Suspected Child Abuse Research Articles

Risk factors for abusive head trauma in the pediatric population.

Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial yet especially challenging for infants and toddlers as they are preverbal. Current guidelines for child abuse do not sufficiently address the specific needs of a younger population. This study aimed to evaluate clinical factors associated with abuse among such populations. The National Trauma Data Bank was queried from 2017 to 2019 for patients younger than 3 years with acute head trauma. Patients who were suspected of having experienced child abuse (suspected child abuse [SCA] group) were propensity score matched with patients who were not suspected of having experienced child abuse (non-SCA group) based on demographics, comorbidities, and Glasgow Coma Scale (GCS) scores. Paired Student t-test and chi-square tests were used to compare differences in hospital outcomes between the two groups. Multivariable regression analysis was used to determine factors associated with SCA (p < 0.05). The authors identified 10,844 patients in the SCA group and 27,912 in the non-SCA group. Regression analysis results showed that patients in the SCA group had higher rates of prematurity (OR 2.30, p < 0.001), GCS scores < 13 (OR 1.79, p < 0.001), congenital disorders (OR 1.56, p < 0.001), and public insurance use (68.38% vs 52.88% p < 0.001). Black and Hispanic patients were more likely to be in the SCA group (OR 1.56, p < 0.001 and OR 1.35, p < 0.001, respectively). Following propensity score matching, SCA patients had a longer length of hospital stay (3.17 vs 1.34 days, p < 0.001) and higher mortality rate (4.89% vs 3.58%, p < 0.001). Acute head injuries in the SCA group were associated with prematurity, congenital disorder, low GCS score, and public insurance use. As such, the current guidelines should implement clinical history and insurance type to better reflect the at-risk patient population when evaluating infants and toddlers for potential abuse. There could be overidentification of child abuse among Black and Hispanic patients, and further research is warranted.

Managing child abuse or suspected child abuse in primary care: Results from a qualitative study of general practitioners trained in detecting child abuse: Managing child abuse or suspected child abuse in primary care

IntroductionIdentifying and alerting suspected child abuse enables its investigation and management. In France, anyone can report the situation to child services when child abuse is suspected. However, the number of reports of concern received from physicians is low, and lack of knowledge is a frequent obstacle. This study aimed to explore the practices of trained general practitioners (GPs) regarding the identification and management of suspected child abuse. MethodWe led a qualitative study from February to November 2021 based on a grounded theory approach. We conducted semi-structured interviews with GPs working in the south of France who had received training in identifying child abuse. We performed an inductive analysis using NVivo software. ResultsWe interviewed 10 GPs (data saturation with seventh GP). Despite the training, obstacles seemed to persist, such as apprehension of the parents’ reaction, the technical difficulties of the process, and the lack of feedback after making a report. Being accompanied by a professional who can be directly contacted would facilitate the communication of worrying information. Without direct links to a single referent, doctors would prefer alternative ways of referring their patients to organizations they were familiar with. Discussion and conclusionGPs expressed a need for easy access to childcare professionals to support them in the decision to file a report of suspected child abuse. A multidisciplinary approach and a dedicated point of contact seemed to help the process. Nominating a child protection referent doctor per department and creating specific units in hospitals for children at risk would help GPs get effectual contacts for reporting worrying information and better care for children at risk of abuse.

Identifying Child Abuse in Patients With Femur Fractures Through Pathway Compliance: A Pilot Study.

