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Wolf ER, Nguyen M, Sabo RT, Foster R, Avula D, Gilbert J, Freymiller C, Nelson BB, Krist AH. School Closure and Child Maltreatment During the COVID-19 Pandemic. CHILD MALTREATMENT 2024:10775595241252350. [PMID: 38733155 DOI: 10.1177/10775595241252350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
It is not known how school closure affected child maltreatment. We conducted a retrospective cohort, linear mixed-models study of 133 counties (comprising 8,582,479 children) in Virginia between 2018 and 2021. Exposure was the opening of schools at least 2 days a week. Outcomes were referrals and incidence of child maltreatment reported to the Department of Social Services. In 2020-2021, there were descriptively more referrals (in-person: 50.9 per 10,000 [95% CI: 47.9, 54.0]; virtual: 45.8 per 10,000 [95% CI: 40.7, 50.9]) and incidence (in-person: 3.7 per 10,000 [95% CI: 3.3, 4.2]; virtual: 2.9 per 10,000 [95% CI: 2.3, 3.5]) of child maltreatment in counties with in-person schooling, though these differences did not reach statistical significance. The referral rate variations (between pandemic and pre-pandemic eras) of counties with in-person schooling was significantly greater than rate changes in counties with virtual schooling during the summer period. There were no differences in incidence in any quarter. Higher poverty within a county was associated with both higher referrals and incidence. Our findings suggest that child maltreatment is driven primarily by underlying differences in counties (namely, poverty) rather than the type of schooling children receive.
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Affiliation(s)
- Elizabeth R Wolf
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
- Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - My Nguyen
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Roy T Sabo
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - Robin Foster
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
- Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Danny Avula
- Virginia Department of Social Services, Richmond, VA, USA
| | - Jennifer Gilbert
- Department of Family Medicine and Population Health,Virginia Commonwealth University, Richmond, VA, USA
| | - Casey Freymiller
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
- Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Bergen B Nelson
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
- Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Alex H Krist
- Department of Family Medicine and Population Health,Virginia Commonwealth University, Richmond, VA, USA
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Kim RC, Aggarwal P, Kuhia R, Sochan AJ, Zhao Z, Fiore S, Chesler D, Alcalá HE, Hsieh H. Pediatric Traumatic Brain Injury Outcomes and Disparities During the COVID-19 Pandemic. J Pediatr Surg 2024; 59:893-899. [PMID: 38388283 DOI: 10.1016/j.jpedsurg.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND To study the impact of the COVID-19 pandemic on traumatic brain injury (TBI) patient demographic, clinical and trauma related characteristics, and outcomes. METHODS Retrospective chart review was conducted on pediatric TBI patients admitted to a Level I Pediatric Trauma Center between January 2015 and June 2022. The pre-COVID era was defined as January 1, 2015, through March 12, 2020. The COVID-19 era was defined as March 13, 2020, through June 30, 2022. Bivariate analysis and logistic regression were performed. RESULTS Four hundred-thirty patients were treated for pediatric TBI in the pre-COVID-19 period, and 166 patients during COVID-19. In bivariate analyses, the racial/ethnic makeup, age, and sex varied significantly across the two time periods (p < 0.05). Unwitnessed TBI events increased during the COVID-19 era. Logistic regression analyses also demonstrated significantly increased odds of death, severe disability, or vegetative state during COVID-19 (AOR 7.23; 95 % CI 1.43, 36.41). CONCLUSION During the COVID-19 pandemic, patients admitted with pediatric TBI had significantly different demographics with regards to age, sex, and race/ethnicity when compared to patients prior to the pandemic. There was an increase in unwitnessed events. In the COVID period, patients had a higher odds ratio of severe morbidity and mortality despite adjustment for confounding factors. LEVEL OF EVIDENCE AND STUDY TYPE Level II, Prognosis.
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Affiliation(s)
- Rachel C Kim
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Priya Aggarwal
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Regina Kuhia
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Anthony J Sochan
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Zirun Zhao
- Department of Neurological Surgery, University of Washington, Seattle, WA 98195, USA
| | - Susan Fiore
- Department of Neurosurgery, Stony Brook Medicine, Stony Brook, NY 11794, USA
| | - David Chesler
- Department of Neurosurgery, Stony Brook Medicine, Stony Brook, NY 11794, USA
| | - Héctor E Alcalá
- Department of Behavioral and Community Health, University of Maryland, School of Public Health, College Park, MD 20742, USA; Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Helen Hsieh
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY 11794, USA.
