Risk Factors for Maltreatment in Siblings of Abused Children

Characteristics of children aged 5 and under presenting with ingestion: An analysis of cases from a tertiary child protection unit

AIM

This study aimed to determine what proportion of children presenting to a tertiary children's hospital with ingestion were referred for child protection assessment, and to describe the characteristics of the referred group.

METHODS

This is a retrospective case series study of children who presented to a tertiary children's hospital between 1 January 2016 and 31 December 2020 with ingestion (poisoning). Demographic and clinical data were collected from the electronic medical record and patients who underwent child protection assessment were identified. The child protection group was compared to the whole cohort. The child protection group had psychosocial data gathered and descriptively analysed.

RESULTS

Two hundred and three patients were included. The most common substances ingested were over-the-counter medications (45%) followed by prescription medications (41%). Most patients were discharged from the emergency department (70%). Of the 203 patients, 24 (11.8%, 95% CI 7.72-17.08) were referred to the child protection unit. A significant proportion of these patients had a history of parental depression (64%) and other mental health conditions (41%), parent separation (77%) and domestic violence in the home (64%).

CONCLUSION

The patients assessed by the child protection team had high prevalence of psychosocial risk factors that also place the patients at risk of child abuse and neglect. Most of the other patients did not have a psychosocial history documented in the medical record, and this group likely contains a high proportion of vulnerable children. By screening patients presenting with ingestion we may be able to identify children at risk and provide opportunities for protective intervention.

Variability in Occult Injury Screening Among Siblings/Household Contacts of Physical Abuse Victims

OBJECTIVE

The objective of this study is to examine radiologic occult injury screening performance/yield among contacts presenting for precautionary medical assessments and assess factors associated with deferred screening.

METHODS

Data were collected retrospectively from charts of contacts younger than 8 years presenting for precautionary evaluation to a level 1 pediatric emergency department January 1, 2018 to March 31, 2023. Demographics, radiologic performance/yield, physical examination, social work-based psychosocial assessment, reasons for deferred imaging, and diagnostic codes were abstracted. Descriptive statistics and χ 2 analysis are reported.

RESULTS

Three hundred ninety contacts were identified; 364 (93.3%) were biological siblings. Most (276, 70.8%) were 2 to 8 years old. Statistically significant relationships were identified with age, insurance, and hospital social work assessment and screening. Thirty-four infants (54%) underwent neuroimaging; no studies were abnormal. Of 114 contacts, <2 years old, 97 (85%) underwent skeletal survey (SS); 9 (9%) SS were abnormal. Twenty-seven (24%) returned for follow-up SS; 4 (14.8%) were abnormal. For 2 contacts, an abnormal initial SS was refuted by follow-up imaging. Physical examinations were abnormal for 11% of contacts. Reasons for deferred imaging included contact well appearance, caregiver concerns, and clinician disagreement with indications. Encounter International Classification of Diseases codes varied, commonly reflecting nonspecific screening assessments.

CONCLUSIONS

Despite national clinical practice guidelines, studies of abusive injury prevalence and radiologic yield among at-risk contacts exposed to unsafe environments are few. Screening evaluations inclusive of physical examination and radiologic studies identify abuse concerns among at-risk contacts. Further study of factors impacting radiologic screening decisions is needed. Considerations to advance epidemiologic research include standardized diagnostic coding and prospective assessment of radiologic yield.

Lifetime Experience of Childhood Abuse and Neglect Among High School Students at Debre Tabor Town, South Gondar Zone, Northwest Ethiopia: An Institution-Based Cross-Sectional Study

Background

Childhood abuse and neglect is defined as any intentional harm or mistreatment of a child that results in actual or potential harm to the child's health, survival and development. It has been linked to an increased risk of a wide range of serious short- and long-term medical and mental health problems. Although it is a complex societal issue, it receives limited research attention in the area.

Objective

To assess lifetime prevalence of childhood abuse and neglect among high school students in Debre Tabor town, south Gondar Zone, Northwest Ethiopia, 2022.

Methods

A cross-sectional study design was used to assess 423 high school students, chosen through a systematic sampling technique. Data were collected using a pre-tested, structured and self-administered international child abuse screening tool, child version (ICAST-C). The effect of independent variables on the outcome variable was explored using logistic regression analyses. The level of significances were determined using an odds ratio with a 95% confidence interval.

