Emergency Visits and Hospitalizations for Child Abuse During the COVID-19 Pandemic

Kaiser, Sunitha V.; Kornblith, Aaron E.; Richardson, Troy; Pantell, Matthew S.; Fleegler, Eric W.; Fritz, Cristin Q.; Parikh, Kavita; Zagel, Alicia; Sills, Marion R.; Souza, Heidi Gruhler De; Goyal, Monika K.; Hogan, Alexander H.; Heller, Kayla; DeLaroche, Amy M.; Cooper, Jennifer N.; Puls, Henry T.

doi:10.1542/peds.2020-038489

Cited by 56 publications

(70 citation statements)

References 5 publications

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“…For example, among children presenting to children's hospitals with billing codes for physical abuse, number of injuries, mortality, and a hospital utilization metric for severity of presentation were similar during and before COVID-19. 15 Specific assessment of a severe form of child abuse, abusive head trauma, also demonstrated decreased presentations without significant increases in several markers of clinical severity (eg, ventilator use). 17 Our results align with these administrative data.…”

Section: Discussionmentioning

confidence: 99%

Child Abuse Imaging and Findings in the Time of COVID-19

Henry¹,

Wood²,

Bennett³

et al. 2022

Pediatr Emer Care

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Objective To assess the impact of the COVID-19 pandemic on physical abuse in young children, we compared the following before and during the pandemic: (1) skeletal survey volume, (2) percent of skeletal surveys revealing clinically unsuspected (occult) fractures, and (3) clinical severity of presentation. We hypothesized that during the pandemic, children with minor abusive injuries would be less likely to present for care, but severely injured children would present at a comparable rate to prepandemic times. We expected that during the pandemic, the volume of skeletal surveys would decrease but the percentage revealing occult fractures would increase and that injury severity would increase. Methods We conducted a retrospective study of children younger than 2 years undergoing skeletal surveys because of concern for physical abuse at a tertiary children's hospital. Subjects were identified by querying a radiology database during the March 15, 2019–October 15, 2019 (pre–COVID-19) period and the March 15, 2020–October 15, 2020 (COVID-19) period, followed by chart review to refine our population and abstract clinical and imaging data. Results Pre–COVID-19, 160 skeletal surveys were performed meeting the inclusion criteria, compared with 125 during COVID-19, representing a 22% decrease. No change was observed in identification of occult fractures (6.9% pre-COVID vs 6.4% COVID, P = 0.87). Clinical severity of presentation did not change, and child protective services involvement/referral decreased during COVID. Conclusions Despite a >20% decrease in skeletal survey performance early in the pandemic, the percent of skeletal surveys revealing occult fractures did not increase. Our results suggest that decreases in medical evaluations for abuse did not stem from decreased presentation of less severely injured children.

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Section: Discussionmentioning

confidence: 99%

Child Abuse Imaging and Findings in the Time of COVID-19

Henry¹,

Wood²,

Bennett³

et al. 2022

Pediatr Emer Care

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“…While there is concern for under detection of child maltreatment cases ( Baron et al, 2020 ; Humphreys et al, 2020 ; Rapoport et al, 2021 ), data is mixed regarding the incidence of presentations and hospitalizations for child abuse. Some studies reported more severe cases of abusive injuries ( Sidpra et al, 2020 ) and/or increased hospitalizations ( Swedo et al, 2020 ), while others demonstrated decreases in hospitalizations for abusive head trauma ( Maassel et al, 2021 ) and in hospital encounters for physical abuse ( Kaiser et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

In their own words: Child and adolescent perceptions of caregiver stress during early COVID-19

Ortiz

Kishton

et al. 2022

Child Abuse & Neglect

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Background The coronavirus disease 2019 (COVID-19) pandemic has exacerbated multiple stressors for caregivers of children in the United States, raising concern for increased family conflict, harsh parenting, and child maltreatment. Little is known regarding children's perceptions and experiences of caregiver stress during the COVID-19 pandemic. Objective To examine how children and adolescents identify and experience caregiver stress during the early COVID-19 pandemic. Methods We analyzed 105 de-identified helpline text and online chat transcripts from children under age 18 who submitted inquiries to the Childhelp National Child Abuse Hotline from March to June of 2020, with COVID-19 as a presenting issue. Inductive, thematic analysis was used to identify how child helpline users: 1) perceived and experienced drivers of caregiver stress and 2) used words to describe manifestations of caregiver stress during the COVID-19 pandemic. Results Children experienced multiple drivers of caregiver stress during COVID-19, including intrapersonal (e.g. caregiver health concerns), interpersonal (e.g. parental discord, perceived dislike of child), and extrapersonal (e.g. financial insecurity, sheltering in place) stressors. Regardless of the driver, caregivers' stress was internalized by children. “Anger,” “control,” and “blame” were most commonly used to label manifestations of caregiver stress, which were often externalizing behaviors, including yelling, name calling, and blaming of others. Conclusion In text and online chat inquiries to a national child helpline during the COVID-19 pandemic, children described multiple drivers of caregiver stress, often feeling as though they were to blame. Providers serving children should address household stress spillover effects by including caregivers and directly acknowledging children's concerns using their own words.

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“… 7 , 8 Additionally, some early studies found increases in child abuse during COVID-19, while others noted a decrease in the number of NAT cases seen compared to previous years. 9 , 10 , 11 , 12 , 13 , 14 …”

Section: Introductionmentioning

confidence: 99%