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Honda C, Yamamoto-Takiguchi N. Association between obtaining injury prevention information and maternal and child health services during COVID-19. BMC Health Serv Res 2024; 24:275. [PMID: 38443936 PMCID: PMC10913221 DOI: 10.1186/s12913-024-10794-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 disrupted the delivery of public maternal and child health services to caregivers of preschool children, leading to decreased opportunities for injury prevention education. We aim to 1) explore the timing, content, and methods of providing injury prevention information desired by pregnant women and mothers and 2) identify mothers who experienced difficulty in obtaining injury prevention information owing to reduced maternal and child health services. METHODS From March 24 to 29, 2022, we conducted a population-based cross-sectional study and web-based survey. Of the registered monitors of the internet research company Rakuten Insight, 675 mothers raising their first child aged 0-2 during the COVID-19 period (February 2020 to March 2022) were included in the analysis. RESULTS Over half of the mothers wanted injury prevention information throughout their pregnancy. They preferred receiving information through traditional face-to-face services provided by local governments, such as antenatal classes or checkups. However, 34.1% of mothers said they did not obtain the information they needed; this was particularly true of unemployed mothers, had children aged 0-1, and had children with illnesses requiring hospital visits. CONCLUSIONS Mothers who could not obtain injury prevention information were originally disadvantaged mothers concerning access to information. The decrease in maternal and child health services may have widened this information gap. These findings can inform recommendations for caregivers, particularly those susceptible to information gaps during emergencies, and offer insights into future injury prevention education strategies.
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Affiliation(s)
- Chikako Honda
- Department of Community Health Nursing, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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Garner JB, Self-Brown S, Emery V, Wootten K, Tiwari A. COVID-19 and Caregiver Risk Factors for Child Maltreatment: The Pandemic in Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:613-629. [PMID: 36935570 PMCID: PMC10030880 DOI: 10.1177/15248380231158609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
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.
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Rebbe R, Reddy J, Kuelbs CL, Huang JS, Putnam-Hornstein E. The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters. J Pediatr 2023; 262:113582. [PMID: 37353150 PMCID: PMC10284615 DOI: 10.1016/j.jpeds.2023.113582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/30/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
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.
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Affiliation(s)
- Rebecca Rebbe
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC.
| | - Julia Reddy
- University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC
| | - Cynthia L Kuelbs
- Rady Children's Hospital, San Diego, CA; Department of Pediatrics, University of San Diego, La Jolla, CA
| | - Jeannie S Huang
- Rady Children's Hospital, San Diego, CA; Department of Pediatrics, University of San Diego, La Jolla, CA
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Ezeokoli EU, Pang LK, Loyd NG, Borici N, Bachim A, Vogel AM, Rosenfeld SB. Child traumatic physical abuse rates and comparisons during the COVID-19 pandemic: Retrospective paediatric single institution review in Texas. J Paediatr Child Health 2023; 59:1129-1134. [PMID: 37455617 DOI: 10.1111/jpc.16468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
AIM The COVID-19 pandemic drastically altered human behaviour and socialisation and may have created an environment that could lead to increased incidence of domestic abuse and non-accidental trauma, or child physical abuse (CPA). Initial reports about the effect of the COVID-19 pandemic on the rates of CPA have been mixed. The purpose of this study is to describe the effects of COVID-19 on rates of CPA in a large metropolitan paediatric hospital and level I paediatric trauma centre. METHODS We identified and compared all CPA admissions under 18 years from May 2019 to February 2020 and considered that to be the pre-COVID time frame. The ensuing 12-month period of March 2020 to February 2021 was considered to be the intra-COVID time frame. RESULTS There were 49 (0.32%) unique CPA patients pre-COVID and 83 (0.85%) unique CPA patients intra-COVID (P < 0.001) with lower total admissions for any reason during the intra-COVID time frame. Monthly CPA cases were increased (P < 0.03) during the intra-COVID time period (mean 6.9, 95% confidence interval: 5.8-12.7) compared to the pre-COVID time period (mean 4.9, 95% confidence interval: 3.3-8.2). CONCLUSION During the COVID-19 pandemic, there were decreased overall hospital admissions in the period of mandated shutdowns and isolation. However, we saw an increased rate of CPA admissions compared to the time period prior to the pandemic. Knowledge of such data, trends and circumstances will help keep health-care providers alert and vigilant in identifying children at risk for maltreatment, and may impact child abuse protocols and guidelines.