Background Child abuse is a significant cause of morbidity and mortality in children. A thorough history and physical exam is critical to identifying abuse. Standardized screening tools as well as clinical pathways can assist with identifying patients who may have an injury secondary to abuse. There are varied recommendations for the upper age in which to routinely evaluate pediatric patients for child abuse. Objectives The primary objective of this study was to describe the outcomes of the implementation of an evidence-based clinical pathway for suspected non-accidental trauma for all pediatric patients aged five years and under presenting with a femur fracture. This pathway includes orders for imaging, labs, and consults. In addition, the characteristics of this population and the findings were described. Methods A retrospective study of patients at a single institution who met the National Trauma Data Standard registry inclusion criteria and had a femur fracture was performed. Variables analyzed included age, demographics, mechanism and location of injury, admission status and service, injury severity, hospital characteristics, and discharge status. Patients with a metabolic bone disease were excluded. Results There were 200 patients who met the inclusion criteria. Thirty-two patients had a diagnosis of confirmed or suspected child abuse. While all 32 patients had a skeletal survey performed, only 23 (71.9%) had the complete workup per the clinical pathway, and 21 (65.6%) had a diagnosis of confirmed child abuse. Conclusion Clinical pathways are established to provide the standardization of clinical assessments and interventions; however, this process relies on a single individual to make a judgment determining whether or not to implement the pathway. Children presenting to an emergency department with confirmed or suspected child abuse are a vulnerable population. A child abuse diagnosis is a clinical judgment; however, clinical pathways aid in the diagnosis in hopes to stop any further abuse. For a pathway to be successful, each step needs to be addressed.

ASPECTOS ORAIS DO ABUSO SEXUAL INFANTIL E CONDUTA DO CIRURGIÃO DENTISTA: REVISÃO DE LITERATURA

The study presents a literature review, the aim of which was to point out the main characteristics for detecting cases of child sexual abuse from the point of view of dentistry, as well as to highlight the importance of the dental surgeon in identifying and reporting cases of suspected child maltreatment and/or abuse. The bibliographic research was carried out in different databases, such as SciELO, Bireme, LILACS and PubMed, selecting studies that addressed the descriptors provided by the DECS database: children, child sexual abuse and dentistry, published between 2015 and 2023. To prepare the literature review, 40 articles were found. However, national and international articles that met the inclusion criteria were selected for the expanded abstract. The literature shows the importance of identifying child mistreatment and abuse in the dental field, listing the main manifestations of injuries in the head and neck region. This research is linked to increasing dental surgeons’ knowledge of child violence, so that professionals are better able to recognize the signs of abuse or neglect in children, which is crucial for identifying cases of violence and taking the necessary measures. Therefore, this paper aims to point out the main characteristics of child sexual abuse, as well as what the dental surgeon’s conduct should be when faced with this occurrence.

ESR Essentials: imaging of suspected child abuse-practice recommendations by the European Society of Paediatric Radiology.

The goal of this paper is to provide a useful desktop reference for the imaging of suspected child abuse with clear, age-specific pathways for appropriate evidence-based imaging and follow-up. We aim to provide a road map for the imaging evaluation and follow-up of this important and vulnerable cohort of patients presenting with signs and symptoms concerning forinflicted injury. As the imaging recommendations differ for children of different ages, we provide a flowchart of the appropriate imaging pathway for infants, toddlers, and older children, which allows ease of selection of which children should undergo skeletal survey, non-contrast computed tomography (CT) brain with 3-dimensional (D) reformats, and magnetic resonance imaging (MRI) of the brain and whole spine. For ease of review, we include a table of the common intracranial and spinal patterns of injury in abusive head trauma. We summarise search patterns, areas of review, and key findings to include in the report. To exclude skeletal injury, infants and children under 2 years of age should undergo a full skeletal survey in accordance with national guidelines, with a limited follow-up skeletal survey performed 11-14 days later. For children over 2 years of age, the need for skeletal imaging should be decided on a case-by-case basis. All infants should undergo a non-contrast-enhanced CT brain with 3-D reformats. If this is normal with no abnormal neurology, then no further neuroimaging is required. If this is abnormal, then they should proceed to MRI brain and whole spine within 2-5 days. Children older than 1 year of age who have abnormal neurology and/or findings on skeletal survey that are suggestive of inflicted injury should undergo non-contrast CT brain with 3-D reformats and, depending on the findings, may also require MRI of the brain and whole spine. We hope that this will be a helpful contribution to the radiology literature, particularly for the general radiologist with low volumes of paediatrics in their practice, supporting them with managing these important cases when they arise in daily practice. KEY POINTS: The choice of initial imaging (skeletal survey and/or brain CT) depends on the age of the child in whom abuse is suspected. A follow-up skeletal survey is mandatory 11-14 days after the initial survey. If an MRI of the brain is performed, then an MRI of the whole spine should be performed concurrently.

