Recurrent concerns for child abuse: repeated consultations by a subspecialty child abuse team

Area of Science:

• Pediatrics
• Child Abuse and Neglect
• Forensic Medicine

Background:

• Physically abused children often have repeated contact with child protection services and medical evaluations.
• Limited data exists on recurrent evaluations by hospital-based child abuse teams for suspected abuse.

Purpose of the Study:

• To determine the frequency of repeat consultations by child abuse teams.
• To describe the characteristics of children undergoing repeat consultations, including injury patterns, perceived abuse likelihood, and disposition.
• To identify factors associated with repeat consultations.

Main Methods:

• Secondary analysis of prospectively collected data from the Examining Siblings to Recognize Abuse (ExSTRA) research network.
• Inclusion of children under 10 years referred to child abuse subspecialty teams at 20 U.S. academic centers.
• Analysis of consultation frequency, injury patterns, perceived abuse likelihood changes, and disposition plans.

Main Results:

• Repeat consultations occurred in 3.5% of 2890 subjects.
• Mortality rates were similar between single (3%) and repeat (4%) consultations.
• Perceived likelihood of abuse remained stable in 57.2% of cases, with shifts from low-to-high (16.5%) and high-to-low (26.4%).
• Factors in repeat abuse cases included return to the same environment, safety plan non-compliance, and abuse in foster care.

Conclusions:

• Repeated consultations by child abuse specialists involve a minority of children.
• This cohort may face a higher risk of subsequent abuse.
• These cases present opportunities for quality improvement in child protection and intervention strategies.