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Affiliation(s)
- Ekene U Ezeokoli
- Division of Pediatric Orthopedic Surgery, Texas Children's Hospital, Houston, Texas, United States
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
| | - Lon Kai Pang
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
| | - Nathaniel G Loyd
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
| | - Neritan Borici
- Division of Pediatric Orthopedic Surgery, Texas Children's Hospital, Houston, Texas, United States
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
| | - Angela Bachim
- Department of Pediatrics, Section of Public Health Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States
| | - Adam M Vogel
- Division of Pediatric Surgery, Department of Surgery Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, United States
| | - Scott B Rosenfeld
- Division of Pediatric Orthopedic Surgery, Texas Children's Hospital, Houston, Texas, United States
- Department of Orthopedic Surgery Baylor College of Medicine, Houston, Texas, United States
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Karami S, Asonye C, Pinnow E, Pratt V, McCulley L, Dwumfour N, Zhou EH. Trends in pediatric nonprescription analgesic/antipyretic exposures during the COVID-19 pandemic. Clin Toxicol (Phila) 2023; 61:190-199. [PMID: 36892525 DOI: 10.1080/15563650.2022.2158847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To examine pediatric exposure trends involving selected nonprescription analgesics/antipyretics, before and during the COVID-19 pandemic. METHODS Using descriptive and interrupted time-series analyses, we assessed monthly United States poison center data involving pediatric (<18 years) exposures to nonprescription paracetamol (acetaminophen), ibuprofen, acetylsalicylic acid, and naproxen before (January 2015-February 2020) and during (March 2020-April 2021) the pandemic. Statins and proton pump inhibitors (prescription or nonprescription) served as controls. RESULTS Most nonprescription analgesic/antipyretic exposures (75-90%) were single-substance; unintentional exposures typically involved children <6 years (84-92%), while intentional exposures involved females (82-85%) and adolescents, 13-17 years (91-93%). Unintentional exposures among children <6 years, declined for all four analgesics/antipyretics immediately after the World Health Organization declared COVID-19 a pandemic (March 11, 2020), but most significantly for ibuprofen (30-39%). Most intentional exposures were classified as suspected suicide. Intentional exposures were relatively low and stable among males. Intentional exposures in females declined immediately after the pandemic was announced but subsequently increased to pre-pandemic levels for acetylsalicylic acid and naproxen and above pre-pandemic levels for paracetamol and ibuprofen. For paracetamol, female intentional exposures increased from 513 average monthly cases in the pre-pandemic to 641 average monthly cases during the pandemic; and reached 888 cases by the end of the study period in April 2021. While for ibuprofen, average monthly cases rose from 194 in the pre-pandemic, to 223 during the pandemic; and reached 352 cases in April 2021. Patterns were similar among females 6-12 and 13-17 years. CONCLUSION Nonprescription analgesic/antipyretic unintentional exposure cases declined among young children, while intentional exposure cases increased among females, 6-17 years, during the pandemic. Findings highlight the importance of safely storing medications and being alert to signs that adolescents may be in need of mental health support services; caregivers should seek medical care or call poison control centers for any suspected poisoning event.
