Suspected Child Abuse Research Articles

Providers Assessing Child Abuse and Neglect

Providers Assessing Child Abuse and Neglect

Judgements of physicians, nurses, and social workers regarding suspected Child maltreatment in community health care services.

This study investigated how physicians, nurses, and social workers in community health care services make judgements about possible child maltreatment in ambiguous situations. We examined the influences of social biases (i.e., perceptions linking ethnicity, gender, and family socioeconomic status to child maltreatment) and belonging to distinctive occupational groups (i.e., physicians, nurses, and social workers) on professionals' assessment of suspected child maltreatment, intention to consult with others, and reporting. We used an experimental survey design including vignettes presenting a child's history inspired by real-life clinical cases. Data were collected from 397 health care professionals-170 physicians, 179 nurses, and 48 social workers-employed at community health care clinics in northern Israel. Findings show that the child's gender and family socioeconomic status had significant effects on assessment of possible child maltreatment. Also, professionals' occupational group had significant effects on assessment of child maltreatment and intention to pursue consultation. Another key finding was the significant effects of judgements about child maltreatment assessment, consultation, and reporting on one another. The study reinforces efforts to improve health care professionals' management of suspected child maltreatment that include the development of clinical decision support systems that use routinely collected electronic medical record data.

Child neglect in Saudi Arabia: The neglected form of child maltreatment.

Objectives:To shed light on types, family profiles, risk factors, and outcomes of child neglect in Saudi Arabia.Methods:A retrospective chart review was carried out at King Abdullah Specialized Children’s Hospital, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia. Cases of child neglect diagnosed by the Suspected Child Abuse and Neglect (SCAN) team were reviewed. Data were extracted from patients’ electronic charts and SCAN team records.Results:A total of 309 cases of child neglect were diagnosed between 2015-2019. Mean age of victims was 4.4±4.1 years, and 51.8% were male gender.Supervisory neglect was the most common form (63.1%), followed by medical neglect (39.2%), emotional neglect (6.8%), physical neglect (5.5%), and educational neglect (3.2%). Children between the ages of one and 3 years were 3.3 times more likely to be victims of supervisory neglect and girls were 4.5 times more likely to be victims of educational neglect. Children living with ≥4 siblings were 7 times more likely to be victims of physical neglect and 1.9 times of medical neglect. With regard to emotional neglect, children of unemployed fathers were 3.5 times more likely to be parentally neglected than children of employed fathers. Worsening of the underlying disease (30%) and internal injuries (23.5%) were the most common consequences of neglect. Mortality attributed to neglect was documented in 8 (2.6%) children.Conclusion:Although child neglect is common in Saudi Arabia, it has not been recognized as an important cause of morbidity and mortality of children. This implies the need for a national protocol that would help identify high-risk families for early detection and implementation of prevention programs.

Postmortem and Antemortem Forensic Assessment of Pediatric Fracture Healing from Radiographs and Machine Learning Classification.

Simple SummaryBeing able to estimate from X-rays alone how long ago a child’s bone was fractured is important for prosecuting suspected child abuse of living or dead children. This estimate can also help identify a child when all that remains are bones. Experts use various indicators to make these estimates of the age of healing and fully healed fractures, in living and deceased persons, even years after the injury occurred. However, it is not a precise science. We proposed a method using a new combination of indicators to classify fracture healing in children and adolescents. We tested its accuracy with a public database of X-rays of children’s fractures taken during the treatment and healing process. We used part of the X-ray database for training artificial intelligence (AI, or machine learning) programs to classify stages of bone healing when using our new system. We used another portion of the same database to test the performance of the AI system that had been trained with our new classification system. Our new system addresses certain classification ambiguities of a currently used system and is similar in accuracy.A timeline of pediatric bone healing using fracture healing characteristics that can be assessed solely using radiographs would be practical for forensic casework, where the fracture event may precede death by days, months, or years. However, the dating of fractures from radiographs is difficult, imprecise, and lacks consensus, as only a few aspects of the healing process are visible on radiographs. Multiple studies in both the clinical and forensic literature have attempted to develop a usable scale to assess pediatric bone healing on radiographs using various healing characteristics. In contrast to the orthopedic definition, a fracture in forensic casework is only considered to be healed when the area around the fracture has been remodeled to the point that the fracture is difficult to detect on a radiograph or on the surface of the bone itself, a process that can take several years. We subjectively assessed visible characteristics of healing in radiograms of fractures occurring in 942 living children and adolescents. By dividing these assessments into learning and test (validation) sets, the accuracy of a newly proposed fracture healing scale was compared to a previous study. Two machine learning models were used to test predictions of the new scale. All three models produced similar estimates with substantial imprecision. Results corroborate the Malone model with an independent dataset and support the efficacy of using less complex models to estimate fracture age in children.

