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Child Physical Abuse During the COVID-19 Pandemic Across Levels of Community Advantage

Henry T Puls1, Daniel M Lindberg2, Clemens Noelke3

  • 1Department of Pediatrics (HT Puls and M Hall), Children's Mercy Kansas City, Kansas City, Mo; University of Missouri-Kansas City School of Medicine (HT Puls), Kansas City, Mo.

Academic Pediatrics
|March 24, 2026
PubMed

Insights

Child physical abuse hospitalizations decreased during the COVID-19 pandemic, particularly for less severe injuries in disadvantaged communities. This suggests social factors influenced detection and reporting during the pandemic.

Area of Science:

  • Public Health
  • Pediatrics
  • Sociology

Background:

  • The COVID-19 pandemic significantly altered societal structures and healthcare access.
  • Understanding the impact on child maltreatment, specifically physical abuse, is crucial for public health.
  • Community socioeconomic status may influence the reporting and diagnosis of child abuse.

Purpose of the Study:

  • To investigate if community advantage moderated hospital encounter rates for child physical abuse during the COVID-19 pandemic.
  • To analyze trends in child physical abuse hospitalizations across different pandemic phases.
  • To examine the relationship between socioeconomic factors and the severity of abusive injuries during the pandemic.

Main Methods:

  • Population-based retrospective study analyzing data from 12 states (2019-2021).
  • Utilized the Child Opportunity Index 3.0 (COI) to measure ZIP code-level community advantage.
  • Calculated monthly rates of hospital encounters for physical abuse per 100,000 children (<5 years) and compared rates across pre-pandemic, early-pandemic, and mid-pandemic periods using Poisson regression.

Main Results:

  • Overall hospital encounters for child physical abuse decreased by 14.0% in the early pandemic compared to pre-pandemic levels.
  • Rates of physical abuse were significantly lower in early pandemic periods in low and very low community advantage areas (20.3% and 17.8% reductions, respectively).
  • Lower severity injuries (isolated skin injuries) saw significant reductions, while abusive traumatic brain injury and fractures did not show significant changes.

Conclusions:

  • The study indicates that lower severity abusive injuries were less frequently diagnosed early in the pandemic, especially in disadvantaged communities.
  • Findings suggest a complex interaction between social policies, community factors, and diagnostic practices affecting child abuse reporting.
  • Further research is needed to understand the interplay of prevention strategies and detection challenges in child abuse cases.
Abstract

Keywords:
COVID-19 pandemicchild abusechild opportunitycommunityneighborhood

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