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Affiliation(s)
- Sara Karami
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Cooma Asonye
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Ellen Pinnow
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Valerie Pratt
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Lynda McCulley
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Nana Dwumfour
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Esther H Zhou
- Center for Drug Evaluation and Research (CDER), U.S. Food and Drug Administration (FDA), Silver Spring, MD, USA
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Bullinger LR, Boy A. Association of Expanded Child Tax Credit Payments With Child Abuse and Neglect Emergency Department Visits. JAMA Netw Open 2023; 6:e2255639. [PMID: 36795416 PMCID: PMC9936349 DOI: 10.1001/jamanetworkopen.2022.55639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE Poverty has long been associated with a higher risk for child maltreatment, and recent research suggests that income support policies are associated with reduced child abuse and neglect. However, income supports tied to employment cannot separate the associations of income from those of employment. OBJECTIVE To estimate the short-term association of universal and unconditional income payments to parents with child abuse and neglect. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, variation in the timing of the 2021 expanded child tax credit (CTC) advance payments was used to determine whether receiving unconditional income is associated with child abuse and neglect. A fixed-effects approach was used to compare child abuse and neglect before and after payments were made in 2021. The study compared 2021 trends with the same period in 2018 and 2019, during which no CTC payments were made. Participants were pediatric emergency department (ED) patients identified as experiencing child abuse or neglect at a level I pediatric hospital system in the Southeastern US from July through December 2021. Data were analyzed from July to August 2022. EXPOSURES Timing in the disbursement of the expanded CTC advance payments. MAIN OUTCOMES AND MEASURES Daily child abuse and neglect-related ED visits. RESULTS During the study period, there were 3169 ED visits related to child abuse or neglect. The 2021 advance payments of the expanded CTC were associated with fewer child abuse and neglect-related ED visits. There was a decrease in these ED visits in the 4 days following the advance CTC payments, although the reduction was not significant (point estimate, -0.22; 95% CI, -0.45 to 0.01; P = .06). There were significant reductions in such ED visits among male children (point estimate, -0.40; 95% CI, -0.75 to -0.06; P = .02) and non-Hispanic White children (point estimate, -0.69; 95% CI, -1.22 to -0.17; P = .01). These reductions did not persist, however. CONCLUSIONS AND RELEVANCE These findings suggest that federal income supports to parents are associated with immediate reductions in child abuse and neglect-related ED visits. These results are important for discussions of making the temporary expansion of the CTC permanent and are applicable to income support policies more broadly.
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Affiliation(s)
| | - Angela Boy
- Stephanie Blank Center for Safe and Healthy Children, Children’s Healthcare of Atlanta, Atlanta, Georgia
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Letourneau N, Luis MA, Kurbatfinski S, Ferrara HJ, Pohl C, Marabotti F, Hayden KA. COVID-19 and family violence: A rapid review of literature published up to 1 year after the pandemic declaration. EClinicalMedicine 2022; 53:101634. [PMID: 36119559 PMCID: PMC9472575 DOI: 10.1016/j.eclinm.2022.101634] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
Background After the World Health Organization declared COVID-19 a pandemic on March 11, 2020, public health restrictions were introduced to slow COVID-19 transmission and prevent health systems overload globally. Work-from-home requirements, online schooling, and social isolation measures required adaptations that may have exposed parents and children to family violence, including intimate partner violence and child abuse and neglect, especially in the early days of the pandemic. Thus, we sought to: (1) examine the occurrence of family violence; (2) identify factors associated with family violence; and (3) identify relevant recommendations, from COVID-19 literature published up to 1 year after the pandemic declaration. Methods This review was registered on PROSPERO (CRD42021241622), employed rapid review methods, and extracted data from eligible papers in medical and health databases published between December 1, 2019 and March 11, 2021 in MEDLINE, PsycINFO, CINAHL, and Embase. Findings 28 articles including 29 studies were included in the rapid review. While many studies of families/households revealed rises in family violence incidence, official justice, police, and emergency department records noted declines during the pandemic. Parental stress, burnout, mental distress (i.e. depression), difficulty managing COVID-19 measures, social isolation, and financial and occupational losses were related to increases in family violence. Health services should adopt approaches to prevent family violence, treat victims in the context of public health restrictions, and increase training for digital service usage by health and educational professionals. Interpretation Globally, restrictions aimed to limit the spread of COVID-19 may have increased the risk factors and incidence of family violence in communities. Official records of family violence may be biased toward under-reporting in the context of pandemics and should be interpreted with caution. Funding RESOLVE Alberta, Canada and the Emerging Leaders in the Americas Program (ELAP), Global Affairs Canada.