Management of Suspicions of Child Maltreatment at Child and Family Clinics: A Mixed-Methods Study

This study investigated Norwegian public health nurses working in child and family health clinics’ decision-making practices concerning child maltreatment. A one-phase convergent mixed-method design was utilized, with quantitative and qualitative data concurrently collected and separately analyzed from a questionnaire that included patient vignettes. These vignettes described three potential child maltreatment scenarios to assess public health nurses’ competence and clinical decision-making processes. A total of 554 public health nurses participated in the study conducted from October 24 to December 31, 2022. Findings reveal a high level of recognition of child maltreatment among public health nurses. However, despite their self-perceived confidence, the qualitative data underscore the complexity and uncertainty inherent in their assessment process. The most supported management approaches involved further exploration of the situation. Few public health nurses would file a report of concerns to Child Protective Services or report the police despite their level of concerns. The findings underscore the necessity for additional training and support to enhance public health nurses’ confidence and competence in reporting suspected child maltreatment cases, as well as the need for increased information exchange regarding the procedures and services provided by the child if Child Protective Service is involved.

Who is involved in child protection investigations? The relationship between gender, ethnicity/migration background, and contacts between parents and caseworkers during investigations and assessments

Involvement of parents in child protection investigations and assessments is important and associated with the quality of care in the system. However, it seems that not all parents are involved to the same extent. Mothers seem to be more involved compared to fathers and parents of minoritized ethnic groups or with migration backgrounds seem less likely to be involved compared to parents of advantaged ethnic populations. In this study, we operationalized involvement by analyzing the number of contacts parents had with child protection agencies. We investigated whether gender and ethnicity or migration background impacted contacts in child protection investigations and assessments in England, the Netherlands, and Germany. We conducted a quantitative case file study and analyzed case files representing investigations and assessments regarding suspected child abuse and neglect (1,954 parents involved in 1,207 child protection cases). Using linear multilevel regression analyses, we investigated whether parent gender and family ethnicity/migration background were associated with the number of contacts that parents had. In all countries, we found that fathers had fewer contacts compared to mothers. In the Netherlands only, we found that parents in migrant families had fewer contacts. We discuss strategies to enhance the involvement of fathers and parents with migration backgrounds.

Factors Associated with Social Workers’ Likelihood to Report Suspected Child Abuse: Findings from a National Survey of Chinese Social Workers

Abstract Whilst there have been recent national surveys about reporting child abuse in several low- and middle-income countries, data from China are lacking. This study examined the prevalence of reporting suspected child abuse and factors associated with having ever reported in a sample of social workers from mainland China. Nationally representative data from the China Social Work Longitudinal Study were used, and responses from 3,510 participants who had completed the children’s social work questionnaire module were analysed. Our results indicate that only 14.4 per cent of social workers from China had ever reported suspected child abuse. Participants who had ever reported were more likely to be female, younger, have higher education levels and social work qualifications, have a higher awareness of abusive behaviours, and have greater working autonomy than social workers who had never reported. We argue that in order to achieve higher levels of reporting suspected child abuse for Chinese social workers, it is necessary to promote the professionalisation of social work through both education and experience gained in practice.

Intervening in Suspected Child Maltreatment: Parents’ Responses to and Perceptions of Maltreatment in a Rural Midwestern County

Intervening in Suspected Child Maltreatment: Parents’ Responses to and Perceptions of Maltreatment in a Rural Midwestern County

Severe haemorrhages leading to a diagnosis of rare bleeding disorder occur at a very young age: A study from the FranceCoag network.

