Treating injured and traumatized children and efforts to implement preventive interventions have become increasingly challenging in the context of the current pandemic. Children are notably at greater risk of injury, morbidity and mortality due to the social isolation, economic stressors, and other challenges related to policies and practices designed to mitigate the spread of the coronavirus. Given the limitations of traditional contexts for identifying and reporting abuse due to these mitigation strategies, research on treatment and care in diverse (e.g. primary, emergency and acute care) settings is essential to identify effective ways of screening, diagnosing and assessing trends in abuse and abuse related injuries in this current context.
This is important because, for example, approximately 10 percent of pediatric emergency department visits are due to various forms of physical child abuse. However, the diagnosis of abuse may be missed due to challenges in distinguishing between inflicted and unintentional injuries, both of which may present with bruising, fractures, and other non-specific signs. This challenge may be further exacerbated by the current context of this pandemic. Additional research is needed to develop and refine tools and technologies to improve diagnostic accuracy of abuse and abuse related injuries as potentially more children may be admitted during the pandemic due to such injuries. The need to study ways to strengthen and/or develop new channels of communication between and among reporting systems and systems of care for children at risk of abuse and/or neglect is paramount.
Additionally, there are important disparities in injury burden, including those by race, ethnicity, gender, socioeconomic status, and urbanicity. National pre-COVID data show that in 2018, the child abuse rate in the United States is highest among American Indian or Alaska Native victims with a rate of 15.2 cases per 1,000 children. It is most common among children between two to five years of age, with about 166,400 cases reported in 2017. Child abuse cases are fairly evenly distributed between girls and boys. However, more boys than girls were victims of abuse resulting in death. Notably, studies have shown that LGBT youth may experience maltreatment at higher rates than other children and youth, however, little research has been done on the ways in which the intersection of sexual and gender minority (SGM) status, race/ethnicity, and socioeconomic status may impact rates, and severity of childhood abuse. These child abuse rates are likely to be exacerbated in the context of current pandemic in light of the fact that disparity populations appear to be disproportionately affected by the coronovirus.
While child abuse is prevalent across both rural and urban settings, hospitals may have widely divergent abilities and resources to address abuse. Although there is little published information characterizing the needs of rural EDs, they likely have fewer resources for managing abuse and less access to community abuse assessment centers for consultation and follow-up than do many urban hospitals. This may be further impacted by the need for resources for treatment and care in the context of the pandemic.
Thus, these pre-existing disparities and apparent challenges in resources for treatment and care of children experiencing abuse call for more data and research resources to identify, substantiate and improve care and ultimately outcomes for vulnerable children and youth during and following the current crisis.
It is anticipated that research stemming from this NOSI will help to provide greater recognition of the need for better resources and support for vulnerable children. More touchpoints for communication, identification and screening for risks of child trauma, and injury will help inform processes for screening, identification, treatment and care in new and emerging disaster related contexts in the future.