|
Abstract
|
Maassel and colleagues1 examine trends in abusive head trauma in the 2 years following the first COVID-19-related shutdowns. Relying on a database of admissions for AHT at 49 children's hospitals across the US from January 2016 through April 2022, the authors report that COVID-19-related shutdowns in the spring of 2020 were associated with a 25% reduction in the incidence of hospitalizations for AHT among children younger than 5 years. Analysis of trends following the first 2 years of the COVID-19 pandemic, however, uncovers a steady rise in AHT incidence back toward prepandemic levels among infants, who account for 75% of all AHT cases. If replicated by future research, these results suggest that pandemic-related policies served as an unplanned child abuse prevention program with a rate of success far above that described for any established child abuse prevention efforts.
In the first months of the COVID-19 pandemic, many experts anticipated a shadow pandemic of family violence. There was national and international coverage of unprecedented levels of intimate partner violence between domestic partners trapped at home under lockdown.2 These reports drew on the fear of violence exacerbated by economic stressors and social isolation and were supported by anecdotal reports of spikes in calls to domestic violence crisis lines. A parallel deluge of child maltreatment seemed inevitable in the face of unparalleled family stressors, including widespread unemployment, housing insecurity, school closures, and social isolation. Child welfare agencies and health care professionals prepared for the anticipated influx of referrals for child abuse and neglect. Conflicting reports of the numbers of calls to child abuse hotlines in the months following pandemic-associated closures increased concern for the invisible threat to children locked down at home without access to mandated reporters.3,4
Contrary to expert predictions, however, evidence demonstrated that the pandemic-related stay-at-home and safer-at-home mandates were associated with an unprecedented decline in rates of referrals to child welfare. After decades of steadily rising, rates of child welfare referral rates dropped 10% from 2019 to 2020 with these reductions occurring almost exclusively in the postlockdown era beginning in late March 2020. This decline in child welfare referrals was widely attributed to decreased exposure of maltreated children to mandated reporters, particularly teachers. Historically, educational professionals have been the largest source of reports to child welfare. With the closure of daycares and schools, many experts remained concerned that cases of abuse were going unrecognized and untreated behind closed doors.4
Throughout these shutdowns, pediatricians and other health care professionals continued to diagnose and care for a steady stream of children with injuries due to abuse or neglect. Diagnoses by medical professionals of severe abuse were considered a more reliable indicator of trends in the incidence of child maltreatment since these cases could not be hidden in homes due to the urgent need for medical care. Early reports described an uptick in AHT and other forms of serious physical abuse, fueling fears that these cases were canaries in the pandemic coal mine.5-7 Subsequent research, however, has largely identified either no change or a reduction in the incidence of--if not the severity of--physical abuse diagnosed in hospital settings.8-13 While a complete understanding of the patterns and severity of child abuse over the course of the COVID-19 pandemic will continue to evolve in the coming years, evidence for the anticipated shadow pandemic of child abuse, including AHT, has not emerged.
At first glance, these findings are surprising. The initial reports of increases in family violence aligned with trends in child abuse during past regional and national crises. In the Great Recession of the late 2000s, Pennsylvania, Ohio, and Washington experienced rates of AHT 1.3 to 2.4 times higher than in preceding years.14 Housing insecurity seemed to drive this phenomenon, with a 4.5% increase in serious maltreatment for each percentage point increase in the foreclosure rate.15 Natural disasters resulting in sustained periods of social and economic disruption have also been associated with increased rates of child maltreatment. After Hurricane Katrina (2005, Louisiana), AHT rates increased 5-fold compared with pre-Katrina rates.16 Reports of child abuse rose by over 20 per 100 000 children in the 6 months following Hurricane Hugo (1989, South Carolina) and after the Loma Prieta earthquake (1989, California). ...
Language: en |