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A silent scream in the pediatric emergency department: child abuse and neglect
Bilge Akkaya1, Cihan İnan2, İpen İlknur Ünlü3
1Department of Pediatric Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkey. bilgekorkusuz@hotmail.com.
Insights
Pediatric emergency departments are crucial for identifying child abuse and neglect. Infants face the highest risk of severe injury or death from maltreatment, highlighting the need for vigilance.
Area of Science:
- Pediatrics
- Child Health
- Emergency Medicine
Background:
- Pediatric emergency departments serve as a critical access point for children experiencing maltreatment.
- Child maltreatment encompasses a broad range of abuse and neglect, including physical, sexual, emotional, and medical child abuse (MCA).
Purpose of the Study:
- To investigate the demographic and clinical characteristics of children presenting with suspected abuse or neglect in a pediatric emergency department.
- To analyze the types of maltreatment and patient outcomes within this setting.
Main Methods:
- A retrospective review of patient records from July 2017 to July 2022.
- Inclusion criteria: patients seen in the pediatric emergency department with a preliminary diagnosis of neglect and/or abuse, consulted by medical social services.
- Categorization of victimization into physical, sexual, emotional abuse, neglect, and medical child abuse (MCA).
Main Results:
- A total of 371 children were analyzed; 59.8% were female, with a median age of 161 months (56.3% adolescents).
- The most frequent admission period was 4 PM to midnight (43.9%).
- Prevalence of victimization included: neglect (50.4%), physical abuse (24.2%), emotional abuse (26.1%), sexual abuse (8.8%), and MCA (3.2%). 29.1% required intensive care, and 1% experienced out-of-hospital cardiac arrest, with deaths occurring in children under two years.
Conclusions:
- Pediatric emergency departments are vital for detecting child maltreatment.
- Infants are particularly vulnerable to severe and fatal injuries.
- A high index of suspicion is essential for healthcare professionals to diagnose and manage child abuse and neglect effectively, preventing recurrence.
Abstract:
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 161 months [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 2 years 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.
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