COVID-19: Differences in sentinel injury and child abuse reporting during a pandemic

Pediatric Homicides: Not Just a Teenage Problem

INTRODUCTION

Homicide is a leading cause of death for American children. We hypothesized demographics and homicide circumstances would differ by victim age.

METHODS

We performed a retrospective analysis of the 2003-2020 National Violent Death Reporting System. The National Violent Death Reporting System collects data from nearly all 50 states, the District of Columbia, and Puerto Rico. Demographics (age, sex, race, and ethnicity), homicide year, and weapon type were abstracted. Inclusion criteria were pediatric victims (age < 18). Two groups: 0-4 y old (young cohort [YC]) and 13-17 y old (teen cohort [TC]) were compared. Chi-squared tests, p-test, and t-tests with significance P < 0.05 were used to determine the association between victim demographics, cohort, and homicide mechanism.

RESULTS

10,569 pediatric (male: 70.2% [n = 7424], median age: 12 y old [interquartile range 1-16], black: 52.7% [n = 5573]) homicides met inclusion. Homicides demonstrated a bimodal age distribution (YC: 40.9% [n = 4320] versus TC: 48.9% [n = 5164]). Gender and race were both associated with homicide victimhood (P < 0.001). TC homicides were more likely to be male (YC: 57.8% [n = 2496] versus TC: 83.7% [n = 4320], P < 0.001) and black (YC: 40.1% [n = 1730] versus TC: 65.0% [n = 3357], P < 0.001). Pediatric homicides increased from 2018 (n = 1049) to 2020 (n = 1597), with only TC demonstrating a significant increase (2018: n = 522 versus 2020: n = 971, P < 0.001). Homicide mechanism was significantly associated with age (Blunt: YC: 57.5% [n = 2484] versus TC: 2.9% [n = 148], P < 0.001; Penetrating: YC: 7.9% [n = 340] versus TC: 92.8% [n = 4794], P < 0.001).

CONCLUSIONS

Pediatric homicides demonstrate distinct demographic characteristics and homicide mechanisms between two at risk age cohorts. Age-based education and intervention strategies may increase injury prevention programs' efficacy.

The impact of SARS-Co-V pandemic on violence against children: one institution's experience

Violence against children (VAC) is a global issue due to its biological, psychological, and social effects. Research in this field is valuable for understanding unknown aspects of VAC and for defining updated intervention strategies. Until now, there have been no clear indications about the possible effects of the SARS-CoV-2 pandemic on VAC. In this study, the authors compared quantitative and qualitative variables of pre-pandemic and pandemic cases evaluated at an Italian center specialized in VAC. The aims were to determine if the cases referred for VAC changed during the pandemic and if there were statistically significant differences in variables' distributions between pre-pandemic and pandemic periods. The referrals during the first 13 months of the 2020 SARS-CoV-2 pandemic were compared to cases referred over 13 months (2018-2019) to the same center. The analysis showed no statistical differences between age distributions and most qualitative variables. A decrease in the number of cases was observed. The comparison of frequency distributions of most variables between pre and post-pandemic samples did not differ. The most important result of the analysis is that the volume of observed VAC cases decreased during the pandemic period, confirming the indications of the scientific literature. It could not be excluded that the decrease was due to the negative impact of the pandemic on the child protection system. The above data could help develop innovative prevention tools and corrective intervention programs for future emergencies.

"Locked in a Jail Cell in Your Own Home": Child Maltreatment Investigators' Perspectives of COVID-19's Effects on Maltreated Children

Children were at a greater risk of adverse experiences, including maltreatment, during the COVID-19 pandemic given the increased stress experienced by families and reduced visibility outside the home. Child maltreatment investigators witnessed the effects of the pandemic on maltreated children and offer valuable insight regarding children's experiences during the pandemic. The objective of this study was to examine child maltreatment investigators' perspectives of the impact of the COVID-19 pandemic on maltreated children and their families in Canada. Sixteen child maltreatment investigators were recruited from agencies across Canada that investigate or offer services to children suspected of having been maltreated. Three focus groups were conducted, which followed a semi-structured interview guide developed by the researchers. Thematic analysis resulted in five primary themes regarding maltreatment investigators' perceptions of the pandemic's effects on children, including child maltreatment during the COVID-19 pandemic, increased exposure to violent and traumatic events, stress and challenges faced by families, reduced access to services, and challenges and delays with maltreatment investigations. Child maltreatment investigators perceived that the pandemic profoundly impacted maltreated children and their families. It is critical to ensure children and parents have access to services during future emergencies.

Ethnically distinct populations and coping with violence against children in the COVID-19 pandemic

OBJECTIVE

To identify policies and programs adopted by a Brazilian municipality to address violence against children during the COVID-19 pandemic.

METHOD

A qualitative documentary study. The study setting was the municipality of Ananindeua, Pará, Brazil. Data was collected from official websites between November 2021 and February 2022. Thematic content analysis was used with the support of webQDA software.

RESULTS

Three empirical categories emerged: a) Impacts of the COVID-19 pandemic on violence against children; b) Action strategies for tackling violence against children in the COVID-19 pandemic; c) Evaluation indicators and targets for action strategies for tackling violence against children.

FINAL CONSIDERATIONS

The documents revealed few direct mentions of children, especially traditional populations; they presented superficial and ineffective evaluations of the policies and programs adopted, using exclusively quantitative indicators.

Long-Term Trends and Sociodemographic Inequalities of Emotional/Behavioral Problems and Poor Help-Seeking in Adolescents During the COVID-19 Pandemic

PURPOSE

During the first 3 years of the coronavirus disease (COVID-19) pandemic, we investigated the long-term trends of emotional/behavioral problems and poor help-seeking behavior in adolescents and examined the sociodemographic inequalities in these trends.

METHODS

A multiwave cross-sectional survey was conducted in Japan from October-November 2020, June-July 2021, and June-July 2022 using an anonymous questionnaire. Trends of emotional/behavioral problems (e.g., emotional symptoms, hyperactivity/inattention, and total difficulties) and poor help-seeking were tested using a chi-squared test with Bonferroni correction. The effects of sociodemographic factors (grade, gender, country of origin, and number of parents) on emotional/behavioral problems and poor help-seeking were examined by two mixed-effect logistic regression models: (1) with fixed effects for years and sociodemographic factors and (2) stratified by years if the interaction terms between years and each sociodemographic factor were significant.

RESULTS

The prevalence of total difficulties and emotional symptoms was the highest in 2021. The number of adolescents reporting hyperactivity/inattention and poor help-seeking increased between 2020 and 2021 and remained high in 2022. Inequalities in emotional/behavioral problems and poor help-seeking behavior were found with respect to all sociodemographic factors.

DISCUSSION

Despite the persistent emotional/behavioral problems, the results suggested that the number of adolescents who were unable to seek help increased during the COVID-19 pandemic. Additionally, heterogeneities in the trends with respect to grade, gender, country of origin, and number of parents were detected. Prioritized supports targeting those with sociodemographic disadvantages may be needed to mitigate these inequalities in response to the pandemic.