In the context of severe unexplained haemorrhage (SH), it is usual to seek haematological evaluation and investigate for an inherited rare bleeding disorder (IRBD). In such circumstances, appropriate screen can discriminate between IRBD and suspected child abuse. Yet, little information is available about the frequency of SH in the population of patients with IRBD. To collect epidemiologic data about SH and IRBD. The database of the FranceCoag network has collected information about IRBD since January 2004. Based on data gathered up to 16 March 2022, a retrospective search was conducted for of SH events having occurred before or at the time of IRBD diagnosis. Demographics and diagnosis circumstances were retrieved, as well as information about SH, defined as any life-threatening bleeding or intracranial haemorrhage. Among the 13,433 patients of the database, 109 (0.8%) fulfilled inclusion criteria including a known date of IRBD diagnosis, haemophilia A or B (HA/HB) being the most frequent (82.5%). IRBD was discovered as a consequence of an SH event in 82.6% of the cases while CNS was involved in 55%. Severe and moderate HA/HB and other severe IRBD presented significantly more intracranial haemorrhage (p<.02) and a lower age at diagnosis (p=.03). These data support that any unusual SH should raise a suspicion of IRBD. Particularly before 1-year of age, it is suggested to first confirm moderate or severe haemophilia and severe IRBD by standard coagulation tests (APTT, PT and fibrinogen), combined with a clotting FXIII assay as first-line investigation. Subsequent assays of coagulation factors should be performed in the case of abnormal values, in second-line investigation.

Urinalysis in Suspected Child Abuse Evaluation in the Emergency Department.

Intra-abdominal injury (IAI) is the second leading cause of mortality in abused children. It is challenging to identify in young patients due to their limited verbal skills, delayed symptoms, less muscular abdominal wall, and limited bruising. We conducted a retrospective cohort study of children aged 0 to 12 months who were evaluated in the emergency department for suspected child abuse with a skeletal survey and urinalysis between January 1, 2015, and December 31, 2017. Our primary objective was to identify the proportion of IAI cases identified by urinalysis alone (>10 RBC/HPF) and not by examination findings or other laboratory results. A secondary objective was to quantify potential delay in disposition while waiting for urinalysis results, calculated as the length of time between receiving skeletal survey and laboratory results and receiving urinalysis results. Six hundred thirteen subjects met our inclusion criteria; two subjects had hematuria, one of whom had a urinary tract infection. The other was determined to have blood from a catheterized urine specimen. One subject was found to have an IAI. We further found that urinalysis was delayed for 78% of subjects and took a median of 93 [interquartile range, 46-153] minutes longer than imaging and/or laboratories. No subjects were diagnosed with abdominal trauma based on urinalysis during evaluation in the emergency department who would not have been identified by other standard testing. In addition, patients' disposition was delayed while waiting for urinalysis.

Development of a standardized peer review and oversight process in cases of suspected child physical abuse

Peer review of medical opinions provided in cases of suspected child physical abuse is generally considered to be best practice for pediatricians engaged in this field. However, there are no published standardized guidelines on how pediatricians should undertake physical abuse peer review including case selection and process. Due to the high-stakes nature in the field of child abuse pediatrics, rigorous quality assurance practices and oversight mechanisms are essential to safeguard children, families, health care providers, and intersecting systems. The Suspected Child Abuse and Neglect program at The Hospital for Sick Children, Toronto, Canada developed a structured peer review process for cases of suspected physical abuse. Included in the process is an approach for the evaluation of institutional complaints received related to a child abuse pediatrician's medical opinion. This quality assurance process is presented so that other child abuse pediatricians and programs may replicate or adapt the protocol for their own local context.

Impacts on paediatricians testifying in cases of child maltreatment: protocol for a systematic review

IntroductionPaediatricians perform medical assessments for children in cases of suspected child maltreatment. Due to their role with statutory child protection agencies and police, paediatricians may be asked to testify in...

A silent scream in the pediatric emergency department: child abuse and neglect.

