Child maltreatment-related children's emergency department visits before and during the COVID-19 pandemic in Connecticut

COVID-19 and Caregiver Risk Factors for Child Maltreatment: The Pandemic in Review

The COVID-19 pandemic has fostered an environment for increased risk of child maltreatment (CM) as families experience increased psychosocial and financial burdens and spend unprecedented amounts of time together in the home. This narrative review aimed to summarize empirical findings on existing or new pandemic-related risk factors among caregivers. A combination of search terms related to CM and COVID-19 were used to identify articles published within five databases between February 2020 and July 2022. Literature searches produced 113 articles, of which 26 published across 12 countries met inclusion criteria. Four previously well-established risk factors for CM perpetration continued to persist during the pandemic, including stress, parental mental health, financial concerns, and parental substance use. Of note, inconsistent definitions and measures were used to capture these risk factors. Several additional emerging and understudied risk factors were also identified among limited articles, such as food insecurity and parental education. Findings emphasize the ongoing need for evidence-based interventions to address CM risk during the pandemic, including parent training programs. However, consolidated measures and consistent conceptualization of risk factors are needed to advance the study of CM. Going forward, practitioners and researchers should (a) strengthen the identification process for families at greatest risk for CM, and particularly those vulnerable to pandemic-related stressors; and (b) augment delivery of CM prevention strategies and evidence-based programs to fit the pandemic context.

Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic

Importance

Several studies have demonstrated a decrease in the occurrence of child abuse in the US since the start of the COVID-19 pandemic. This finding has generated concern for missed cases due to the initial lockdowns and lack of childcare resources. Determining the association of the pandemic on hospitalizations for severe forms of abuse is essential to focus preventive efforts.

Objective

To examine trends in abusive head trauma (AHT) before and during the COVID-19 pandemic.

Design, Setting, and Participants

Retrospective, multicenter, repeated cross-sectional study, conducted January 1, 2016, through April 30, 2022, with data from tertiary care children's hospitals and contributors to the Pediatric Health Information System. Data were obtained for 2380 hospitalizations of children younger than 5 years with International Classification of Diseases, Tenth Revision, Clinical Modification codes for both abuse and head trauma.

Main Outcomes and Measures

Monthly hospitalizations were analyzed using interrupted time-series analysis. Hospitalization severity (eg, intensive care unit stay) and clinical characteristics (subdural hemorrhages and retinal hemorrhages) were compared before and after the start of the pandemic.

Results

We identified 2380 hospitalizations due to AHT (median age, 140 [IQR, 75.0-325.5] days) from 45 hospitals. The mean (SD) monthly incidence of AHT was 34.3 (5.8) before the COVID-19 pandemic compared with 25.6 (4.2) during COVID-19 (a 25.4% decrease). When the pre-COVID-19 and during COVID-19 periods were compared, there were no significant differences in severity or clinical characteristics. On interrupted time-series analysis, there was a significant decrease in the number of monthly hospitalizations (-8.1; 95% CI, -12.41 to -3.72; P < .001) in the first month of the pandemic. In the subgroup of children younger than 1 year, there was a significant decrease in monthly hospitalizations at the onset of the pandemic (-8.2; 95% CI, -12.02 to -4.43; P < .001) followed by a significant temporal increase across the COVID-19 period (P = .01).

Conclusions and Relevance

The findings of this cross-sectional study suggest there was a significant decrease in monthly hospitalizations for AHT following the start of the pandemic in March 2020. Although there was no corresponding increase in hospitalization severity, the decrease during the pandemic may have been transient, as monthly hospitalizations for children younger than 1 year increased significantly over time during COVID-19, after the initial decrease.

The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters

OBJECTIVE

To assess the counts of infant maltreatment-related medical encounters at a large medical system during a 21-month span of the COVID-19 pandemic.

METHODS

Retrospective data for this study came from all inpatient and emergency department medical encounters for infants from January 1, 2016, through November 30, 2021, at a single children's hospital system in California. Distributions of medical encounters were tabulated and plotted over time. Interrupted time series models were used to evaluate changes in child maltreatment medical encounters.

RESULTS

Medical encounters for infants with child maltreatment diagnoses increased following the onset of COVID-19. Monthly counts of encounters with indicated maltreatment trended upward following the start of the pandemic. Interrupted time series models showed that the count of maltreatment encounters increased 64% with the onset of COVID-19.

CONCLUSIONS

We found an increase in infant maltreatment medical encounters during a 21-month period following the onset of COVID-19. These findings suggest that the pandemic may have adversely affected the safety of infants and ongoing work is needed to understand better the pandemic impacts on child maltreatment.

Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness

The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March-30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.

Hospitalization for child maltreatment and other types of injury during the COVID-19 pandemic

BACKGROUND

The possibility that child maltreatment was misclassified as unintentional injury during the COVID-19 pandemic has not been evaluated.

OBJECTIVE

We assessed if child maltreatment hospitalizations changed during the pandemic, and if the change was accompanied by an increase in unintentional injuries.

PARTICIPANTS AND SETTING

This study included children aged 0-4 years who were admitted for maltreatment or unintentional injuries between April 2006 and March 2021 in hospitals of Quebec, Canada.

METHODS

We used interrupted time series regression to estimate the effect of the pandemic on hospitalization rates for maltreatment, compared with unintentional transport accidents, falls, and mechanical force injuries. We assessed if the change in maltreatment hospitalization was accompanied by an increase in specific types of unintentional injury.

RESULTS

Hospitalizations for child maltreatment decreased from 16.3 per 100,000 (95 % CI 9.1-23.4) the year before the pandemic to 13.2 per 100,000 (95 % CI 6.7-19.7) during the first lockdown. Hospitalizations for most types of unintentional injury also decreased, but injuries due to falls involving another person increased from 9.0 to 16.5 per 100,000. Hospitalization rates for maltreatment and unintentional injury remained low during the second lockdown, but mechanical force injuries involving another person increased from 3.8 to 8.1 per 100,000.

CONCLUSIONS

Hospitalizations for child maltreatment may have been misclassified as unintentional injuries involving another person during the pandemic. Children admitted for these types of unintentional injuries may benefit from closer assessment to rule out maltreatment.

Child Maltreatment During the Pandemic

What happened with child abuse and neglect during the pandemic? Emergency department and child welfare data suggest a decline in reports; however other sources of data suggest that risk for abuse and neglect remained high during COVID-19. In this commentary, the authors highlight the complicated, and at times contradictory, evidence as to what occurred with child abuse and neglect during the pandemic. The commentary concludes with suggestions for future research.