COVID and Child Abuse May 27, 2020 - PowerPoint Presentation

1. COVID and Child AbuseMay 27, 2020Gunjan Tiyyagura MDAssistant Professor of Pediatrics and Emergency Medicine

2. ObjectivesReview risk factors for child abuseConsider parental stress Recognize the impact of lockdown on surveillanceDCF Careline numbers since COVIDRemember what we learned from the Great Recession of 2007-2009Review what EMS providers can doRecognize sentinel injuries

3. Framing the risk: babies and toddlers2018 Child Protective Services data:Of all child abuse fatalities, 46.6% were infants younger than 1 year old.70.6% of all child abuse fatalities were children less than 3 years old.

4. Ecological model of risk for maltreatmentChildParentFamilyCommunityUnwantedMother < 19 years at child’s birthFamily violencePovertyDisabled (including behavioral, learning, emotional disability)Substance abuseFamily isolationUnemploymentMultipleMental illnessSingle parentCommunity violencePretermDevelopmental delayMany children under 5 years of ageResidential fluxAbuse in childhoodHousehold flux

5. Impact of lockdown

6. DCF Careline calls down by almost 50%TeachersIn home servicesPediatric offices

7. To evaluate the rate of abusive head trauma (AHT) in 3 geographic regions of the US before and during an economic recessionThe recession was defined as December 1, 2007, through June 30, 2009.

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9. Increase in the AHT rate during an economic recession in 3 distinct geographic regions encompassing a total of 74 counties. Even though the unemployment rate increased in each of the three regions, there was no association between AHT rates and county level unemployment rates.

10. What can you do?Safety check-insCall med control at pediatric ED for any questions or concernsConsider abuse and neglectReport to DCF when concern about abuse or neglectRecommend resources“When it Builds Up, Talk it Out” or call 1-833-258-5011DCF COVID-19 resource pageSafe Connect

11. History Red FlagsParental refusal to interviewing child aloneHx inconsistent with injuryHx vague, lacking in detailHx changes or is conflictingInjury attributed to sibling (or pet) actionsNo hx offeredHx inconsistent with developmental stageImplausible History

12. Worrisome exam findingsBruises Oral injuries

13. Bruises: epidemiologyTo obtain a prevalence rate and determine the distribution of accidental bruising in babies177 babies aged 6–12 months seen in primary care settings22 (12%)babies had bruises. All bruises were found on the front of the body and were located over bony prominences. (12%)There was a highly significant increase in bruises with increase in mobility. Carpenter 1998

14. Prospective study examining bruising in children < 4years of ageTorso NeckEar Any bruise < 4 months (upto 5 mos) TEN 4

15. F: Frenulum tearsA: Angle of JawC: CheekE: EyelidS: Subconj hemorrhageP: Patterned FACES PSens 97% and Spec of 87% to predict abuse Pierce, MC

16. Oral injuries: Epidemiology in the PED setting1303 children < 2 y.o. presenting to pediatric ED36 (2.76%) had oral injuries26 (72%) were associated with traumatic chief complaints (most in mobile children)Only 6 (1.4%) oral injuries in children < 5 mos5/6 had medical chief complaints and 4/6 underwent child abuse consultation Consider Abuse in pre mobile infants with oral injuriesWoolf S et al, Child Abuse & Neglect

17. Sentinel InjuriesOf 200 definitely abused infants, 27.5% had a previous sentinel injury compared with 8% of the 100 infants with intermediate concern for abuse.None of the 101 non-abused infants (controls) had a previous sentinel injury. The type of sentinel injury in the definitely abused cohort was bruising (80%), intraoral injury (11%), and other injury (7%). Sheets, et al 2013

18. Case Presentation2-month-old female with oral injury

19. Comments or Questions?THANK YOU FOR ALL YOU DO