COVID-19 and Caregiver Risk Factors for Child Maltreatment: The Pandemic in Review

The COVID-19 pandemic has fostered an environment for increased risk of child maltreatment (CM) as families experience increased psychosocial and financial burdens and spend unprecedented amounts of time together in the home. This narrative review aimed to summarize empirical findings on existing or new pandemic-related risk factors among caregivers. A combination of search terms related to CM and COVID-19 were used to identify articles published within five databases between February 2020 and July 2022. Literature searches produced 113 articles, of which 26 published across 12 countries met inclusion criteria. Four previously well-established risk factors for CM perpetration continued to persist during the pandemic, including stress, parental mental health, financial concerns, and parental substance use. Of note, inconsistent definitions and measures were used to capture these risk factors. Several additional emerging and understudied risk factors were also identified among limited articles, such as food insecurity and parental education. Findings emphasize the ongoing need for evidence-based interventions to address CM risk during the pandemic, including parent training programs. However, consolidated measures and consistent conceptualization of risk factors are needed to advance the study of CM. Going forward, practitioners and researchers should (a) strengthen the identification process for families at greatest risk for CM, and particularly those vulnerable to pandemic-related stressors; and (b) augment delivery of CM prevention strategies and evidence-based programs to fit the pandemic context.

Counts and child protection reports of diagnosed child maltreatment before and after the COVID-19 pandemic onset

BACKGROUND

Mechanisms for reporting child maltreatment (CM) were affected by changes in service provision immediately following the onset of the COVID-19 pandemic.

OBJECTIVE

To examine changes in counts and CPS reporting of CM medical encounters before and after the onset of COVID-19.

PARTICIPANTS AND SETTING

All emergency department and inpatient medical encounters with at least one CM diagnosis during the study period at Rady Children's Hospital San Diego, the largest pediatric hospital in California between 2016 and November 2021.

METHODS

Using linked medical record and CPS administrative data, interrupted time series models tested for changes in monthly counts and percentages of CM medical encounters reported to CPS with the onset of COVID-19. Logistic regression tested for the likelihood of a CPS report being associated with a CM encounter.

RESULTS

CM medical encounters totaled 2528, including 793 after the onset of COVID-19. Interrupted time series models indicated with the onset of the pandemic, the counts of CM encounters increased 18 % (RR: 1.18, 95 % CI 1.03-1.34) and the percentages reported to CPS increased 10 % (RR: 1.10, 95 % CI: 1.05-1.17). CM encounters that occurred after the onset of the COVID-19 pandemic had increased odds of a CPS report (fully adjusted model: OR: 1.08; 95 % CI: 1.05-1.12).

CONCLUSIONS

This study found increases in monthly counts and a higher percentage of CM medical encounters with CPS reports after the pandemic onset.

Review of pediatric emergency care and the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic posed new challenges in health care delivery for patients of all ages. These included inadequate personal protective equipment, workforce shortages, and unknowns related to a novel virus. Children have been uniquely impacted by COVID-19, both from the system of care and socially. In the initial surges of COVID-19, a decrease in pediatric emergency department (ED) volume and a concomitant increase in critically ill adult patients resulted in re-deployment of pediatric workforce to care for adult patients. Later in the pandemic, a surge in the number of critically ill children was attributed to multisystem inflammatory syndrome in children. This was an unexpected complication of COVID-19 and further challenged the health care system. This article reviews the impact of COVID-19 on the entire pediatric emergency care continuum, factors affecting ED care of children with COVID-19 infection, including availability of vaccines and therapeutics approved for children, and pediatric emergency medicine workforce innovations and/or strategies. Furthermore, it provides guidance to emergency preparedness for optimal delivery of care in future health-related crises.

Pivoting injury prevention efforts during a pandemic: results of an international survey

BACKGROUND

The COVID-19 a pandemic changed the world. Public health directives to socially distance with stay-at-home orders altered injury risk factor exposure, resulting injury patterns and conducting injury prevention (IP). The objective of this study was to determine the impact the COVID-19 pandemic on injury and IP at North American trauma centers (TC).

RESULTS

Sixty-two responses were received from pediatric (44%), adult (11%), and combined (31%) TC, from 22 American states, 5 Canadian provinces and Australia. The majority (91%) of programs targeted age groups from birth to 15 years old. Nearly one-third reported IP to be less of an institutional priority with funding redistributed in 15% of centers [median (IQR) - 25% (- 43, 1)], and resultant staffing changes at 38% of centers. A decrease in IP efforts was reported at 64% of TC. Overall, the majority of respondents reviewed injury data, with the top reported increased mechanisms mainly intentional: Firearm-related (75%), assaults (72%), and abuse (71%). Leading increased unintentional injuries were injuries occurring in the home such as falls (70%), followed by ATV (62%), and cycling (57%). Sites pivoted by presenting (74%) or participating (73%) in IP education virtually, social media posts (61%) and the addition of technology (29%). Top barriers were redeployment of partners (45%) and staff (31%), as well as lack of technology (40%) in the target population. Facilitators were technology at TC (74%), support of trauma program (63%), and having IP funding maintained (55%).

CONCLUSIONS

Nearly two-thirds of TC decreased IP efforts during the pandemic due to staffing and funding reductions. The leading reported increased injuries were intentional, indicating that violence prevention is needed, along with support for mental health. While TC successfully pivoted by using technology, access issues in the target population was a barrier resulting in health inequities.

The Impact of COVID-19 on Infant Maltreatment Emergency Department and Inpatient Medical Encounters

OBJECTIVE

To assess the counts of infant maltreatment-related medical encounters at a large medical system during a 21-month span of the COVID-19 pandemic.

METHODS

Retrospective data for this study came from all inpatient and emergency department medical encounters for infants from January 1, 2016, through November 30, 2021, at a single children's hospital system in California. Distributions of medical encounters were tabulated and plotted over time. Interrupted time series models were used to evaluate changes in child maltreatment medical encounters.

RESULTS

Medical encounters for infants with child maltreatment diagnoses increased following the onset of COVID-19. Monthly counts of encounters with indicated maltreatment trended upward following the start of the pandemic. Interrupted time series models showed that the count of maltreatment encounters increased 64% with the onset of COVID-19.

CONCLUSIONS

We found an increase in infant maltreatment medical encounters during a 21-month period following the onset of COVID-19. These findings suggest that the pandemic may have adversely affected the safety of infants and ongoing work is needed to understand better the pandemic impacts on child maltreatment.

COVID-19 lockdown effect on healthcare utilization and in-hospital mortality in children under 5 years in Cape Town, South Africa: a cross-sectional study

BACKGROUND

COVID-19 pandemic measures resulted in the de-escalation of non-COVID-19 healthcare provision.

METHODS

A retrospective cross-sectional study of routinely collected data was done to investigate the effect of COVID-19 policies on the healthcare utilization and mortality of children younger than 5 years in Eastern Cape Town, South Africa. We compared visits to primary and urgent care facilities, hospitalization, in-hospital deaths, and vaccine uptake from 1 January to 31 December 2020 to similar periods in 2018 and 2019.

RESULTS

During April and May 2020, the most restricted period, visits to primary care facilities declined from 126 049 in 2019 to 77 000 (1.8-fold; p < 0.05). This corresponded with a 1.2-fold reduction in the provision of the first dose of measles vaccine at 6 months compared to 2019. Throughout 2020 there was a 4-fold decline in the number of fully immunized children at 1 year of age (p = 0.84). Emergency room visits fell by 35.7% in 2020 (16 368) compared to 2019 (25 446). Hospital admissions decreased significantly (p < 0.01) in 2020 (9810) compared to 2018 (11 698) and 2019 (10 247). The in-hospital mortality rate increased from 2.3% (96/4163) in 2019 to 3.8% (95/2498) (p < 0.01) in Tygerberg Hospital, where 80% (95/119) of deaths were recorded. Twelve of the 119 (10%) deaths occurred in HIV-positive children (p = <0.01).