Clown doctors and forensic paediatricians enhance the patient experience at the Royal Children's Hospital in Melbourne

AbstractWe evaluated medical clown intervention in suspected child abuse and neglect assessments. A mixed method methodology (Likert scales and free text responses) was used to measure the impact of clown doctors at 49 forensic consultations. Of 35 responding children, 43 per cent reported neutral or negative feelings on arrival whereas 97 per cent reported either positive feelings or sadness at leaving the clown doctor. Children’s memories of the consultation were of interacting with clown doctors, not their physical examinations. Of 45 responding caregivers, 95 per cent deemed the clown doctor developed a positive connection with the child, 96 per cent felt their child enjoyed their visit and 93 per cent felt the clown doctor improved their own experience. Both caregivers (94%) and paediatricians (92%) valued an opportunity to talk privately while children engaged with clown doctors. All 45 responding caregivers felt their child would be willing to return to hospital in the future. In all 49 cases, paediatricians reported that clown doctors increased children’s willingness to cooperate with the medical assessment. Forensic paediatricians (92%) reported that clown doctors actively supported the medical evaluation process while 100 per cent reported no harm from the intervention. We concluded that clown doctors positively impact the patient, carer and paediatricians experience during children’s forensic medical assessments.

Identification of Initial and Subsequent Injury in Young Infants: Opportunities for Quality Improvement in the Evaluation of Child Abuse.

Six children's hospitals identified infants with an initial injury and recurrent injury over a 1-year period using 2 methods: (1) diagnostic code method - infants 6 months or younger presenting with at least 1 diagnostic code for injury were tracked for 12 months to determine the frequency of recurrent injury, and (2) consult method - all available medical records of children 18 months or younger seen for an inpatient consultation for suspected child abuse were reviewed to identify history of a first injury at 6 months or younger. Using the diagnostic code method, 682 unique infants were identified with initial injuries, most commonly fractures (37.0%), bruising/ecchymosis (35.9%), and superficial injuries (28.3%). Forty-two infants (6.2%) returned with a second injury, and no demographic factors were significantly associated with the likelihood of a second injury. Using the consult method, 37 of 342 consults (10.8%) were identified as having a history of at least 1 initial injury. Of the initial injuries identified, the most common was bruising/ecchymosis (64.9%). The number of injuries identified with either method varied significantly across hospitals, as did completion of skeletal surveys for infants with bruising (range, 4.5%-71.1%; P < 0.001) and any injury (range, 4.4%-62.7%; P < 0.001). Our study demonstrates that young infants who experience 1 injury often experience a second injury. There exists significant variability in the identification of injury and the completion of skeletal surveys across a network of 6 children's hospitals. A standardized quality improvement approach may improve identification of injury and reduce the variability in practice observed.

Description of the initial approach to patients with suspected child abuse in the emergency department of a pediatric hospital.

Child abuse is one of the leading causes of morbidity and mortality worldwide. This study aimed to identify whether the approach to the diagnosis of child abuse was comprehensive in a tertiary care hospital. We conducted a retrospective study of patients with a final diagnosis of child abuse admitted through the emergency department. A total of 73 confirmed cases were analyzed. We observed a predominance of female patients (65.8%). Physical abuse was the most common type of abuse (80.8%). Complete blood count and a nutritional status analysis were recorded in 100% of the patients and coagulation times in 43%; however, no patient had a thorough bone series study. According to the evidence found in medical records, gaps were detected in the approach to patients with suspected child abuse upon arrival at the emergency department. For this reason, all areas where pediatric medical care is provided should have tools that offer agility and ease of diagnosis.

Evidence-Based Screening to Optimize the Yield of Positive Ophthalmologic Examinations in Children Evaluated for Suspected Child Abuse.