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Affiliation(s)
- Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute Owerko Centre, University of Alberta, AB, Canada
| | - Mayara Alves Luis
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Graduate Program in Public Health, Federal University of Espirito Santo, ES, Brazil
| | - Stefan Kurbatfinski
- Department of Community Health Sciences, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute Owerko Centre, University of Alberta, AB, Canada
| | - Hannah J. Ferrara
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute Owerko Centre, University of Alberta, AB, Canada
- Departments of Pediatrics and Psychiatry, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Carrie Pohl
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute Owerko Centre, University of Alberta, AB, Canada
- Departments of Pediatrics and Psychiatry, Cumming School of Medicine University of Calgary, Calgary, AB, Canada
| | - Franciele Marabotti
- Graduate Program in Public Health, Federal University of Espirito Santo, ES, Brazil
- Department of Nursing, Federal University of Espírito Santo, Vitória, Brazil
| | - K. Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Canada
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Hennocq Q, Adjed C, Chappuy H, Orliaguet G, Monteil C, Kebir CE, Picard A, Segna E, Beeker N, Khonsari RH. Injuries and child abuse increase during the pandemic over 12942 emergency admissions. Injury 2022; 53:3293-3296. [PMID: 36008172 PMCID: PMC9359596 DOI: 10.1016/j.injury.2022.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/10/2022] [Accepted: 08/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A strict lockdown was decided from 17/03/2020 to 11/05/2020 in France in order to tackle the first wave of the COVID19 pandemic. In the Great Paris region, several areas are severely affected by overcrowding, creating difficult conditions for children and their families during a period of nearly two months. The objective was to assess the effects of the 2020 spring lockdown on injuries, child abuse and neglect. MATERIAL AND METHODS The central medical data warehouse was screened for all pediatric admissions at emergency and critical care departments of 20 hospitals, in a cohort of 12942 children. Specific keywords were used to screen for both injuries and child abuse and neglect. RESULTS We found head and neck trauma (1.2% in 2020 vs. 0.7% in 2019, p<0.001), burns (0.6% in 2020 vs. 0.1% in 2019, p < 0.001), lacerations (0.5% in 2020 vs. 0.3% in 2019, p<0.001), fractures (0.5% in 2020 vs. 0.3% in 2019, p<0.017), dog bites (0.1% in 2020 vs. 0.0% in 2019, p<0.001), and child abuse and neglect (18 cases during the 2020 lockdown vs. 24 cases in 2019, p=0.005) were significantly more prevalent during this period than during the same control period in 2019. CONCLUSIONS These results indicate that specific prevention measures are crucial if strict lockdowns are to be decided in the future.
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Affiliation(s)
- Quentin Hennocq
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris, 149 rue de Sèvres, Paris 75015, France.
| | - Célia Adjed
- AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU PRIME, Unité de Recherche Clinique, Paris, France
| | - Hélène Chappuy
- Service des urgences pédiatriques, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de Médecine, Université de Paris, Paris, France
| | - Gilles Orliaguet
- Service d'anesthésie-réanimation pédiatrique et obstétricale, Hôpital universitaire Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de Médecine, Université de Paris & EA 7323, Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Université de Paris, Paris, France
| | - Cécile Monteil
- Services des urgences pédiatriques, Hôpital Robert-Debré, Assistance Publique - Hôpitaux de Paris ; Faculté de Médecine, Université de Paris, Paris, France
| | - Claire El Kebir
- Service social, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris; Faculté de Médecine, Université de Paris, Paris, France
| | - Arnaud Picard
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris, 149 rue de Sèvres, Paris 75015, France
| | - Eleonora Segna
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris, 149 rue de Sèvres, Paris 75015, France
| | - Nathanael Beeker
- AP-HP.Centre, Groupe Hospitalier Cochin Port Royal, DMU PRIME, Unité de Recherche Clinique, Paris, France
| | - Roman Hossein Khonsari
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris, 149 rue de Sèvres, Paris 75015, France
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Williams S, Bruer KC, Evans AD, Price HL. The impact of COVID-19 on Canadian child maltreatment workers. CHILDREN AND YOUTH SERVICES REVIEW 2022; 138:106492. [PMID: 35400775 PMCID: PMC8983073 DOI: 10.1016/j.childyouth.2022.106492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 03/07/2022] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
As cases of child maltreatment become an increasing concern during the COVID-19 pandemic, the perspectives of those charged with protecting and supporting children and families is an important area of inquiry. We sought to examine the experiences of child maltreatment workers during the first wave of the pandemic (i.e., May-July 2020). We specifically aimed to examine child maltreatment experiences related to the following: (1) their work practices during the pandemic, (2) their perceived safety during the pandemic, and (3) their perceptions on the safety of the children and families with whom they work. A total of 106 child maltreatment investigators and forensic interviewers provided responses to a national survey disseminated across Canada. Using a cross-sectional design, data were collected through a survey management program. The survey combined both open-ended and forced choice questions to gather perspectives on respondents' experiences. More than half (67%) reported a reduction in their caseloads during the pandemic (May-July 2020) and continued in-person interviews, with the use of preventative health measures (i.e., PPE, physical distancing, gloves). Most respondents reported elevated stress levels and similarly high stress levels amongst the children and families to whom they provide services. Overall, our findings highlight both how child maltreatment investigators have adapted to preventative measures and the continuing areas of weakness where further supports are required.
