Child Maltreatment: Hospital Admissions Fell During COVID-19 Lockdown, Then Rose in ICUs

Hospital admissions for maltreatment of children under the age of 2 years decreased by 31% during the initial 16-week lockdown phase of the COVID-19 pandemic, according to research published in the Canadian Medical Association Journal (CMAJ). However, following the lifting of restrictions, admissions to intensive care units (ICUs) for child maltreatment subsequently increased by 80%.

Researchers suggest the initial decline may not represent a true decrease in the incidence of child maltreatment, but rather a delay in case identification due to restricted healthcare access. As Dr. Matthew Carwana, a pediatrician at BC Children’s Hospital Research Institute in Vancouver, British Columbia, and his co-authors write, “young children experiencing maltreatment that may have warranted hospital admission did not appear to present to care during the period of restricted health care access.”

The study, conducted by the POPCORN (Pediatric Outcomes Improvement Through Coordination of Research Networks) group, compared hospital admissions from March 1, 2020, to March 25, 2023, with a prepandemic period spanning from April 3, 2016, to February 29, 2020. Data were analyzed from all Canadian provinces and territories, excluding Quebec, with additional data provided by l’Institut national d’excellence en santé et en services sociaux (INESSS) for Quebec. The analysis included 1,518 hospital admissions for child maltreatment among children under 2 years of age, representing approximately 750,000 children in that age range across the country.

The researchers posit that the subsequent increase in ICU admissions after the 16-week period of healthcare restrictions ended may indicate that child maltreatment continued during that time, but went undetected. This raises concerns that children may have been living in unsafe situations or experiencing abuse that was not identified due to the disruptions caused by public health measures.

The strict public health measures implemented during the early pandemic – including school closures, limited access to primary care physicians, and increased household stress and parental isolation – created a complex environment that could potentially increase the risk of child maltreatment. Despite this, few studies had previously examined the pandemic’s specific impact on this issue.

The authors emphasize the importance of considering hospital admissions for assessment of injuries consistent with child maltreatment as a potential trigger for intervention and prevention of more severe cases. They suggest that future pandemic preparedness plans should include mechanisms to identify cases of child maltreatment, even during periods of public health restrictions.

A related practice article published in the same issue of CMAJ provides guidance for clinicians on recognizing sentinel injuries and indicators of child physical abuse, encouraging vigilance in identifying potential cases. This article serves as a valuable resource for healthcare professionals seeking to remain alert for signs of abuse, particularly in the context of ongoing or future public health crises.

The study highlights the complex interplay between public health interventions and the well-being of vulnerable populations. While necessary to control the spread of the virus, restrictions on healthcare access may have inadvertently created conditions that increased the risk of undetected child maltreatment. The findings underscore the need for proactive strategies to ensure the safety and protection of children, even during times of significant public health challenges.