Child abuse reports spiked during COVID-19 lockdowns, study finds

The rate of children who presented to nine pediatric trauma centers for nonaccidental trauma more than doubled while COVID-19 stay-at-home orders were in place last year, according to a study.

The finding was reported at the AAP National Conference & Exhibition by Katherine T. Flynn-O'Brien, MD, MPH, a pediatric surgeon at Children’s Wisconsin hospital in Milwaukee, and colleagues.

In an interview with Healio, Flynn-O’Brien said she saw changes in the “kind of injuries” children had beginning in April 2020.

“Way back at the beginning of the pandemic, I just empirically felt as a provider in the hospital that we were seeing a very distinct change in the type of pediatric injuries we were seeing, particularly in the relative proportions of pediatric injury, between unintentional and intentional,” Flynn-O’Brien said. “And so, it really felt like it warranted investigation.”

Flynn-O’Brien and colleagues included 39,331 pediatric trauma patients from nine Level 1 pediatric trauma centers in the Midwest, including 2,064 who met the criteria for nonaccidental traumatic injuries as defined by the National Trauma Data Bank.

They compared the rate of nonaccidental trauma during stay-at-home orders through September 2020 with a control period of March through September in the years 2016 to 2019.

“We wanted to look at, obviously, the pandemic experience in 2020, and we compared it to a merged cohort, which we call the historical average between 2016 and 2019,” Flynn-O’Brien said. “The desire there was to look at a merged historical cohort rather than just a single year so that we were able to account for any single glimpse or abnormalities pertaining to one year alone. We did a sensitivity analysis comparing 2020 to 2019, alone, to account for temporal variation that may have occurred with things like referral patterns, consolidation of trauma care.”

In the weeks immediately following the implementation of stay-at-home orders, O’Brien said, the numbers went down.

“Interestingly, initially, they went down, and then about 2 months in after the stay-at-home orders were initiated, we saw a big spike in the reported child abuse cases through the trauma registries,” Flynn-O’Brien said.

There was a significant increase in the proportion of patients aged older than 5 years who presented with nonaccidental trauma during the COVID-19 period (30.8%) compared with the control years (13.5%), the researchers reported.

They said that for school aged children at home during the pandemic, increased reports of nonaccidental trauma “may reflect the absence of normal safeguards provided by the educational system, potentially leaving a vulnerable population at risk.”

“We felt like even during a national crisis like the pandemic, systemic safeguards and typical social services for families are really critical, particularly for those who are less resourced and most vulnerable,” Flynn-O’Brien said.

She said they hypothesized that people who needed access to social services may not have had it during the pandemic.

“Could that have played a role here? I don't think we'll ever know that for sure. These data are far too limited to draw any definitive conclusion about that,” Flynn-O’Brien said. “Going forward in terms of resource allocation and injury prevention, we really have to focus and make sure that there's attention to this.”

References:

• COVID-19 stay at home orders brought uptick in child abuse. https://www.eurekalert.org/news-releases/930167?. Published Oct. 8, 2021. Accessed Oct. 8, 2021.