An unfortunate rise in child abuse

Due to stay-at-home orders, many public health advocates have expressed concern about potential rises in domestic abuse. Concerns have also been raised about the lack of recognition of abuse, especially with child abuse, as teachers are often the first members of a community to sound the alarm. With schools closed, such whistleblowers do not have the chance to intervene.

Literature from early in the covid-19 pandemic now appears to validate this concern. British researchers in London recently reported their institutional findings in a letter published in the British Medical Journal. The incidence of the abusive head trauma (AHT) during the month of self-isolation (March 23-April 23, 2020) in the United Kingdom was reviewed and compared with the rates from the corresponding period during the previous three years. 

All children who presented with AHT received a comprehensive examination and testing workup which included an ophthalmological assessment, skeletal survey (x-rays of the bones) and computed tomography and magnetic resonance imaging of the head and spine. Over the month-long period, ten children (six boys, four girls) with a mean age of 192 days (17-401 days) were treated compared to a mean of 0.67 cases per month in the same period over the previous 3 years. The most common complaints at the time of presentation were colic (50 percent), apnea (lack of breathing) with decreasing levels of consciousness (40 percent) and seizures (20 percent). The most common physical findings were hemorrhages in the retina (50 percent), extensive body bruising (50 percent) and swelling of the scalp (50 percent). The most common radiological findings were subdural hematomas (60 percent; subdural hematomas are abnormal collections of blood between the brain and the skull, usually caused by trauma, which can cause pressure to build up, eventually compressing the brain and potentially causing serious brain damage). 

When examining parental vulnerabilities, 70 percent of all parents with children suffering from AHT were found to have significant problems or stressors. These issues included financial concerns, mental health disorders and criminal histories. 

Despite a small overall number, when compared to the data from the previous three years, the increase in child abuse is a shocking development. And as noted by the authors of this study, the numbers reported in this article are likely to underrepresent the true increase in child abuse that occurred during the stay-at-home periods, given our knowledge of reduced patient volumes and hospital avoidance of patients and caregivers. In addition, because of social distancing, there may be others in the community (in addition to school teachers) who are not interacting with at-risk children as often as they normally would, making detection and reporting by concerned outside observers less likely.

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