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Affiliation(s)
- Shanna Williams
- Faculty of Education, McGill University, Room 614, Education Building, 3700 McTavish Street, Montreal, Quebec H3A 1Y2, Canada
| | - Kaila C Bruer
- Faculty of Arts, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
- Luther College, Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Angela D Evans
- Department of Psychology, Faculty of Social Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON L2S 3A, Canada
| | - Heather L Price
- Department of Psychology, Faculty of Arts, Thompson Rivers University, 805 TRU Way, Kamloops, BC V2C 0C8, Canada
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Chaiyachati BH, Wood JN, Carter C, Lindberg DM, Chun TH, Cook LJ, Alpern ER. Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study. Pediatrics 2022; 150:e2022056284. [PMID: 35707943 PMCID: PMC10947367 DOI: 10.1542/peds.2022-056284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The reported impacts of the COVID-19 pandemic on child maltreatment in the United States have been mixed. Encounter trends for child physical abuse within pediatric emergency departments may provide insights. Thus, this study sought to determine the change in the rate of emergency department encounters related to child physical abuse. METHODS A retrospective study within the Pediatric Emergency Care Applied Research Network Registry. Encounters related to child physical abuse were identified by 3 methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury, or age-restricted skeletal survey completion. The primary outcomes were encounter rates per day and clinical severity before (January 2018-March 2020) and during the COVID-19 pandemic (April 2020-March 2021). Multivariable Poisson regression models were fit to estimate rate ratios with marginal estimation methods. RESULTS Encounter rates decreased significantly during the pandemic for 2 of 3 identification methods. In fully adjusted models, encounter rates were reduced by 19% in the diagnosis-code cohort (adjusted rate ratio: 0.81 [99% confidence interval: 0.75-0.88], P <.001), with the greatest reduction among preschool and school-aged children. Encounter rates decreased 10% in the injury cohort (adjusted rate ratio: 0.90 [confidence interval: 0.82-0.98], P = .002). For all 3 methods, rates for lower-severity encounters were significantly reduced whereas higher-severity encounters were not. CONCLUSIONS Encounter rates for child physical abuse were reduced or unchanged. Reductions were greatest for lower-severity encounters and preschool and school-aged children. This pattern calls for critical assessment to clarify whether pandemic changes led to true reductions versus decreased recognition of child physical abuse.
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Affiliation(s)
- Barbara H. Chaiyachati
- Division of General Pediatrics, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
- SafePlace: The Center for Child Protection and Health, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Joanne N. Wood
- Division of General Pediatrics, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA
- SafePlace: The Center for Child Protection and Health, Children’s Hospital of Philadelphia, Philadelphia, PA
- PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Camille Carter
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Daniel M. Lindberg
- Department of Emergency Medicine and Kempe Center for the Prevention & Treatment of Child Abuse & Neglect, The University of Colorado Anschutz Medical Campus, Denver, CO
| | - Thomas H. Chun
- Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Hasbro Children’s Hospital, Warren Alpert Medical School of Medicine at Brown University, Providence, RI
| | - Lawrence J. Cook
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of Pediatrics, Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
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Greene HM, Maguire-Jack K, Malthaner L, Truelove A, Leonard JC. The relationship between emergency medical services use and social service needs in a pediatric emergency department population. CHILD ABUSE & NEGLECT 2022; 125:105482. [PMID: 35030391 DOI: 10.1016/j.chiabu.2022.105482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Emergency Medical Services (EMS) use for children is correlated with areas of resource deprivation as well as child maltreatment. Households using EMS may have more social needs and be willing to accept services. OBJECTIVE To compare social service needs and willingness to accept services in families arriving to a pediatric emergency department (ED) via EMS vs non-EMS, before and during COVID-19. PARTICIPANTS AND SETTING Caregivers of children 0-5 years old in a quaternary pediatric ED, with a 1:1 ratio of EMS vs non-EMS arrivals. METHODS Participants completed a survey of demographics, social service needs, and willingness to accept services, before and during COVID-19. RESULTS Of 220 participants, 84 were enrolled before COVID-19. The EMS group reported less full-time employment (34.6% vs 51.8%, p < 0.05) and more social service needs (2.47 vs 1.76 needs, p < 0.05). Mean score for willingness to accept a service provider in the home was 3.62 for EMS and 3.19 for non-EMS (p = 0.09). Mean score for accepting a phone referral was 3.84 for EMS and 3.40 for non-EMS (p = 0.07). COVID-19 impacted needs for both groups (20.9% EMS vs 30.3% non-EMS). For all subjects presenting to the ED, COVID-19 was associated with decreased food insecurity (28.6% vs 15.4%) and children with a chronic medical condition (31.0% vs 12.5%). CONCLUSIONS The EMS group had more social service needs. There was no difference in social services acceptance. COVID-19 affected both groups' needs. Future interventions may use EMS systems to mitigate social service needs which may be risk factors for child abuse.
