Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK

Abstract

ObjectivesTo determine any change in referral patterns and outcomes in children (0–18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years.DesignRetrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown.SettingBirmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children.ParticipantsChildren aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018–2020.Main outcome measuresNumbers of referrals, source of disclosure and outcomes from CPME.ResultsThere were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns.ConclusionsSchool closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.

COVID-19 at the Deep End: A Qualitative Interview Study of Primary Care Staff Working in the Most Deprived Areas of England during the COVID-19 Pandemic

“…However, social prescribing link workers were praised for their work, telephoning vulnerable people and navigating their non-medical needs. Concerns around child safeguarding were not unfounded, with a significant reduction in the number of children referred for Child Protection Medical Examinations during the period of the first lockdown [21,22]. A recent report highlighting Child Welfare Inequality shows the unequal distribution of safeguarding interventions across the socioeconomic spectrum and the need for enhanced safeguarding support in deprived communities during and after the pandemic [23].…”

Impact of lockdown and school closure on children’s health and well-being during the first wave of COVID-19: a narrative review

“…36 Violence, abuse against children Routinely collected clinical data on Child Protection Medical Examinations (CPME) from Birmingham (UK) showed a significant drop of 39% (95% CI 14% to 57%) in CPME referrals during 2020 compared with previous years, mainly associated with decreased school staff referrals. 37 A study from the US found an increase in the Open access number of children with physical child abuse trauma, 38 and the Florida child abuse allegation data showed a decrease in 27% (n=15 000) in the number of allegations of child abuse and neglect comparing with the same 2 months of 2019 (table 5). 39…”

“…Outcome measures Five studies addressed mental health, [19][20][21][22][23] three studies analysed physical activity and obesity, 18 24 25 three studies examined diabetes mellitus, [26][27][28] eight studies approached changes in the access and use of healthcare services, [29][30][31][32][33][34][35][36] while three studies analysed data regarding child abuse and violence. [37][38][39] Mental health One Australian study showed a significant increase in depressive symptoms and anxiety and a significant decrease in life satisfaction during school closure and lockdown, mainly in girls (table 1). 19 A Spanish study gave evidence to a worse total difficulty score of the Strengths and Difficulties Questionnaire according to parent-proxy responses.…”

EAP and ECPCP Statement Risks for Children's Health During the COVID-19 Pandemic and a Call for Maintenance of Essential Pediatric Services

“…The data show an increase in the number of children exposed to violence and witnessing domestic violence during the pandemic. Whereas, limited school activities and reduced direct contact with primary healthcare may cause a decrease in child abuse victims' identification (39)(40)(41).…”