Researchers say decrease may indicate abuse was missed during distance learning
Child abuse evaluations in emergency departments dropped during the COVID-19 pandemic, according to a new study by UC Davis Health. But researchers believe the decrease may reflect less recognition of child abuse while kids were attending school online.
“When the world shut down, families lost access to resources and children had fewer interactions with adults outside their homes. As ‘normal’ disappeared, the deep stress and isolation seemed like a set up for increased child abuse,” explained Julia Magaña, associate professor in the Department of Emergency Medicine and co-author of the study that sought to determine the impact the COVID-19 pandemic had on child physical abuse.
About 1 in 7 children experienced child abuse or neglect in the prior year in the United States according to the Centers for Disease Control and Prevention (CDC). Disruptive events in the world, such as the pandemic, may increase the risk for physical abuse. Therefore, the early days of the COVID-19 pandemic prompted safety concerns for children due to the disruption of daily routines.
“However, there were added resources as well – families were together, potentially with more caregivers reliably around, some day-to-day pressures were lifted, and there were expansions in a number of government programs. So, we wanted to look if physical abuse increased or decreased during the pandemic as measured in healthcare encounters,” Magaña said.
Magaña teamed up with colleagues from the Pediatric Emergency Care Applied Research Network (PECARN) to conduct this research.
The study, which was published in the Journal of the American Academy of Pediatrics, looked at over 1.5 million emergency department encounters at nine children's hospitals.
The team identified the abuse by three 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 (Jan. 2018–March 2020) and during the COVID-19 pandemic (April 2020–March 2021).
“Severity of encounters was an important aspect because, for low severity yet concerning injuries, seeking medical care may have been more influenced by societal interactions,” Magaña said. “It is also hard to identify encounters for abuse in hospital records, so we used multiple methods to single out child abuse.”
Across the three methods, they identified approximately 10,000 relevant encounters. The encounter rate for physical abuse diagnoses overall among all ages, per day, decreased by 19% during the pandemic. This decrease was seen in school aged children 2-13 years old, but less so for young children under two years old and older children over 13.
For age-restricted high-risk injury encounters, diagnoses decreased by 10% during the pandemic across all demographics. Again, this reduction was in low severity (minor) abuse cases and not in severe abuse. Finally, there was no reduction in total collection of skeletal survey numbers, though there was a reduction in low severity encounters identified by this method – with no change in high severity.
Overall, the data collected showed lower severity physical abuse encounters decreased across all three sets of analysis while more severe physical abuse encounters did not change.
“Based on our results, it is possible abuse did occur less often during the pandemic because of the added resources available to families or other unknown protective factors,” Magaña explained. “However, it is also possible abuse occurred as frequently or even more often, but it was not identified and reported by mandated reporters. School personnel are a common reporting source, and it is easy to imagine that these interactions may have been different during the pandemic, particularly with virtual schooling.”
The team believes further studies are needed to clarify whether pandemic changes led to true reductions versus decreased recognition of child physical abuse.