CONCLUSION

Measures instituted during the COVID-19 pandemic disrupted access to healthcare services for children. This resulted in an immediate, and potential future, indirect effect on child morbidity and mortality in Cape Town.

Child traumatic physical abuse rates and comparisons during the COVID-19 pandemic: Retrospective paediatric single institution review in Texas

AIM

The COVID-19 pandemic drastically altered human behaviour and socialisation and may have created an environment that could lead to increased incidence of domestic abuse and non-accidental trauma, or child physical abuse (CPA). Initial reports about the effect of the COVID-19 pandemic on the rates of CPA have been mixed. The purpose of this study is to describe the effects of COVID-19 on rates of CPA in a large metropolitan paediatric hospital and level I paediatric trauma centre.

METHODS

We identified and compared all CPA admissions under 18 years from May 2019 to February 2020 and considered that to be the pre-COVID time frame. The ensuing 12-month period of March 2020 to February 2021 was considered to be the intra-COVID time frame.

RESULTS

There were 49 (0.32%) unique CPA patients pre-COVID and 83 (0.85%) unique CPA patients intra-COVID (P < 0.001) with lower total admissions for any reason during the intra-COVID time frame. Monthly CPA cases were increased (P < 0.03) during the intra-COVID time period (mean 6.9, 95% confidence interval: 5.8-12.7) compared to the pre-COVID time period (mean 4.9, 95% confidence interval: 3.3-8.2).

CONCLUSION

During the COVID-19 pandemic, there were decreased overall hospital admissions in the period of mandated shutdowns and isolation. However, we saw an increased rate of CPA admissions compared to the time period prior to the pandemic. Knowledge of such data, trends and circumstances will help keep health-care providers alert and vigilant in identifying children at risk for maltreatment, and may impact child abuse protocols and guidelines.

Effect of the COVID-19 pandemic on emergency department attendances for pediatric injuries in Mozambique's central hospitals: an interrupted time series and a comparison within the restriction periods between 2019 and 2020

Objectives

Hospital-based studies indicate that restriction measures imposed during the COVID-19 pandemic have affected the number and characteristics of pediatric injuries. However, few studies have been conducted in resource-poor countries. This study aimed to determine whether injury-related emergency department (ED) attendances in Mozambique were affected during the restriction periods in 2020 and how the pattern of injury changed.

Methods

Mozambique faced two restriction periods in 2020. An interrupted time series was applied to weekly data of pediatric injuries from the ED records of four central hospitals in Mozambique in 2019 and 2020. Weekly numbers of injuries were modeled using a Poisson regression model to estimate the effect of COVID-19 restrictions on trends over calendar time. Then, for each restriction period, differences in injury mechanisms, severity, need for surgery, and intensive care unit (ICU) attendances were compared between 2019 and 2020.

Results

During the 76 weeks preceding the restrictions, there was a stable trend in ED attendances. The weekly number dropped by 48.7% after implementation of the first restrictions. By the end of 2020, the weekly numbers were back to the levels observed before the restrictions. Road traffic injuries (RTIs) and falls dropped during the first restriction period and RTIs and burns during the second. There was an increase of 80% in ICU attendances in all periods of 2020 at three hospitals during the first and second restriction periods.

Conclusion

The COVID-19 restrictions yielded a reduction in the weekly number of pediatric injuries seen at Mozambique's central hospitals, above all RTIs and falls. The drop reflects reductions in visits most importantly for RTIs, falls, and burns, but was accompanied by an increase in the proportion of ICU cases. This effect was not maintained when the restrictions were relaxed. Whether this reflects reduced exposure to injury or hesitancy to seek care remains to be determined.

Level of evidence

Level III, retrospective study with up to two negative criteria.

Prolonged school closure during the pandemic time in successive waves of COVID-19- vulnerability of children to sexual abuses - A case study in Tamil Nadu, India

Objectives

The Tamil Nadu government mandated several stay-at-home orders, with restrictions of varying intensities, to contain the first two waves of the COVID-19 pandemic. This research investigates how such orders impacted child sexual abuse (CSA) by using counterfactual prediction to compare CSA statistics with those of other crimes. After adjusting for mobility, we investigate the relationship between situational factors and recorded levels of cases registered under the Protection of Children from Sexual Offences Act (POCSO). The situational factors include the victims' living environment, their access to relief agencies, and the competence and responsiveness of the police.

Methods

We adopt an auto-regressive neural network method to make a counterfactual forecast of CSA cases that represents a scenario without stay-at-home orders, relying on the eight-year daily count data of POCSO cases in Tamil Nadu. Using the insights from Google's COVID-19 Community Mobility Reports, we measure changes in mobility across various community spaces during the various phases of stay-at-home orders in both waves in 2020 and 2021.

Results

The steep falls in POCSO cases during strict stay-at-home periods, compared with the counterfactual estimates, were -72% (Cliff's delta -0.99) and -36% (Cliff's delta -0.65) during the first and second waves, respectively. However, in the post-lockdown phases, there were sharp increases of 68% (Cliff's delta 0.65) and 36% (Cliff's delta 0.56) in CSA cases during the first and second waves, with concomitantly quicker reporting of case registration.

Conclusions

Considering that the median delay in filing CSA complaints was above 30 days in the mild and post-intervention periods, the upsurge of cases in the more relaxed phases indicates increased occurrences of CSA during strict lockdowns. Overall, higher victimization numbers were observed during the prolonged lockdown-induced school closures. Our findings highlight the time gap between the incidents and their registration during the strict lockdown phases.

Impact of COVID-19 pandemic on emergency department attendances for young people

INTRODUCTION

There are concerns that the COVID-19 pandemic is having an indirect negative impact on young people. We aimed to assess the impact of the pandemic on emergency department (ED) presentations and admissions.

DESIGN

We analysed ED presentations and admissions from a 5-year period (April 2016-February 2021). An interrupted time series analysis was used to estimate the presentations and admissions that would have been seen in year 5 without the pandemic using the data from years 1 to 4. These estimations were used to calculate the difference between the expected and the observed presentations and admissions during the pandemic year.

RESULTS

There were 166 459 presentations over 5 years. There was a 38.1% (95% CI 33.9% to 42.3%) reduction in presentations during the pandemic with no variation by sex, age, deprivation or ethnicity. Largest reductions were associated with children being home schooled rather than with lockdowns. For admissions, there was a 23.4% (17.4% to 29.4%) reduction, less for 5-17 year age group. Infection and asthma/wheeze presentations reduced by around 60% with smaller reductions for mental health and trauma. There was no change for surgical presentations, burns/scolds or allergic reactions. There was an increase in females aged 11-17 years presenting with mental health issues during the pandemic.

CONCLUSIONS

During the pandemic, there was a substantial reduction in both ED presentations and admissions. The differential impact on specific presentations suggests this was due to the impact of social distancing and reduced social mixing rather than widening of health inequality or increased barriers to care.

TRIAL REGISTRATION NUMBER

NCT04893122.