To determine nonocular findings associated with significant retinal hemorrhage on dilated fundus examination in cases of suspected child abuse. This was a retrospective chart review from May 2014 to August 2021 at a level-1 trauma center. Two hundred seventy-four patients met the following inclusion criteria: (1) children 36 months and younger; (2) concern for child abuse; and (3) had an ophthalmology consultation. Through univariate and multivariate logistic regression, the study produced a screening algorithm for ophthalmic work-up in child abuse. One or more abnormal neuroimaging findings had a statistically significant association with retinal hemorrhages and produced the strongest association with a univariate odds ratio of 170 (confidence interval: 10.245 to > 999.999). The multivariate model (P < .0001 with a c-statistic of 0.980) proposes using the following variables for predicting retinal hemorrhage on examination: abnormal neuroimaging, Glasgow Coma Scale score less than 15, altered mental status on examination, seizure activity, vomiting, bruising, scalp hematoma/swelling, and skull fractures. This study elucidates clinical and imaging factors that correlate to retinal findings, validating previously studied variables and introducing new variables to be considered. The authors propose an evidence-based screening algorithm to increase the yield of positive dilated examinations and decrease the burden of potentially unnecessary child abuse ophthalmologic examinations. [J Pediatr Ophthalmol Strabismus. 2022;59(5):310-319.].

Potential Reporters of Suspected Child Maltreatment are Sensitive to the Amount of Evidence and the Potential Consequences of Reporting

Potential Reporters of Suspected Child Maltreatment are Sensitive to the Amount of Evidence and the Potential Consequences of Reporting

Segregating Suspected Child Maltreatment from Non-Child Maltreatment Injuries: A Population-Based Case-Control Study in Taiwan.

Objective: To identify the differential patient characteristics, injury types, and treatment outcomes between hospitalized child abuse and non-child abuse injuries in Taiwan. Methods: Using the data from the National Health Insurance Research Database, we selected a total of 1525 patients under the age of 18 that were diagnosed with child abuse, as well as an additional 6100 patients as a comparison group. Chi-square test, Fisher exact test, and independent samples t-test were used to compare the differences between the abused children and the non-abuse-related injured children. The multivariate conditional logistic regression was performed to measure the risk factor of child maltreatment in injured children. Results: Intracranial injury was more frequent in the child abuse group than it was in the non-child abuse group (35.0% vs. 8.2%; p < 0.001). Children in the child abuse group tended to stay longer in the hospital and incur higher medical expenses (8.91 days vs. 4.41 days and USD 2564 vs. USD 880, respectively). In multivariate analysis, the Adjusted Odds Ratio (Adjusted OR) of abuse resulting in an injury for children in low-income families is 1.965 times higher than those in non-low-income families (p < 0.001). Children living in high urbanization areas had a significantly higher probability of being abused than those living in low urbanization areas (p < 0.001). Conclusion: Children under the age of 1 who were hospitalized with severe intracranial injuries are highly at risk for child maltreatment. Moreover, numerous high-risk environmental factors were observed in child abuse cases, including living in urban areas, families with low income, and seasonality, as child maltreatment cases occur more frequently in autumn.

Potential Reporters of Suspected Child Maltreatment are Sensitive to the Amount of Evidence and the Potential Consequences of Reporting.

The context of suspected maltreatment cases is likely to influence the decision of whether or not to make a formal report. Across one pilot study (N = 368) and two experiments (Exp. 1N = 444; Exp. 2N =416), undergraduate students and online community participants reported their anticipated actions and beliefs when confronted with evidence of child maltreatment. Participants reviewed case dossiers built from real-world child neglect cases in which increasing levels of evidence were presented and the consequences of reporting, or not reporting, the maltreatment were made salient to the adult or child. The experiments revealed a clear difficulty in deciding whether or not to report suspected maltreatment. Highlighting the impact on either the child or the adult by describing potential consequences moved participants either closer to (child-salient) or farther from (adult-salient) a formal report. Participants were also sensitive to the amount of evidence to support a suspicion of abuse, which influenced the likelihood of a formal report. This work suggests that increasing the salience of maltreatment consequences to child victims may increase the likelihood that suspected maltreatment will be reported.

Home‐visiting mental health professionals' differentiations between acceptable and unacceptable parent discipline behaviours in Hong Kong: A q‐study

Home-visiting mental health professionals (HMHPs) have an important role in identifying suspected child maltreatment in the community. However, it is unclear how professionals in Hong Kong differentiate acceptable discipline behaviours from reportable forms of abuse, and how their characteristics may influence their view. This study examined HMHPs' views on acceptable versus unacceptable parent discipline behaviours. Using Q-methodology, 50 HMHPs in Hong Kong sorted 52 statements on parent discipline behaviours along a continuum ranging from ‘Most Unacceptable’ to ‘Most Acceptable’. By-person factor analysis was conducted to uncover prevailing views based on their sorts. Three unique viewpoints in differentiating discipline behaviours from abuse were uncovered, which varied based on how HMHPs prioritised children's physical safety, mental wellness and parental intention. Different views were supported by professionals with different characteristics and occupational backgrounds.

Did Child Neglect Cause Severe Injuries in Nine Children?: Case series from a regional hospital in Oman.

