.7% of events, respectively, and their involvement significantly increased during the pandemic period to 18.8%, 14.9%, and 23.8% (P < 0.001). Most patients (98.7%) were discharged from the ED.ConclusionsMore than half of violence-related injuries treated in the ED in this population resulted from family violence. Family violence is a prevalent and possibly underrecognized cause of injuries during adolescence. Further research should explore the potential of the ED as a setting for preventive interventions.

Objectives: Parents of children with medical complexity experience substantial financial burdens. It is unclear how NICU clinicians prepare new parents of medically complex infants for this reality. This study explored new parent awareness of healthcare costs, desire to discuss costs with clinicians, and impact of costs on parents’ medical decision-making. Study Design: Semistructured interviews and surveys of parents of infants with medical complexity currently or previously in a NICU. Conventional content analysis was performed on interview transcripts and descriptive analyses were applied to surveys. Results: Thematic saturation was reached with 27 families (15 NICU families, 12 Post-NICU families) of diverse race/ ethnicity/ education/ household income. Most were worried about their infants current/ future medical expenses and approximately half wanted to discuss finances with clinicians, only one parent had. While finances were not part of most parent’s NICU decision-making, some later regretted this and wished cost had been incorporated into treatment choices. Family desire to discuss costs did not vary by family financial status. Parents described their infant’s healthcare costs as: “We are drowning;” and “We’ll never pay it off.” Conclusion(s): Most parents worried about current and future medical expenses related to their infant’s evolving medical complexity. Many wanted to discuss costs with clinicians; almost none had. NICU clinicians should prepare families for future financial realities of pediatric medical complexity.