Prevalence and Correlates of Non-Dating Sexual Violence, Sexual Dating Violence, and Physical Dating Violence Victimization among U.S. High School Students during the COVID-19 Pandemic: Adolescent Behaviors and Experiences Survey, United States, 2021

The COVID-19 pandemic created an environment of disruption and adversity for many adolescents. We sought to establish the prevalence of non-dating sexual violence, sexual dating violence, and physical dating violence victimization among adolescents during the COVID-19 pandemic and to investigate whether experiences of disruption and adversity placed adolescents at greater risk for these forms of interpersonal violence. We conducted a secondary analysis of data from the Adolescent Behavior and Experiences Survey, collected January to June 2021 from a nationally representative sample of U.S. high school students (N = 7,705). Exposures included abuse by a parent; economic, housing, and food and nutrition insecurity; interpersonal connectedness; and personal well-being. Among female students, 8.0% experienced non-dating sexual violence; 12.5% experienced sexual dating violence; and 7.7% experienced physical dating violence. Among male students, 2.2% experienced non-dating sexual violence; 2.4% experienced sexual dating violence; and 4.9% experienced physical dating violence. Among female students, both emotional and physical abuse by a parent was related to non-dating sexual violence, emotional abuse was related to sexual dating violence, and physical abuse was related to physical dating violence. Among males, emotional abuse by a parent was related to physical dating violence and physical abuse by a parent was related to sexual dating violence. Hunger was associated with sexual and physical dating violence among female students and homeless was associated with physical dating violence among male students. Although there were differences by sex, abuse by a parent, hunger, and homelessness created precarity that may have increased the likelihood that adolescents would be exposed to risky peer or dating relationships. Adolescents need support that stops and prevents experiences of non-dating sexual and dating violence connected to interventions that address adversities experienced during the COVID-19 pandemic.

"We will need to build up the atmosphere of trust again": Service providers' perceptions of experiences of COVID-19 amongst resettled refugee adolescents

Adolescent resettled refugees across the United States have been significantly impacted by the COVID-19 pandemic, through socio-economic stressors in households, disproportionate morbidity and mortality in immigrant communities, and social isolation and loss of learning due to school closures and the shift to online learning. The Study of Adolescent Lives after Migration to America [SALaMA] investigates the mental health and wellbeing of adolescents who come from-or who have parents who came from-the Middle East and North Africa [MENA] region and settled in the U.S. There is a gap in understanding of the experiences during the pandemic of MENA-background adolescents in the U.S. The objective of this study was to describe the perspective of educators and other school-affiliated service providers on the impact of the COVID-19 pandemic on mental health and wellbeing of adolescent resettled refugees and access to and quality of education and support services for adolescent resettled refugees. The researchers collected data using in-depth interviews with key informants in Chicago, Illinois; Harrisonburg, Virginia; and Detroit Metropolitan Area [DMA], Michigan, Key informants were school administrators, managers of English language learning services and programs, teachers, therapists, staff of non-governmental organizations and/ or community-based organizations, and case workers. Data analysis was conducted utilizing directed content analysis to develop an initial codebook and identify key themes in the data. Findings revealed a number of pathways through which the pandemic impacted adolescent refugees and immigrants' mental health and wellbeing, with online programming impacting students' engagement, motivation and social isolation in terms of peer and provider relationships. Specific dynamics in refugee adolescents' households increased stressors and reduced engagement through online learning, and access to space and resources needed to support learning during school closures were limited. Service providers emphasized multiple and overlapping impacts on service quality and access, resulting in reduced social supports and mental health prevention and response approaches. Due to the long-term impacts of school closures in the first two years of the pandemic, and ongoing disruption, these data both provide a snapshot of the impacts of the pandemic at a specific moment, as well as insights into ways forward in terms of adapting services and engaging students within restrictions and limitations due to the pandemic. These findings emphasize the need for educators and mental health service providers to rebuild and strengthen relationships with students and families. These findings indicate the need to consider, support and expand social support and mental health services, specifically for refugee adolescent students, in the context of learning and well-being during the COVID-19 pandemic.

Evaluating the regional differences in pediatric injury patterns during the COVID-19 pandemic

Background

Reports of pediatric injury patterns during the COVID-19 pandemic are conflicting and lack the granularity to explore differences across regions. We hypothesized there would be considerable variation in injury patterns across Pediatric Trauma Centers (PTCs) in the United States.

Materials and Methods

A multicenter, retrospective study evaluating patients <18-years-old with traumatic injuries meeting National Trauma Data Bank criteria was performed. Patients injured after Stay-at-Home Orders through September 2020 (“COVID” cohort) were compared to “Historical” controls from an averaged period of equivalent dates in 2016–2019. Differences in injury type, intent, and mechanism were explored at the site level.

Results

47,385 pediatric trauma patients were included. Overall trauma volume increased during the COVID cohort compared to the Historical (COVID 7,068 patients vs. Historical 5,891 patients); however, some sites demonstrated a decrease in overall trauma of 25% while others had an increase over 33%. Bicycle injuries increased at every site, with a range in percent change from 24% to 135% increase. Although the greatest net increase was due to blunt injuries, there was a greater relative increase in penetrating injuries at 7/9 sites, with a range in percent change from 110% increase to a 69% decrease.

Conclusions

There was considerable discrepancy in pediatric injury patterns at the individual site level, perhaps suggesting a variable impact of the specific sociopolitical climate and pandemic policies of each catchment area. Investigation of the unique response of the community during times of stress at PTCs is warranted to be better prepared for future environmental stressors.

Child physical abuse screening in a pediatric ED; Does TRAIN(ing) Help?

BACKGROUND

Child maltreatment is distressingly prevalent yet remains under-recognized by healthcare providers. In 2015 the Ohio Children's Hospital Association developed the Timely Recognition of Abusive INjuries (TRAIN) collaborative in an effort to promote child physical abuse (CPA) screening. Our institution implemented the TRAIN initiative in 2019. The objective of this study was to examine the effects of the TRAIN initiative at this institution.

METHODS

In this retrospective chart review we recorded the incidence of sentinel injuries (SIS) in children presenting to the Emergency Department (ED) of an independent level 2 pediatric trauma center. SIS were defined and identified by a diagnosis of ecchymosis, contusion, fracture, head injury, intracranial hemorrhage, abdominal trauma, open wound, laceration, abrasion, oropharyngeal injury, genital injury, intoxication, or burn in a child < 6.01 months of age. Patients were stratified into pre-TRAIN (PRE), 1/2017-9/2018, or post-TRAIN (POST), 10/2019-7/2020, periods. Repeat injury was defined as a subsequent visit for any of the previously mentioned diagnoses within 12 months of the initial visit. Demographics/visit characteristics were analyzed using Chi square analysis, Fischer's exact test, and student's paired t-test.

RESULTS

In the PRE period, 12,812 ED visits were made by children < 6.01 months old; 2.8% of these visits were made by patients with SIS. In the POST period there were 5,372 ED visits, 2.6% involved SIS (p = .4). The rate of skeletal surveys performed on patients with SIS increased from 17.1% in the PRE period to 27.2% in the POST period (p = .01). The positivity rate of skeletal surveys in the PRE versus POST period was 18.9% and 26.3% respectively (p = .45). Repeat injury rates did not differ significantly in patients with SIS pre- versus post-TRAIN (p = .44).

CONCLUSION

Implementation of TRAIN at this institution appears to be associated with increased skeletal survey rates.

Epidemiology of Injuries to Early Adolescents from Family Violence Evaluated in an Urban Pediatric Emergency Department

BACKGROUND

Exposure to family violence during childhood and adolescence increases the risk for experiencing or perpetrating future violence. Social distancing protocols combined with reduction in access to youth/family services during the COVID-19 pandemic may have intensified the risk of exposure to familial violence.

OBJECTIVES

This study describes the epidemiology of violence-related injuries to 10- to 15-year-old children from family violence, including child maltreatment and physical fighting, resulting in emergency department (ED) evaluation.

