Emergency room visits for child abuse in US may be down but injury severity has not decreased, finds CDC
Public health emergencies increase the risk for child abuse and neglect because of increased stressors and loss of financial and social supports, say experts. During the Covid-19 pandemic, the total number of emergency department visits related to child abuse and neglect decreased, but the percentage of such visits resulting in hospitalization increased, compared with 2019, suggesting that injury severity did not decrease during the pandemic, according to researchers.
According to experts, broad implementation of prevention strategies can reduce child abuse and neglect and help ensure that children and adolescents experience safe, stable, nurturing relationships and environments.
“Child abuse and neglect are preventable. Prevention opportunities include strengthening families’ economic supports, ensuring family-friendly work policies so that parents can continue to work while balancing childcare responsibilities, and modifying early home visitation practices to be virtual while social distancing measures are in effect,” recommend authors from the US Centers for Disease Control and Prevention (CDC).
The analysis
Heightened stress, school closures, loss of income and social isolation resulting from Covid-19 have worried child abuse experts, who fear that this could have increased the risk for child abuse and neglect. To understand this aspect, using National Syndromic Surveillance Program (NSSP) data from January 6, 2019, to September 6, 2020, the CDC tabulated weekly numbers of emergency department (ED) visits related to child abuse and neglect. They also looked at the percentage of suspected or confirmed ED visits related to child abuse and neglect ending in hospitalization, overall and stratified by age group: 0-4, 5-11 and 12-17 years.
The analysis reveals that the total number of ED visits related to child abuse and neglect began decreasing below the corresponding 2019 period during week 11 (March 15-March 22, 2020) for all age groups examined, coinciding with the declaration of a national emergency in the US on March 13. ED visits related to child abuse and neglect among children and adolescents aged less than 18 years reached their lowest point during week 13, that is, March 29 to April 4, 2020.
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“During the 4 weeks following this early pandemic nadir (March 29-April 25), the number of ED visits related to child abuse and neglect among children and adolescents aged below 18 years averaged 53% less than the number that occurred during the corresponding period in 2019 (March 31-April 27). The number of ED visits related to child abuse and neglect was lower during this period in 2020, compared with visits during the corresponding period in 2019 for every age group, with the largest proportional declines in the number of visits by children aged 5-11 years (61%),” the findings state.
Despite the drop in the total number of ED visits related to child abuse and neglect, the number of these ED visits resulting in hospitalization did not decline in 2020. As a result of the “consistent number of hospitalizations and the decrease in the number of overall ED visits,” the percentage of ED visits related to child abuse and neglect ending in hospitalization increased significantly among children and adolescents below 18 years, from 2.1% in 2019 to 3.2% in 2020.
The team observed considerable increases in the percentage of ED visits related to child abuse and neglect ending in hospitalization in children aged 0-4 years (3.5% in 2019 versus 5.3% in 2020) and 5-11 years (0.7% in 2019 versus 1.3% in 2020), and adolescents aged 12-17 years (1.6% in 2019 versus 2.2% in 2020.
“The Covid-19 pandemic and the social and economic effects of mitigation measures, such as loss of income, increased stress related to parental child care and schooling responsibilities, and increased substance use and mental health conditions among adults, increase the risk for child abuse and neglect. These pandemic-related risk factors might be tied to the observed increased proportions of ED visits related to child abuse and neglect,” explains the agency.
Based on their findings, the research team recommends continued surveillance of child abuse and neglect during the pandemic. They note that identification and support of alternative means to detect and report child abuse and neglect are needed during the pandemic. “Because of the numerous negative consequences of child abuse and neglect on children’s short-term and long-term physical and mental health, further research into the epidemiology of child abuse and neglect during the pandemic (such as risk factors and protective factors, types of abuse observed, types of injuries sustained, and reasons for hospitalization) is needed to better understand the pandemic’s effects on child abuse and neglect,” suggests the CDC.