Child abuse and neglect (CAN) is a global phenomenon that takes many forms, with child neglect being the most common. CAN comprises serious incidents with medicolegal implications for the caregivers. The recognition of CAN is still in its early stages in Middle Eastern cultures, including in Oman, where parental authority over children is traditionally sacrosanct. This case series presents nine serious incidents from a regional hospital in Oman from 2020-2021 that appear to fulfil the definition of child neglect. All cases were diagnosed by the Suspected Child Abuse and Neglect (SCAN) team. This article provides evidence that child neglect exists in Oman and has resulted in the death of some children while causing significant physical, psychological and social sequelae in others. It also addresses risk factors and provides recommendations for management. Furthermore, the experience of the SCAN team and limitations of the current Child Protection Services in Oman are highlighted.

Effect of Quarantine and Reopening Measures on Pediatric Trauma Admissions During the 2019 SARS-CoV2 Virus Pandemic.

Several studies have reported decreased trauma admissions and increased physical abuse in children resulting from stay-at-home measures. However, these studies have focused on a limited period after the implementation of lockdown policies. The purpose of this study was to examine the effect of quarantine and reopening initiatives on admissions for varying types of injuries in pediatric patients. Registry data for an urban Level I pediatric trauma center were evaluated from April 1, 2018, to March 30, 2021. A timeline of local shutdown and reopening measures was established and used to partition the data into 6-month intervals. Data about demographics and injury characteristics were compared with similar intervals in 2018 and 2019 using appropriate statistical methodology for categorical, parametric, and nonparametric data. A total of 3,110 patients met criteria for inclusion. A total of 1,106 patients were admitted the year after the closure of schools and nonessential businesses. Decreases in overall admissions and evaluations for suspected child abuse noted early in the pandemic were not sustained during shutdown or reopening periods. However, we observed a 77% increase in all-terrain vehicle injuries, along with a 59% reduction in sports injuries (chi-square [8, N = 3,110] = 49.7; p < 0.001). Significant shifts in demographic and payor status were also noted. This is the first study to comprehensively examine the effects of quarantine and reopening policies on admission patterns for a pediatric trauma center in a metropolitan area. Total admissions and child abuse evaluations were not impacted. If shutdown measures are re-instituted, preventative efforts should be directed towards ATV use and recreational activities.

School‐based child abuse prevention: The role of school climate in intervention outcomes for teachers

AbstractSchool climate is an important potential mechanism by which school‐based prevention and intervention efforts exert their effects, although this is rarely examined in the context of child abuse prevention programs. The current study evaluated the effectiveness of a school‐based child abuse prevention curriculum; the Second Step Child Protection Unit (CPU), on improving teachers' knowledge and attitudes toward reporting suspected child abuse and the potential role school climate has on teachers' reporting behaviors. The sample included 162 school teachers participating in a randomized controlled trial who completed assessment measures at three time‐points (pretest, posttest, and 6‐month follow‐up). Results from the current study revealed that the Second Step CPU significantly improved teachers' knowledge and attitudes toward reporting suspected child abuse and there was a partial mediation effect of school climate on teacher outcomes at 6‐month follow‐up. These findings add to the literature on child abuse prevention by indicating that a comprehensive child safety intervention is not only effective for improving targeted outcomes, but also for improving the overall school climate. Therefore, understanding school climate as a mechanism of change may promote the successful implementation of school‐based child abuse prevention programs.

How do States Inform Nurses of Their Policies for Mandatory Reporting of Child Maltreatment?

Every state includes nurses as mandated reporters of suspected child maltreatment, and each state has its own law and policy regarding what is reportable and reporting requirements. These differences mean that generic training on child abuse and reporting needs to be augmented by practical state-specific information. In nearly every study of nurses, participants report having inadequate child abuse training. This paper presents an analysis of the information states post on their websites to educate nurses to appropriately identify and report suspected child abuse or neglect. Specifically, this study aims to answer the following questions: (1) how do mandated reporting laws that apply to nurses vary by state, (2) what information do states provide on their child protection and Board of Nursing websites about child maltreatment and mandatory reporting, and (3) what training resources do states make available on their websites to educate nurse mandatory reporters to ably fulfill their obligation? Data on state-by-state practices regarding mandated reporting of child abuse were gathered from the Rape, Abuse, & Incest National Network (RAINN) database, review of state statutes, Child Welfare Information Gateway, Board of Nursing sites, and the Nursing Licensure Compact (NLC) website. This analysis found that states provide little guidance or education about their child maltreatment laws, and few have resources targeted for nurses. Given rising membership in the NLC it is critical for nurses to have education about state specific mandated reporting requirements. States should consider adding mandatory reporting training as a requirement for licensure and for continuing education.