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Affiliation(s)
- H Michelle Greene
- Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, OH, United States of America; Division of Child Abuse Pediatrics, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Kathryn Maguire-Jack
- School of Social Work, University of Michigan, Ann Arbor, MI, United States of America
| | - Lauren Malthaner
- Division of Epidemiology, Human Genetics and Environmental Services, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Annie Truelove
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Julie C Leonard
- Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, OH, United States of America; Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, United States of America.
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Association of Economic Recession and Social Distancing with Pediatric Non-Accidental Trauma During COVID-19. J Surg Res 2022; 276:110-119. [PMID: 35339779 PMCID: PMC8866081 DOI: 10.1016/j.jss.2022.02.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
Abstract
Introduction There has been concern that the incidence of non-accidental trauma (NAT) cases in children would rise during the COVID-19 pandemic due to the combination of social isolation and economic depression. Our goal was to evaluate NAT incidence and severity during the pandemic across multiple US cities. Methods Multi-institutional, retrospective cohort study comparing NAT rates in children <18 y old during the COVID-19 pandemic (March-August 2020) with a recent historical data (January 2015-February 2020) and during a previous economic recession (January 2007-December 2011) at level 1 Pediatric Trauma Centers. Comparisons were made in local and national macroeconomic indicators. Results Overall rates of NAT during March-August 2020 did not increase compared to historical data (P = 0.8). Severity of injuries did not increase during the pandemic as measured by Glasgow Coma Scale (GCS) (P = 0.97) or mortality (P = 0.7), but Injury Severity Score (ISS) slightly decreased (P = 0.018). Racial differences between time periods were seen, with increased proportions of NAT occurring in African-Americans during the pandemic (P < 0.001). NAT rates over time had low correlation (r = 0.32) with historical averages, suggesting a difference from previous years. Older children (≥3 y) had increased NAT rates during the pandemic. Overall NAT rates had low inverse correlation with unemployment (r = −0.37) and moderate inverse correlation with the stock market (r = −0.6). Significant variation between sites was observed. Conclusions Overall NAT rates in children did not increase during the COVID-19 pandemic, but rates were highly variable by site and increases were seen in African-Americans and older children. Further studies are warranted to explore local influences on NAT rates.
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Bullinger LR, Marcus S, Reuben K, Whitaker D, Self-Brown S. Evaluating child maltreatment and family violence risk during the COVID-19 Pandemic: Using a telehealth home visiting program as a conduit to families. Infant Ment Health J 2021; 43:143-158. [PMID: 34969151 PMCID: PMC9015231 DOI: 10.1002/imhj.21968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The COVID‐19 pandemic has affected many child maltreatment risk factors and may have affected maltreatment among vulnerable families. We surveyed 258 certified providers of an evidence‐based home visiting program, SafeCare, about their perception of the impact of the pandemic on the families they serve. We examined if the providers perceived an overall change in child maltreatment and family violence risk among the families with young children they served and factors that may have contributed to changes. Regressions estimated the relationship between providers’ assessment of families’ ability to social distance, emotional struggles, and access to public resources/services with providers’ perception of child maltreatment and family violence risk in the home. Findings indicate that 87% of providers believed maltreatment risk had increased during the pandemic. Providers serving families who were unable to social distance due to employment were more likely to report increased supervisory neglect and material neglect among the families they serve. Providers reporting that families were struggling with elevated frustration levels also reported more family conflict and material neglect among the families they serve. Results from this research can inform strategic decision‐making for policies and programs that address the challenges low‐income families with young children face in emergency situations.
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Affiliation(s)
| | - Stevan Marcus
- School of Public Policy, Georgia Tech, Atlanta, Georgia, USA
| | - Katherine Reuben
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Daniel Whitaker
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Shannon Self-Brown
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
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