METHODS

This retrospective cohort study located in an urban academic pediatric ED in the mid-Atlantic region is a review of electronic medical records between January 2019 and March 2020 (prepandemic period) and March to December 2020 (pandemic period). This review focused on visits for youth aged 10 to 15 years who presented for evaluation of an injury due to a violent event involving a family member. Demographic and clinical data were abstracted, including circumstances of the event. Descriptive statistics were used to summarize data and compare prepandemic to postpandemic proportions.

RESULTS

Of 819 youth aged 10 to 15 years evaluated for a violence-related injury, 448 (54.7%) involved a family member. Of these, most involved parents/guardians, 343 (76.6%), and occurred at home (83.9%). Most patients were girls (54.0%), Black/African American (84.4%), and were enrolled in a public insurance plan (71.2%). Most youth were transported to the hospital by police (66.7%). Overall, alcohol, drugs, and weapons were involved in 10.0%, 6.5%, and 10.7% of events, respectively, and their involvement significantly increased during the pandemic period to 18.8%, 14.9%, and 23.8% ( P < 0.001). Most patients (98.7%) were discharged from the ED.

CONCLUSIONS

More than half of violence-related injuries treated in the ED in this population resulted from family violence. Family violence is a prevalent and possibly underrecognized cause of injuries during adolescence. Further research should explore the potential of the ED as a setting for preventive interventions.

Influence of epidemics and pandemics on paediatric ED use: a systematic review

OBJECTIVE

To assess the impact of epidemics and pandemics on the utilisation of paediatric emergency care services to provide health policy advice.

SETTING

Systematic review.

DESIGN

Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the Cochrane Library for studies that reported on changes in paediatric emergency care utilisation during epidemics (as defined by the WHO).

PATIENTS

Children under 18 years.

INTERVENTIONS

National Institutes of Health quality assessment tool for observational cohort and cross-sectional studies was used.

MAIN OUTCOME MEASURES

Changes in paediatric emergency care utilisation.

RESULTS

131 articles were included within this review, 80% of which assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED) visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli outbreaks found an increase in PED visits. For COVID-19, there was a reduction of 63.86% (95% CI 60.40% to 67.31%) with a range of -16.5% to -89.4%. Synthesis of results suggests that the fear of the epidemic disease, from either contracting it or its potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation, respectively.

CONCLUSIONS

The scale and direction of effect of PED use depend on both the epidemic disease, the public health measures enforced and how these influence decision-making. Policy makers must be aware how fear of virus among the general public may influence their response to public health advice. There is large inequity in reporting of epidemic impact on PED use which needs to be addressed.

TRIAL REGISTRATION NUMBER

CRD42021242808.

Violence and sexual abuse rates before and during the Covid-19 pandemic: A prospective population-based study on Norwegian youth

BACKGROUND

Considerable concern is raised as to whether the pandemic has led to an increase in violence and sexual abuse against children.

OBJECTIVE

The present study objective is to provide rates of violence and sexual abuse against adolescents the year before the pandemic compared to one year into the pandemic.

PARTICIPANTS AND SETTING

Two samples of Norwegian 12-16-year-olds were approached. A representative pre-pandemic sample of 9240 adolescents (M age (SD) = 14.11(0.88), and a sample recruited one year into the pandemic resulting in 3540 responses (M age (SD) = 14.5 (0.96)).

METHODS

An online survey was administered during school hours including established measures of violence and sexual abuse exposure. Sociodemographic characteristics were assessed.

RESULTS

There was 1.4 percentage point increase in sexual abuse by an adult, and a 3.9 percentage point decrease in psychological violence by a parent during the pandemic compared to the year before the pandemic. Otherwise, violence and sexual abuse rates remained stable across these two time periods. Risk factors for violence and sexual abuse were amplified during the pandemic.

CONCLUSION

Norway, a high-income welfare state, imposed measures to counteract the burden of the pandemic mitigation actions for adolescents. This might partly explain the absence of the feared increase in violence towards adolescents. The disproportionate risk for violence and sexual abuse for some groups of adolescents is however concerning, and should be followed up over time.

The prevalences, changes, and related factors of child maltreatment during the COVID-19 pandemic: A systematic review

BACKGROUND

The impact of the COVID-19 pandemic has been extensive and drastic during the twenty-first century. The increasing phenomenon of child maltreatment during the pandemic is a significant public health concern.

OBJECTIVE

This study is the first systematic review to analyze and summarize the prevalence rates, risk factors, and protective factors related to child maltreatment during the COVID-19 pandemic.

METHODS

Four electronic databases (PubMed, Web of Science, Scopus, Embase) were systematically searched. Some potential studies were also identified from the reference lists of previously included articles. The quality of the included studies was assessed by the National Institutes of Health (NIH) Quality Assessment Tool and Critical Appraisal Skills Program (CASP) Quality Assessment Tool.

RESULTS

A total of 35 articles were included in the analysis, with 16 having prevalence information and 22 having factor information. Sixteen studies were conducted in the US, the other 17 studies were from 12 countries, and only two studies contained mixed countries. The prevalences of child maltreatment during the pandemic varied widely in different types and measurements. The pandemic rates of physical abuse, psychological abuse, neglect, and sexual abuse were 0.1 %-71.2 %, and 4.9 %-61.8 %, 7.3 %-40 % and 1.4 %-19.5 %, respectively. There was a decline in allegations of child maltreatment and an increase in severe cases of child maltreatment during the COVID-19 pandemic. Lockdown measures and their side effects were the main risk factors contributing to child maltreatment.

CONCLUSIONS

This review calls for targeted measures to prevent child maltreatment during the COVID-19 pandemic and current and future lockdowns and more future replication studies conducted in countries other than the US.

Child maltreatment reporting during the initial weeks of COVID-19 in the US: Findings from NCANDS

BACKGROUND

After the national COVID-19 emergency declaration in the U.S. in March 2020, child welfare agencies observed large reductions in maltreatment reporting.

OBJECTIVE

To quantify the impact of the COVID-19 pandemic on child maltreatment reporting nationally to inform policy for future emergencies.

PARTICIPANTS AND SETTING

Administrative data from the National Child Abuse and Neglect Data System (NCANDS) for 48 states for federal fiscal years (FFYs) 2017 through 2020.

METHODS

Analyses focused on reports to child protective services (CPS) between weeks 12 and 24 of calendar years 2017 through 2020 (mid-March through mid-June). Report sources of screened in and substantiated reports were compared with those during the prior year. Likelihood of a report being substantiated in 2020 compared with 2019 based on report source was calculated using odds ratios.

RESULTS

In 2020, CPS screened in 39 % fewer reports than during the same period in 2019 and the proportion of reports substantiated increased from 18 to 22 %. Reports from all report sources decreased, especially from education personnel (90 % decrease) and child daycare providers (65 % decrease). The odds for substantiation were significantly higher during 2020 than in 2019 for reports from all but three sources.

CONCLUSION

During the initial weeks following the national COVID-19 emergency declaration, the number of reports to CPS declined sharply at the national level and across all states, primarily in association with a large reduction in referrals from education sentinels. Explanations for the increase in percent of substantiation in the context of reduction of reports are considered.

