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Abstract
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In this month's Pediatrics, Schneiderman et al examine infant deaths for medical causes among infants previously reported to child protective services.1 Using probabilistically linked birth records, child protective service records, and death records, the authors examined risk of death through the first year of life. Their analyses controlled for sex, race and ethnicity, maternal age, early prenatal care, insurance status, birth weight, and prematurity. Infants reported for maltreatment had an almost twofold increase in risk of for any medical cause of death.
Are infants with serious medical conditions at higher risk for maltreatment or is maltreatment more likely to be detected among those with serious medical conditions? An increased risk for death would follow from prematurity, congenital abnormalities, or intrauterine exposure to infection.2 Children with these conditions likely require careful and more frequent medical encounters. Missed appointments and lack of follow-through on medications and treatment may be life-threatening. Medical teams caring for chronically ill infants are often sources of reports for neglect for infants whose caregivers fail to keep scheduled appointments, accept referrals, or take prescribed medications. Furthermore, the increased frequency of medical visits over the first year of life for ill children may also increase detection of sentinel injuries.3 Maltreatment may also be increased beyond failures in following medical care recommendations. Infants with chronic disease can contribute to financial and emotional stresses on their parents. Ill infants may be less capable of the responsiveness that helps create a strong bond between parent and child.4 Infants with chronic conditions may have high-pitched cries or disordered sleep patterns that add to parental stress. It therefore follows that infants with medical conditions are both at higher risk of maltreatment and more likely to be reported...
Language: en |