Stephenson J. Child Abuse–Related Emergency Department Visits Declined During Pandemic, but Share of Visits Leading to Hospitalization Increased, CDC Reports. JAMA Health Forum. Published online December 15, 2020. doi:10.1001/jamahealthforum.2020.1544
Despite heightened risks for child abuse and neglect related to the coronavirus disease 2019 (COVID-19) pandemic and the social and economic strains of efforts to limit its spread, new findings from the Centers for Disease Control and Prevention (CDC) show fewer emergency department (ED) visits for child abuse and neglect during the first 6 months of the pandemic compared with the same period in 2019.
However, although the number of visits related to child abuse and neglect had decreased, the proportion of those visits per 100 000 ED encounters increased from 2019 to 2020. This suggests, the authors wrote in the December 11 issue of the Morbidity and Mortality Weekly Report, a change in “health care–seeking patterns” during the pandemic, with a sharper decline in ED visits for other causes compared with the drop in visits for child abuse and neglect.
A concerning finding was that even though the total number of child abuse and neglect–related ED visits had fallen in 2020, a greater proportion of these visits led to hospitalization. This suggests, the report said, “that victims might not have received care and that severity of injuries remained stable or worsened.”
Pandemics, like other events marked by economic uncertainty, civil unrest, or disaster, pose known risks for child abuse and neglect. The researchers noted that despite preliminary reports indicating problems in some facilities, there has been a 20% to 70% decline in official reports to child protective agencies—a drop attributed to children having less in-person contact with mandated reporters, such as teachers, social workers, and physicians.
The CDC researchers used data collected from more than 3300 EDs by the National Syndromic Surveillance Program from January 6, 2019, through September 6, 2020 (before and during the COVID-19 pandemic), which they analyzed for trends in visits for suspected or confirmed abuse or neglect of a child or adolescent by a parent or other caregiver.
Beginning on March 15, 2020, after President Trump’s declaration of a national emergency, the total number of such visits decreased below 2019 levels, reaching a nadir during March 29 through April 4. During that week, ED visits for child abuse and neglect averaged 53% less than the number during the same period in 2019, with the largest proportional declines of ED visits (61%) among children aged 5 to 11 years.
This finding echoes trends reported for all ED visits early in the pandemic: the volume of visits during March 29 through April 25, 2020, declined up to 72% among children and adolescents 14 years or younger compared with the same period in 2019.
However, despite the drop from 2019 levels in total number of child abuse and neglect–related ED visits, such encounters comprised a larger proportion of all ED visits for any reason—indicating that visits for child abuse and neglect declined less than those for other causes.
“Despite the ongoing pandemic, caregivers were more likely to take children to EDs for evaluation of complaints related to child abuse and neglect relative to other chief complaints,” the researchers wrote. “This pattern might reflect decreased health care–seeking for other medical complaints or a need to seek medical care because of persistence or worsening of child abuse and neglect.”
In fact, the number of ED visits for child abuse and neglect that resulted in hospitalization was consistent between 2019 and 2020, suggesting that the severity of injuries did not decrease during the pandemic.
Because the number of hospitalizations remained the same as the number of overall ED visits decreased, the percentage of ED visits related to child abuse and neglect ending in hospitalization increased significantly overall among children and adolescents younger than 18 years, from 2.1% in 2019 to 3.2% in 2020. The highest rates and increases occurred among children 4 years or younger (increasing from 3.5% in 2019 to 5.3% in 2020).
Alternative ways to detect and report child abuse and neglect are needed during the COVID-19 pandemic, the researchers noted, as is implementation of evidence-based strategies for reducing the problem.
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Joan Stephenson, PhD Joan Stephenson, PhD, is Consulting Editor for the Forum and JAMA and an award-winning independent writer and editor based in Chicago. She joined JAMA as a writer and editor for JAMA's Medical News & Perspectives department and subsequently served...