Impact on the incidence of suspected physical abuse in children under 24 months of age during a global pandemic: A multi-centre Irish regional retrospective cross-sectional analysis

OBJECTIVES

The advent of the COVID-19 pandemic has resulted in periods of nationwide restrictions in Ireland including school and workplace closures. The authors hypothesised that this disruption to society may have led to a change in patterns of suspected physical abuse (SPA) presentations to the paediatric emergency department (ED), whilst ED attendance fell dramatically during the period. We reviewed data to determine whether there was an increase in presentations of SPA during periods of social restrictions.

METHODS

The National Integrated Medical Imaging Service was searched for all skeletal survey examinations performed between the dates of the 1 March 2016 and 28 Feb 2021 for studies performed in cases of SPA. Electronic records of attendance were extracted from the emergency department administrative system at the three paediatric emergency departments which serve the 400,000 children regionally. The data were reviewed to determine if SPA presentations increased during restriction periods.

RESULTS

311 individual paediatric patients aged 24 months and under were referred for SPA skeletal survey during the study period. During the 2020/2021 period, 60 children were referred for SPA workup and there was no statistically significant difference between monthly referrals (mean 5, sd 2.92) in this period and matched periods over the preceding 4 years (mean 5.23, sd 2.69).

CONCLUSIONS

The incidence of SPA did not increase during the period of national restrictions during the COVID-19 pandemic.

ADVANCES IN KNOWLEDGE

Periods of social restrictions taken to protect the public health during a pandemic do not result in short term increases in suspected physical abuse in the regional paediatric population.

The silent crisis of child abuse in the COVID-19 pandemic: A scoping review

Background and Aims

The global outbreak of COVID-19 has become an international concern. The lives of children are severely affected by COVID-19 pandemic. There is evidence of a pandemic impact on violence against children. This scoping review study aimed to investigate the effects of the COVID-19 pandemic on child abuse.

Methods

We searched PubMed, Scopus, and Web of Science databases to retrieve related studies. Regarding the recent incident of COVID-19, the articles were reviewed from 2019 to June 1, 2021. The terms Child abuse and COVID-19 were used in the precise search technique of each database. The search techniques were created to work with any scientific database that used the keywords given.

Results

In the initial search of scientific databases, 568 articles were retrieved. After applying the inclusion and exclusion criteria during the screening process, 16 papers were included in the scoping review. Twelve articles have mentioned the increase of physical, psychological, and neglect types of abuse. However, sexual violence has not been reported in any of the articles. Four articles reported a reduction in the incidence of child abuse.

Conclusion

During the COVID-19 pandemic, a crisis occurred in the form of an upsurge in violence toward children, since limits made to diminish the virus, in general, increased the danger to children. Numerous factors such as stress, poverty, financial situation, history of violence, school closures, and lack of contact with support organizations contribute to this phenomenon. Social action and support needed is the right of every child in need in this critical situation.

Child Abuse and the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic has widespread effects, including enhanced psychosocial stressors and stay-at-home orders which may be associated with higher rates of child abuse. We aimed to evaluate rates of child abuse, neglect, and inadequate supervision during the COVID-19 pandemic.

METHODS

Patients ≤5 y old admitted to a level one pediatric trauma center between 3/19/20-9/19/20 (COVID-era) were compared to a pre-COVID cohort (3/19/19-9/19/19). The primary outcome was the rate of child abuse, neglect, or inadequate supervision, determined by Child Protection Team and Social Work consultations. Secondary outcomes included injury severity score (ISS), mortality, and discharge disposition.

RESULTS

Of 163 total COVID-era pediatric trauma patients, 22 (13.5%) sustained child abuse/neglect, compared to 17 of 206 (8.3%) pre-COVID era patients (P = 0.13). The ISS was similar between cohorts (median 9 pre-COVID versus 5 COVID-era, P = 0.23). There was one mortality in the pre-COVID era and none during COVID (P = 0.45). The rate of discharge with someone other than the primary caregiver at time of injury was significantly higher pre-COVID (94.1% versus 59.1%, P = 0.02). In addition, foster family placement rate was twice as high pre-COVID (50.0% versus 22.7%, P = 0.10).

CONCLUSIONS

The rate of abuse/neglect among young pediatric trauma patients during COVID did not differ compared to pre-pandemic, but discharge to a new caregiver was significantly lower. While likely multifactorial, this data suggests that resources during COVID may have been limited and the clinical significance of this is concerning. Larger studies are warranted to further evaluate COVID-19's effect on this vulnerable population.

COVID-19 patient care predicts nurses' parental burnout and child abuse: Mediating effects of compassion fatigue

BACKGROUND

Nurses who are also parents may be at risk not only for professional compassion fatigue, but also parental burnout - a reliable and valid predictor of child abuse and neglect. In support, recent research reveals that parents' COVID-19 related stressors predicted elevated potential for child abuse (Katz and Fallon, 2021).

OBJECTIVE

We explored the harmful effects of the COVID-19 pandemic on nurses' parental burnout, child abuse, and child neglect, as mediated by compassion fatigue (i.e., a combination of job burnout and secondary traumatic stress).

PARTICIPANTS AND SETTING

Participants were 244 nurses (M age = 32.4; 87% female) who were parents of young children (age 12 or under) recruited via chain referral sampling.

METHODS

Participants completed an anonymous survey assessing the extent to which they care for COVID-19 patients, are exposed to patients suffering and dying from COVID-19, and have lost family income due to COVID-19. We also measured their compassion fatigue, compassion satisfaction, substance abuse, spouse conflict, parental burnout, child abuse, and child neglect.

RESULTS

As hypothesized, direct care of COVID-19 patients, exposure to patient death and suffering due to COVID-19, and family income loss due to COVID-19 predicted greater compassion fatigue, which in turn, predicted greater parental burnout, child abuse, child neglect, spouse conflict, and substance abuse, (IEs ≥ 0.06, all ps < 0.05). Also, as compassion satisfaction increased, parental burnout, child abuse, child neglect, spouse conflict, and substance abuse decreased, rs ≥ -0.203, ps < 0.01.

CONCLUSIONS

Theoretical implications and practical implications for medical practice and child abuse prevention are discussed.

Jeopardized mental health of children and adolescents in coronavirus disease 2019 pandemic

The coronavirus disease 2019 (COVID-19) outbreak became a worldwide pandemic in 2020. Social distancing measures, such as self-quarantine, lockdowns, and school closures, which have proven efficacy in various pandemic situations, remain in use in Korea. These measures prevented viral transmission to some extent; however, adverse effects have also resulted. First, the negative effect of social isolation on mental health is evident. This influences the psychiatric milieu of parents and children directly and indirectly. The most stressful factor among Korean youth was the restriction of outdoor activities. Increasing parenting burden result in increased screen time among youth, and social isolation created depressive mood with symptoms similar to those of attention deficit hyperactivity disorder and anxiety. Second, symptoms of posttraumatic stress disorder (PTSD) and somatization are prevalent among children and adolescents. The sense of threatened health and life during the pandemic, one symptom of PTSD, is a strong risk factor for somatization. Finally, the increased pattern of child abuse in pandemic indicates increased levels of emotional/psychological abuse and nonmedical neglect. Social isolation makes people less aware of these events. Because pediatricians evaluate pediatric patients and their families, they should regularly assess emotional/stress factors, especially when somatization is prominent during the pandemic, and cautiously recommend that families seek advice from mental health professionals when warranted. Primary physicians must understand the characteristics and aspects of child abuse in the COVID-19 pandemic, make efforts to identify signs of child abuse, and deliver accurate information and preventive strategies for child abuse to caregivers, thereby functioning as a professional guardian. To promote the mental health of parents and children during the COVID-19 pandemic, more research and cooperation among health professionals, families, governments, and schools are needed in the future.

