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Concerns about child maltreatment in hospitalized children
U Thyen1, J M Leventhal, S R Yazdgerdi
1Department of Pediatrics, Harvard Medical School Boston, MA, USA.
Insights
Clinicians reported concerns for child abuse and neglect in hospitalized children, particularly those from low-income, single-parent families. Illness severity also influenced reporting decisions for specific conditions.
Area of Science:
- Pediatric healthcare
- Child welfare
- Clinical social work
Background:
- Child abuse and neglect are significant public health concerns.
- Understanding factors influencing clinician reporting is crucial for child protection.
- Previous research highlights socioeconomic disparities in child maltreatment reports.
Purpose of the Study:
- To identify factors associated with clinicians' concerns about child abuse and neglect.
- To examine predictors of reporting hospitalized children to Child Protective Services (CPS).
- To investigate the influence of socioeconomic status, family structure, and illness severity on reporting.
Main Methods:
- Cross-sectional chart review of pediatric hospitalizations (n=5,446) across three cities.
- Data collected on clinician concerns for abuse/neglect, CPS reports, family income, ethnicity, family structure, child's age, and illness severity.
- Statistical analysis to determine independent associations between variables.
Main Results:
- Concerns for abuse (2.5%) and neglect (3.1%) were noted; 2.9% of children were reported to CPS.
- Younger child age, low income, and single-parent families were linked to increased concerns and reports.
- Low income correlated with neglect concerns, while illness severity impacted abuse concerns in head trauma and neglect concerns in meningitis cases.
Conclusions:
- Confirms associations between neglect, poverty, and single-parent families in hospitalized children.
- Increasing illness severity may prompt clinicians to consider delayed care and potential neglect.
- Findings underscore the need for targeted interventions and support for vulnerable families in pediatric settings.
Abstract:
This study examined factors associated with clinicians' concerns about abuse and neglect and reporting hospitalized children to Child Protective Services (CPS). Data came from a cross-sectional chart review from a random sample of pediatric hospitalizations 1988-1990 in three cities for five condition groups (n = 5,446), and included evidence of clinicians' concerns about physical abuse or neglect and reports to CPS, family income, ethnicity, family structure, child's age, and illness severity at admission. Concerns about abuse were noted in 2.5% of the total sample, concerns about neglect in 3.1%, and 2.9% of children were reported to CPS. Concerns about abuse were most frequent in children with head trauma (8.2%), and concerns about neglect in children with toxic ingestion (12.3%). Young age of child, low income, and single parent family were independently associated with increased frequencies of concerns and reports. Low income was significantly associated with clinicians' concerns about neglect, but not abuse or reports to CPS. Ethnicity was not significant after controlling for income and family structure. Severity of illness was associated with concerns about physical abuse (p = .02) among children with head trauma, and with concerns about neglect and frequency of reporting among children with meningitis (p < .01). Our results confirm the associations among neglect, poverty, and single-parent families among hospitalized children. Increasing severity of illness may make clinicians consciously or unconsciously consider that care has been delayed and the child neglected.