Child abuse and neglect includes any behavior that harms the child or hinders the child's development. The aim of this study was to determine the demographic and clinical characteristics of patients with suspected child abuse or neglect in the pediatric emergency department. Between July 2017 and July 2022, patients admitted to our pediatric emergency department and consulted to the medical social services unit with a preliminary diagnosis of neglect and/or abuse were retrospectively scanned through the registry system. The patients were divided into five groups according to their victimization: physical, sexual, and emotional abuse; neglect; and medical child abuse (MCA)-Munchausen by proxy. A total of 371 children were included in the study. Two hundred twenty-two (59.8%) of the patients were female and the median age was 161months [IQR (46-192)]. Then, 56.3% of the patients were in the adolescent age group. The most common admission time period was between 16.00 and 24.00 (n 163, 43.9%). Then, 24.2% of the patients were exposed to physical abuse, 8.8% to sexual abuse, 26.1% to emotional abuse, 50.4% to neglect, and 3.2% to MCA. One hundred eight (29.1%) patients were followed up as inpatients in the pediatric intensive care unit. Four of the patients (1%) had out-of-hospital cardiac arrest, and the deaths were in patients under 2years of age. Conclusion: Pediatric emergency departments are one of the important units visited by child maltreatment patients. Victimized children may reflect their silent screams with various clinical presentations. Infants are at the greatest risk of suffering serious or fatal injuries. Health professionals working in the emergency department have an important role in detecting, treating, and preventing recurrence of child neglect and abuse. What is Known: • The pediatric emergency department is an important entry point in the health care system for children who experience maltreatment. • It has a wide spectrum of physical, sexual, emotional abuse and neglect. What is New: • A high index of suspicion is required to diagnose cases of child maltreatment. • Infants are at the greatest risk of suffering serious or fatal injuries.

The Nature and Scope of Reported Child Maltreatment in Euro-CAN Countries: Current Evidence and Future Opportunities

Most European Cooperation on Science and Technology (COST) affiliated countries aim to advance the goal of protecting children from maltreatment. However, despite the increasing numbers of population-based surveys, the development of administrative data systems has lagged. In this study, we aimed to examine the current state of development of administrative data systems in a sample of countries represented in the COST Action 19106 network, Multi-Sectoral Responses to Child Abuse and Neglect in Europe: Incidence and Trends (Euro-CAN). A structured questionnaire was distributed to researchers and professionals within Euro-CAN-affiliated countries, which captured economic, legislative, systemic, and data infrastructure characteristics. Thematic trends for 13 sampled countries were presented descriptively. The implementation of legislative measures such as banning corporal punishment varied substantially, with some countries decades apart. Almost all sampled countries mandate reports of suspected child maltreatment for all or some professionals in contact with children. In most countries, public child protection, health, or law enforcement systems are decentralized, and unsubstantiated/inconclusive incidents of suspected child maltreatment are not systematically collected at the national level. Child maltreatment data is not routinely collected in health sectors in all sampled countries. Where data is collected in different sectors, such as police and child protection agencies, different descriptions are often used. Systematic data linkage remains a seldom occurrence with only a few countries offering this capability. The call for Euro-CAN countries to develop multi-sectoral data systems to capture recorded instances of child maltreatment remains relevant.

Effects of COVID on Mandated Child Abuse Reporting Among Nurses: The Mediating Role of Compassion Fatigue.

Because COVID triggered elevated rates of child abuse, but diminished rates of child abuse reporting, we explored predictors of nurses' attitudes toward reporting suspected child abuse during the COVID pandemic. In particular, we expected that compassion fatigue and compassion satisfaction would mediate the effects of COVID-related stressors (i.e., exposure to COVID patient death and suffering; COVID-related family income loss; frequent direct care of COVID patients; and parental burnout) on nurses' negative attitudes toward reporting suspected child abuse. Employing chain-referral sampling, we recruited a sample of 244 registered nurses (83% White; 87% women). Supporting hypotheses, compassion fatigue mediated the effects of job-related COVID stressors (exposure to COVID patient death and suffering; COVID-related family income loss; and frequent direct care of COVID patients) on nurses' negative attitudes toward reporting suspected child abuse. In addition, among nurses who were also parents, nurses' self-reported parental burnout mediated the relation between compassion fatigue and negative attitudes toward reporting suspected child abuse. In addition, compassion satisfaction mediated the effect of nurses' parental burnout on nurses' negative attitudes toward reporting suspected child abuse.