Prevalence of suspected child abuse in children with constipation: a case–control study

BackgroundA possible association between child abuse and neglect (CAN) and functional constipation (FC) has been described in adults, however, limited data are available in children. Our objective was to determine...

“A rising tide floats all boats”: The role of neighborhood collective efficacy in responding to child maltreatment

BackgroundNearly one-quarter of the approximately 400,000 reports to child protective services originating from non-mandated reporters come from neighbors. Understanding factors leading non-mandated reporters to contact authorities is important because if modifiable, they might serve as intervention targets to promote reporting of suspected maltreatment. ObjectiveInvestigate associations between neighbors' reported responses to scenarios involving children in need, child/teen misbehavior, and suspected maltreatment with individual and neighborhood characteristics, including neighborhood collective efficacy, fear of victimization, and fear of retaliation. HypothesisIncreased collective efficacy would be associated with increased likelihood of neighbors taking action in response to the situation. Participants & setting400 caregivers of minors in Cleveland, OH, USA living in 20 census tracts. MethodsGeneralized linear mixed-effects modeling. ResultsAnalyses adjusted for covariates confirmed our primary hypothesis: a 1-unit increase in the collective efficacy measure was associated with a 64% increase in the odds of neighbors taking action compared to doing nothing (odds ratio = 1.64, 95th percentile confidence interval 1.41–1.92). Also, participants with less than a high-school education had 36% greater odds of reporting their neighbors taking action compared to more educated participants. An interaction effect between participants' fear of victimization in their neighborhood, but not fear of retaliation, was also observed: the effect of collective efficacy on the odds of neighbors taking action was substantially greater among residents expressing moderate and high fear of victimization. ConclusionEnhancing collective efficacy may be an effective strategy for fostering community response to suspected child maltreatment and other situations of a child in need because it may catalyze a variety of positive responses to these situations.

A regional multidisciplinary network enhances child abuse case management

We previously reported an inadequate response to intracranial hemorrhage (ICH) cases under 24 months of age in Yokohama from 2011 to 2013. Hence, it is very important to evaluate how the establishment of a regional multidisciplinary network for child abuse affects the response to ICH cases in medical institutions. We conducted a questionnaire survey of ICH cases under 24 months of age from 2014 to 2016 using a regional multidisciplinary network for child abuse established in Yokohama in September 2013. We investigated the patients' characteristics, examinations to identify inflicted injury, and reports made to the hospital-based child protection team (CPT) or regional child protective service (CPS), and compared the results of a previous study and the current study, which corresponds to before and after the establishment of the regional network, respectively. The total number of ICH cases was 50 in 3 years. The number of cases surveyed for covert fracture and fundus hemorrhage increased significantly after the establishment of the regional network (P = 0.0001 and P = 0.0182, respectively). The number of cases reported as suspected child abuse was 41 (82%) to the hospital-based CPTs and 27 (54%) to the regional CPSs. There were significant differences between before and after the establishment of the regional network regarding CPT (P = 0.0062) and CPS (P = 0.0215) reports. A regional multidisciplinary network can enhance response and cooperation to address child abuse. It deepens our understanding of such care and improves awareness by hospital personnel of child abuse.

Knowledge and attitude of physicians toward child abuse and reporting in a tertiary hospital in Riyadh.

Child abuse is a common global devastating issue for the patient and physician. It can lead to much unpleasant and danger and even death. One of the most essential parts of a doctor's job is to help people in need and a child should be top priority as they are dependent for protection and care. To analyze the experience and knowledge of Saudi residents from both specialty family medicine and pediatrics working in Riyadh city toward the recognition and diagnosis of child abuse and neglect and spot the light on the barriers that prevent its reporting and to assess the need for further training. A cross-sectional study was conducted in four major tertiary hospitals in Riyadh (KKUH, National Guard Hospital, King Fahad Medical City, Prince Sultan Medical City) from March 2019 to January 2020. Most participants did not have sufficient knowledge regarding the physical assessment of suspected child abuse and neglect. The result showed no significant difference in terms of knowledge and attitude between family physicians and pediatrics working in tertiary centers in Riyadh. The study concluded that the Saudi residents from both specialties, that is, family medicine and pediatrics, had insufficient knowledge regarding child abuse. In addition, the residents had positive attitudes toward child abuse prevention. Finally, the study recommends conducting awareness campaigns to increase the knowledge of physicians about child abuse and the predictive factors.