The impact of the resumption of in-person school attendance on COVID-affected child abuse and neglect trends in Florida

BACKGROUND

The COVID-19 pandemic has led to fewer child abuse and neglect (CAN) hotline calls, CAN investigations, and foster care entries across the U.S.

OBJECTIVE

To determine if there were decreases in CAN hotline calls, CAN investigations, foster care entries, and foster care exits in Florida (the largest among the few states that publishes monthly public data on the four areas) after the pandemic began, and to determine if there was any amelioration of these trends in Florida once schools had reopened for in-person learning.

METHODS

Secondary data analyses of administrative child welfare data from January 2010 to June 2021 from Florida were used. Spline regression equations were calculated for CAN hotline calls, CAN investigations, foster care entries, and foster care exits during three periods: 1) before the COVID-19 pandemic (January 2010 to February 2020); 2) after the pandemic, but before schools reopened (March 2020 to October 2020); and 3) after the pandemic and after schools reopened (November 2020 to June 2021).

RESULTS

Prior to the pandemic, there was a non-statistically significant increase of 1.35 hotline calls per 100,000 children per month (p = .478), a statistically significant increase of 0.01 investigations per 100,000 children per month (p < .001), a non-statistically significant increase of 0.01 foster care entries per 100,000 children per month (p = .415), and a statistically significant increase of 0.03 foster care exits per 100,000 children per month (p < .05). Once the pandemic started in March 2020, there were statistically significant decreases of 136.02 hotline calls per 100,000 children per month (p < .001), 102.84 investigations per 100,000 children per month (p < .001), 6.32 foster care entries per 100,000 children per month (p < .001) and 5.75 foster care exits per 100,000 children per month (p < .01). Once all schools reopened for in-person learning in November 2020, there continued to be statistically significant decreases of 47.86 hotline calls per 100,000 children per month (p < .05), 6.38 foster care entries per 100,000 children per month (p < .001) and 6.53 foster care exits per 100,000 children per month (p < .001). This suggests that there were an estimated 34,374 fewer CAN hotline calls, 2338 children who did not enter foster care, and 2587 youth residing in foster care (YRFC) whose foster care exits were delayed. The delay in foster care exits suggests that YRFC in Florida had stayed a combined cumulative equivalent of 477.1 years longer in care.

CONCLUSION

With the COVID-19 variants like Omicron continuing to wreak havoc in Florida, there will be a continued trend of decreasing CAN hotline calls, foster care entries and foster care exits even with in-person learning in all Florida schools. A real-time interoperable data system utilizing real-time predictive analytics must be developed in concert with the development of leaders and executives with advanced degrees in child welfare organizations who are able to maximize information from such systems.

Changing Patterns of Pediatric Trauma During the COVID-19 Pandemic

The implementation of lockdown and social distancing policies at the beginning of the coronavirus disease 2019 (COVID-19) pandemic changed both the nature of pediatric traumatic injuries and how those injuries were managed by pediatric trauma centers. At the start of the pandemic, the number of injured children evaluated at trauma centers decreased. Trauma volumes have since rebounded, and a concerning increase in abuse-related injuries has been seen. Pediatric trauma systems responded to the pandemic with new approaches to protect health care providers, conserve critical resources, and assist adult trauma systems overburdened by patients with COVID-19. The widespread effect of COVID-19 continues to have significant repercussions on children's health, but the lessons learned and gaps exposed by the pandemic may be an opportunity to positively transform injury prevention and health care delivery. [Pediatr Ann. 2022;51(7):e286-e290.].

Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study

BACKGROUND AND OBJECTIVE

The reported impacts of the COVID-19 pandemic on child maltreatment in the United States have been mixed. Encounter trends for child physical abuse within pediatric emergency departments may provide insights. Thus, this study sought to determine the change in the rate of emergency department encounters related to child physical abuse.

METHODS

A retrospective study within the Pediatric Emergency Care Applied Research Network Registry. Encounters related to child physical abuse were identified by 3 methods: child physical abuse diagnoses among all ages, age-restricted high-risk injury, or age-restricted skeletal survey completion. The primary outcomes were encounter rates per day and clinical severity before (January 2018-March 2020) and during the COVID-19 pandemic (April 2020-March 2021). Multivariable Poisson regression models were fit to estimate rate ratios with marginal estimation methods.

RESULTS

Encounter rates decreased significantly during the pandemic for 2 of 3 identification methods. In fully adjusted models, encounter rates were reduced by 19% in the diagnosis-code cohort (adjusted rate ratio: 0.81 [99% confidence interval: 0.75-0.88], P <.001), with the greatest reduction among preschool and school-aged children. Encounter rates decreased 10% in the injury cohort (adjusted rate ratio: 0.90 [confidence interval: 0.82-0.98], P = .002). For all 3 methods, rates for lower-severity encounters were significantly reduced whereas higher-severity encounters were not.

CONCLUSIONS

Encounter rates for child physical abuse were reduced or unchanged. Reductions were greatest for lower-severity encounters and preschool and school-aged children. This pattern calls for critical assessment to clarify whether pandemic changes led to true reductions versus decreased recognition of child physical abuse.

Impact of "Stay-at-Home" orders on non-accidental trauma: A multi-institutional study

BACKGROUND

It is unclear how Stay-at-Home Orders (SHO) of the COVID-19 pandemic impacted the welfare of children and rates of non-accidental trauma (NAT). We hypothesized that NAT would initially decrease during the SHO as children did not have access to mandatory reporters, and then increase as physicians' offices and schools reopened.

METHODS

A multicenter study evaluating patients <18 years with ICD-10 Diagnosis and/or External Cause of Injury codes meeting criteria for NAT. "Historical" controls from an averaged period of March-September 2016-2019 were compared to patients injured March-September 2020, after the implementation of SHO ("COVID" cohort). An interrupted time series analysis was utilized to evaluate the effects of SHO implementation.

RESULTS

Nine Level I pediatric trauma centers contributed 2064 patients meeting NAT criteria. During initial SHO, NAT rates dropped below what was expected based on historical trends; however, thereafter the rate increased above the expected. The COVID cohort experienced a significant increase in the proportion of NAT patients age ≥5 years, minority children, and least resourced as determined by social vulnerability index (SVI).

CONCLUSIONS

The COVID-19 pandemic affected the presentation of children with NAT to the hospital. In times of public health crisis, maintaining systems of protection for children remain essential.

LEVEL OF EVIDENCE

III.

Identification and Incidence of Child Maltreatment During the COVID-19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has raised serious concerns about child maltreatment, which is known to increase in frequency and severity during times of high stress. The present study used diverse datasets to concurrently examine changes in identification and medical evaluation of maltreatment allegations from before to during COVID-19. Four sources of data were collected from two counties for the months of March-December in 2019 and 2020, including reports to social services and child maltreatment evaluation clinic medical evaluations (CMECs). The number of reports, number of children reported, and rate of children reported were used to evaluate identification. Incidence was estimated based on the number of medical evaluations conducted at the CMECs. Maltreatment type, reporter type, and child demographics were also considered. Across both counties, there were significantly fewer reports and reported children in 2020 compared to 2019, signifying decreased identification of suspected maltreatment cases. This was especially true in spring and fall when children are typically in school. Across both counties, the proportion of children reported to the county that received medical evaluations was higher in 2020 compared to 2019. This suggests that the pandemic was related to an increase in the occurrence maltreatment serious enough to warrant medical evaluations, or perhaps in the relative number of serious cases identified. Findings show divergent trends in reporting and evaluation of suspected maltreatment cases from before to during COVID-19. Identification and service delivery methods need creative solutions to adapt to changing environments. Medical, social, and legal systems need to prepare for increases in families seeking services as pandemic-related restrictions are lifted.