Improving access to child abuse evaluations through innovation & telemedicine

Many children and families do not have access to specialized pediatric health care, including child abuse pediatricians. Medical evaluations in cases of suspected child maltreatment including physical abuse, sexual abuse, and neglect are a critical component of the multidisciplinary team response to these concerns. We review the role of child abuse pediatricians in cases of suspected child maltreatment. We discuss the advantages and disadvantages of current models of care including co-location of child abuse specialists within children's advocacy centers, hospital-based medical evaluation programs and community-based clinics. We review barriers to universal and equitable access to specialized care. We then highlight the significance of telemedicine as an important tool for improving access to care for children who would not otherwise have access.

Mandated reporting policies and the detection of child abuse and neglect

In federal fiscal year 2019, approximately 3 million reports of suspected child abuse or neglect (CAN) met the criteria for an investigation or alternative response. Yet only 656,000 children were found to be victims of CAN. Such a large proportion of unsubstantiated CAN reports may indicate that the child welfare system is using already limited resources on reports that could be avoided with policies that better foster the accurate detection of CAN. Little research exists examining the relationship between mandated reporting policies and reported and substantiated CAN. To address this gap, we explore how five different mandated reporting policies are associated with rates of reporting and odds of substantiation. We utilized data from NCANDS, the SCAN Policies Database, and the U.S. Census. We found mandated reporting policies were not associated with rates of reporting or substantiation. However, the relationship between different policy characteristics and reports and substantiation were moderated by child race/ethnicity and the type of CAN experienced.

Associations between nurse characteristics, institutional characteristics and perceived nurse knowledge and self-efficacy of reporting suspected child abuse and neglect.

To determine the association between nurse and institutional characteristics and perceived professional nurse knowledge and self-efficacy of reporting child abuse and neglect. A sample of N = 166 nurses were recruited to respond to the Reporting of Suspected Child Abuse and Neglect (RSCAN) survey. A multiple linear regression examined whether nurse characteristics and institutional characteristics were associated with the two RSCAN survey domain scores. Perceived knowledge of a workplace child abuse and neglect protocol was associated with the knowledge subscale. Education and child abuse and neglect expertise were significant predictors of the self-efficacy subscale. Nurses with a master's or higher degree and those who identified as being either forensic, paediatric or Emergency Department nurses, had less perceived institutional barriers to self-efficacy of reporting child abuse and neglect. This study provides a preliminary insight into the institutional barriers and facilitators of nurses as child abuse and neglect mandated reporters. To encourage innovative education and collaborations to support nurses as fully informed child abuse and neglect mandated reporters. This research identifies the gaps and facilitators of nurses as child abuse and neglect mandated reporters to inform healthcare professionals and academic institutions on the importance of nurse education and experience in nurse knowledge and self-efficacy in reporting suspected child abuse and neglect. The authors of this study have adhered to relevant EQUATOR guidelines: STROBE. There is no patient or public contribution as the study only looked at nurses.

Childhood trauma and factors influencing primary school teachers' reporting of child abuse: Insights from Italy

BackgroundChildhood traumatic experiences can profoundly impact individuals, posing risks to the physical and psychological well-being of children and influencing their psychological development. Teachers in primary schools play a critical role in identifying and reporting suspected cases of child abuse and maltreatment (CAM), which initiates child protection interventions. However, the psychological factors that influence teachers' likelihood of reporting suspected CAM cases remain largely unexplored. AimThis study investigates the influence of teachers' childhood traumatic experiences and psychological factors (i.e., cognitive empathy and psychological detachment) on their reporting behavior regarding child abuse and maltreatment, addressing an important social issue. ParticipantsThe study involved 1380 primary school teachers from Italy (88.3 % female; aged 21–69, Mage 46.7, DS 10.3). ResultsThe results reveal that teachers with a history of childhood emotional abuse tend to report a higher number of suspected child abuse and maltreatment cases. Other forms of traumatic childhood experiences were not significantly associated with teachers' reporting suspected cases of CAM. Additionally, cognitive empathy and psychological detachment emerge as significant predictors of teachers' reporting behavior. ConclusionsThis research contributes to the existing literature by providing unique insights into actual reporting behavior within an unexplored cultural context.