Research to be presented at the 2021 American Academy of Pediatrics National Conference & Exhibition finds that stay-at-home orders and pandemic stress during the COVID outbreak brought an increase in non-accidental child injuries, the result of child abuse
ITASCA, IL – The stress of the COVID-19 pandemic, including financial strain and physical distancing, presented challenges for families that may have led to an increase in physical abuse injuries of school-aged children, according to new research.
The study abstract, “Impact of ‘Stay-at-Home’ Orders on Non-Accidental Trauma: A Multi-Institutional Study,” to be presented at the virtual American Academy of Pediatrics National Conference & Exhibition, compared trauma registry data for March-September 2020 from nine pediatric trauma centers, against the same period in 2016-2019. Researchers found an increase in child abuse victims over age 5 in 2020.
“The findings of our study may reflect the difference in how schools and daycares are viewed. In many areas, daycares were considered essential businesses and remained open during the shutdown. It is possible this is why we didn’t see a large change in suspected abuse rates in the younger age group. However, with older children out of school and many parents financially vulnerable during this time, family dynamics may have escalated to oftentimes untenable situations,” said Amelia Collings, MD, the abstract author and Midwest Pediatric Surgery Consortium (MWPSC) Research Fellow. “We need to be able to provide support for these families and safeguard against feelings of desperation."
Researchers analyzed data on 39,331 pediatric trauma patients, of which 2,064 were victims of suspected abuse. Among children aged 5 years and older, the number of child abuse victims tripled during the study period, to 103 patients, up from an average of 36 patients during a similar period before the pandemic. For school-aged children, the increase in potentially abuse-related injuries may reflect the absence of normal safeguards provided by the educational system, teachers and social workers who have direct access to the child at school, potentially leaving a vulnerable population at risk.
“Economic and emotional stress, in addition to the absence of other adults in the child’s life that would typically recognize and report abuse, may have contributed to increased rates of child abuse during the COVID-19 pandemic,” Dr. Collings said. “While school-aged children were sheltered at home, teachers, health care workers, coaches, and other adults outside the family were not there to notice signs of physical abuse.”
Dr. Collings will present the study abstract at 9:15 a.m. CT Saturday, October 9, 2021.
To request an interview, journalists may contact the senior author, Dr. Katherine Flynn-O’Brien.
This study was supported and conducted through the Midwest Pediatric Surgery Consortium, a collaborative of surgeon investigators from 11 children’s hospitals dedicated to advancing the care of pediatric patients.
Editor’s note: A related abstract, “The Impact of the COVID-19 Pandemic on Pediatric Non-Accidental Trauma,” will be presented at 4:48 p.m. CTFriday, October 8, 2021.
Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.
Program Name:
Abstract Title: Impact of “Stay-at-Home” Orders on Non-Accidental Trauma: A Multi-Institutional Study
Amelia Collings
Louisville, KY, United States
Saturday, October 9, 2021: 9:15 AM –
In response to the COVID-19 pandemic, local and regional Stay-at-Home orders (SHO) were implemented. Families experienced job loss, financial strain, and children were unable to attend school. It is unclear how this combination of events and social stress affected the welfare of children and rates of pediatric injury nationwide. We hypothesized that the rate of non-accidental trauma (NAT) would increase during the SHO as children did not have access to mandatory reporters, such as schoolteachers and primary care physicians.
A multi-center, retrospective study was conducted evaluating patients <18 years old with traumatic injuries as defined by National Trauma Data Bank. Patients with ICD-10 Diagnosis and/or External Cause of Injury codes meeting criteria for NAT were included. “Historical” controls from an averaged period of March-September 2016-2019 were compared to patients injured after the implementation of SHO through September 2020 (“COVID” cohort). SHO were defined at the state level for each site. An interrupted time series analysis was utilized to evaluate the effect of the implementation of SHO.
A total of 9 Level I pediatric trauma centers were included, contributing 39,331 pediatric trauma patients, of which 2,064 met criteria for NAT. During the initial SHO, the rate of NAT dropped below what was expected based on the historical trends, however, thereafter the rate increased above the expected rates of NAT [Figure 1]. The COVID cohort experienced a significant increase in the proportion of NAT patients age >5 years (Historical 36 patients [13.5%] vs. COVID 103 patients [30.8%], p<0.001). Ultimately, 2020 experienced an increased cumulative burden of NAT cases as reported to institutional trauma registries when compared to the Historical cohort [Figure 2].
The COVID-19 pandemic affected the presentation of children with NAT to the hospital. For school-aged children sequestered at home by the pandemic, increased NAT may reflect the absence of normal safeguards provided by the educational system, potentially leaving a vulnerable population at risk. Particularly in times of public health crisis, maintaining systems of protection for children remains essential.
Interrupted Time Series Analysis for NAT during Stay-at-Home Orders
Cumulative Burden of NAT Patients