Health Care Providers' Perspectives on COVID-19 and Medical Neglect in Children with Life-Threatening Complex Chronic Conditions

PURPOSE

Little is known regarding medical neglect in children with Life-Threatening Complex Chronic Conditions (LT-CCCs). We examined the impact of COVID-19 on concern for medical neglect in this population.

METHODS

Qualitative interview study of multi-disciplinary health care providers (HCPs) from critical care, palliative care, and complex care services on the topic of medical neglect in children with LT-CCCs. We used inductive thematic analysis to generate themes. Findings presented herein are derived from a sub-analysis of the larger study that focused specifically on discussion of COVID-19 by HCPs.

RESULTS

9 of the 20 HCPs interviewed mentioned COVID-19 as influencing situations of potential medical neglect. These 9 represent all disciplines and teams. Interviewees reported COVID-19 increased burden on parents and likelihood of medical neglect due to: 1) Familial distancing from medical and social support and, 2) Changes to medical care delivery that impaired the medical community's ability to engage and support families.

CONCLUSIONS

The COVID-19 pandemic has exposed the fragility of the medical and social systems that supports families of children with LT-CCCs. These findings are consistent with previous literature that suggest that the COVID-19 pandemic has increased the risk for child maltreatment. It additionally highlights the vulnerability of this patient population.

Abuse in Patients with Spinal Cord Injury During the COVID-19 Pandemic

Background: One of the chronic diseases with various challenges for patients and caregivers is spinal cord injury (SCI). The spread and prevalence of coronavirus disease 2019 (COVID-19) have been an influential risk factor for abuse. Objectives: The aim of this study was to assess the rate of abuse in patients with SCI during the COVID-19 pandemic. Methods: This cross-sectional descriptive study population was all SCI cases in Ilam, Iran. Researcher-made forms and questionnaires with confirmed validity and reliability, including the demographic characteristics, form and perceived abuse researcher-made questionnaire for people with SCI, were used. The perceived abuse questionnaire for patients with SCI was a researcher-made questionnaire designed based on library studies, interviews with patients, and determination of abuse instances. This instrument consists of 20 questions answered as yes (score 1) or no (score 0). After data collection, statistical analyzes were performed using the SPSS software version 16. Results: According to our results, the mean ± SD of the perceived abuse score by caregivers and patients was 8.48 ± 2.31 and 42.45% during the COVID-19 pandemic, respectively. Moreover, the mean ± SD of the age of patients was 62.86 ± 19.15 years, and the patient abuse increased with elevation in age (P = 0, F = 27.42). The possible abuse score was 0 - 20 divided into three categories of low (20, 20.4%), moderate (76, 76.5%), and high (2, 2%). The perceived abuse score was significantly higher among women and patients with a history of more than 10 years of SCI. Abuse prevalence did not have a significant relationship with income and marital status. Regarding age and abuse, our results showed a rise in perceived abuse scores with an increase in age. Conclusions: The present study showed that it is necessary to take measures to prevent abuse in patients with SCI. Moreover, the prevalence of abuse related to COVID-19 in patients with SCI was high. Therefore, preventive actions need to be proposed in this field.

The incidence of psychosocial disturbances during the coronavirus disease-19 pandemic in an Iranian sample

The spreading of the Corona Virus Disease 2019 (COVID-19) pandemic could be associated with psychosocial implications. This study, therefore, aimed to investigate the psychosocial disturbances before and during the COVID-19 pandemic. The cross-sectional study included 20,885 participants (12,343 females and 8,542 males) with psychosocial trauma who were selected by the census sampling method from Fars province, Iran. The mean age of participants in this study was 35.76 (7.52). The results showed that the incidence rate for psychosocial disturbances was 150.86 and 273.69 per 100,000 cases prior to and during the COVID-19 pandemic, respectively. Analysis showed that reports of spousal abuse, child abuse, elderly abuse, disability abuse, the violence of other relatives, child labor, divorce petition, acute family dispute, unemployment/financial problems, substance abuse, and health questions about COVID-19 increased significantly during the COVID-19 pandemic. This study shows that the COVID-19 pandemic influences the increase of psychopathology and social pathology. Therefore, recommends a comprehensive assessment to prevent and address the psychosocial consequences associated with COVID-19.

The impact of the COVID-19 pandemic on child health

Most Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections in children are mild or asymptomatic. Severe Coronavirus Disease 2019 (COVID-19) in children is infrequent. An estimated 0.3–1.3% of children with SARS-CoV-2 infection were admitted to hospital, and of these 13–23% needed critical care. SARS-CoV-2 related deaths were very rare in children, estimated at 2 per million. The vast majority of admitted children had one of shortness of breath, fever, and cough, but atypical symptoms are more common in children. Cases of Multisystem Inflammatory Syndrome in Children (MIS-C) have been linked to SARS-CoV-2 infection. Cardinal symptoms include prolonged fever, clinical signs of inflammation, gastro-intestinal symptoms, and cardiac dysfunction. Twenty two to 80% of patients with MIS-C needed critical care; mortality of MIS-C is around 2%. Six to 24% of children with MIS-C had coronary artery dilatation or cardiac aneurysms. Equipoise still exists between first-line treatment with immunoglobulins and steroids. Outcomes for children with MIS-C are generally very good in those recognised early and started on appropriate treatment. Vaccination schemes for children are rapidly expanding, with the benefits of preventing severe COVID-19 disease and MIS-C and reducing community transmission outweighing the risks of adverse events of, amongst others, myocarditis temporally related to COVID-19 vaccination in children and young adults. The imposed social distancing measures reduced the overall number of children with acute illness or injury presenting to urgent and emergency care facilities worldwide. No clear signal was seen that large numbers of children had a delayed presentation to emergency care departments with a serious illness. The social distancing measures negatively impacted the mental health of children.

The impact of COVID-19 related educational disruption on children and adolescents: An interim data summary and commentary on ten considerations for neuropsychological practice

OBJECTIVE

The coronavirus 19 (COVID-19) pandemic resulted in educational disruption of historic breadth and duration. The authors describe early studies and interim standardized assessment reports to highlight effects of educational disruption and present critical questions for neuropsychologists.

METHOD

A summary of pre-pandemic and interim literature was compiled, including analyses of national and local assessment data and preliminary studies on academic gains related to remote learning, educational and school services disruption, chronic absenteeism, and child and adolescent mental and physical health during 2020-2021. Ten major themes were identified in the early reports on impacts of educational disruption.

RESULTS

Preliminary information indicates prolonged educational disruption has resulted in attenuated learning gains, most remarkably for those already at risk for educational disparities: students of color, students with disabilities, English learners, and students from low-income households. There have also been increased mental and physical health challenges for some youth during the pandemic. Other literature highlights challenges such as diagnosis of learning disabilities, reliance on normative data and development of academic recovery programs.

CONCLUSION

The effects of prolonged educational disruption and psychological stressors on learning and mental health should be considered in the neuropsychological evaluation of children and adolescents, especially marginalized students. Normative data collected prior to the pandemic may be insufficient for interpretation of scores, and evaluation and treatment may be delayed due to backlog and increased demand. Clinical practice considerations are presented.