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Abstract
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For children, the collateral damage of the COVID-19 pandemic response has been considerable: 'nearly insurmountable' educational losses,1 deteriorating mental health,2 low routine childhood vaccination rates,3 39 billion missed school meals by January 20214 and millions of estimated life-years lost among students in the USA alone.5 It is difficult to deny the harmful impact of lockdowns on children, who are society's most vulnerable members. In this paper, we use the framework of evidence-based medicine to argue that child abuse is another negative side effect of COVID-19 lockdowns.
One of us serves as the American Academy of Pediatrics (AAP) Early Childhood Champion for the State of New Jersey, and we firmly stand by the AAP's initial goal of having every student physically present in school during the pandemic.6 Yet, the potential reduction of COVID-19 transmission has been cited as justification for lockdowns, an intensive package of non-pharmaceutical interventions which include the prolonged use of general population restrictions and school closures.7 While it was certain that school closures would have profound social and economic costs, it remains uncertain whether they have any effect on COVID-19 transmission.8 One such cost is the negative effects on the detection, reporting and prevention of child abuse. Meanwhile, Sweden, which notably did not close primary schools, has emerged from the pandemic with one of the lowest overall excess mortality rates in Western Europe and finds no evidence of learning loss.9 10
There is emerging evidence that lockdowns significantly worsened child abuse on a global scale. Low-income and middle-income countries are particularly vulnerable to increases in child abuse. In Uganda, for example, there was a 1565% increase in the average number of calls per day to the Uganda Child Helpline in the first month of lockdown.11 Yet, even wealthy nations in the West did not escape unscathed. In the UK, there was a 1493% increase in cases of abusive head trauma at Great Ormond Street Hospital.12 In France, there was an 89% increase in national child abuse helpline calls, a 48% increase in home visits by law enforcement officers and a 50% increase in the relative frequency of child abuse hospitalisations.13 14 Furthermore, there appears to have been insidious changes with potentially long-term effects which are more difficult to measure. In the Netherlands, for example, there was a 32% increase in previously rare harsh parenting behaviours, including shaking and name calling...
Language: en |