Results

Of the 423 study participants, 84.4% had lifetime experience of childhood abuse and neglect. Being female (AOR=4.5, 95% CI: 2.38, 8.60), parental marital status (AOR=5.4, 95% CI: 1.07, 27.3), illiteracy of father (AOR=1.65, 95% CI: 4.5, 6.03), birth order (AOR=4.5, 95% CI: 1.57, 13.0), open family discussion of sexual matters (AOR=0.37, 95% CI:1.74, 7.86), and watching pornography (AOR=0.08, 95% CI: 0.02, 0.40) were significantly associated with lifetime experience of childhood abuse and neglect.

Conclusion

Lifetime experience of childhood abuse and neglect was high as compared with previous studies. Being female, parental marital status, illiterate fathers, watching pornography, and open family discussion of sexual matters were predictors of childhood abuse and neglect. Dealing with this issue should be considered an integral component of high school students' care, including parental education and respite care.

International Consensus Statement on the Radiological Screening of Contact Children in the Context of Suspected Child Physical Abuse

Importance

Physical abuse is a common but preventable cause of long-term childhood morbidity and mortality. Despite the strong association between abuse in an index child and abuse in contact children, there is no guidance outlining how to screen the latter, significantly more vulnerable group, for abusive injuries. Consequently, the radiological assessment of contact children is often omitted, or variably performed, allowing occult injuries to go undetected and increasing the risk of further abuse.

Objective

To report an evidence-based and consensus-derived set of best practices for the radiological screening of contact children in the context of suspected child physical abuse.

Evidence Review

This consensus statement is supported by a systematic review of the literature and the clinical opinion of an internationally recognized group of 26 experts. The modified Delphi consensus process comprised 3 meetings of the International Consensus Group on Contact Screening in Suspected Child Physical Abuse held between February and June 2021.

Findings

Contacts are defined as the asymptomatic siblings, cohabiting children, or children under the same care as an index child with suspected child physical abuse. All contact children should undergo a thorough physical examination and a history elicited prior to imaging. Contact children younger than 12 months should have neuroimaging, the preferred modality for which is magnetic resonance imaging, and skeletal survey. Contact children aged 12 to 24 months should undergo skeletal survey. No routine imaging is indicated in asymptomatic children older than 24 months. Follow-up skeletal survey with limited views should be performed if abnormal or equivocal at presentation. Contacts with positive findings should be investigated as an index child.

Conclusions and Relevance

This Special Communication reports consensus recommendations for the radiological screening of contact children in the context of suspected child physical abuse, establishing a recognized baseline for the stringent evaluation of these at-risk children and providing clinicians with a more resilient platform from which to advocate for them.

Predictors of Maternal Recidivism in the Child Protection System

Child maltreatment recidivism is typically measured and studied at the individual level. Conditions that give rise to child abuse and neglect, however, typically affect multiple children in a given family. In the current study, we estimated maltreatment recidivism at the maternal level and examined its risk as a function of maternal sociodemographic characteristics that may change over time. Using linked administrative records, we identified a subset of first-time mothers in California whose first child was reported to the child protection system (CPS) between birth and age 5 and who then gave birth to another child (n = 14,715). Following the firstborn child's CPS reporting, nearly half of these mothers (43.3%) were re-reported concerning the non-firstborn children during the first 5 years of the child's life. Risk factors consistently documented across births were associated with a heightened risk of maternal CPS recidivism. Our study advances an understanding of the full extent of maltreatment recidivism by broadening the focus from individual children.

Psychiatric disorders and reoffending risk in individuals with community sentences in Sweden: a national cohort study

BACKGROUND

Community sentences are widely used in many countries, often comprising the majority of criminal justice sanctions. Psychiatric disorders are highly prevalent in community-sentenced populations and are thus potential targets for treatment interventions designed to reduce reoffending. We examined the association between psychiatric disorders and reoffending in a national cohort of individuals given community sentences in Sweden, with use of a sibling control design to account for unmeasured familial confounding.

METHODS

We did a longitudinal cohort study of 82 415 individuals given community sentences between Nov 1, 1991, and Dec 31, 2013, in Sweden using data from population-based registers. We calculated hazard ratios (HRs) for any reoffending and violent reoffending with Cox regression models. We compared community-sentenced siblings with and without psychiatric disorders to control for potential familial confounding. Additionally, we calculated population attributable fractions to assess the contribution of psychiatric disorders to reoffending behaviours. The primary outcomes of the study were any (general) reoffending and violent reoffending.

FINDINGS

Between Nov 1, 1991, and Dec 31, 2013, those given community sentences who were diagnosed with any psychiatric disorder had an increased reoffending risk in men (adjusted HR 1·59, 95% CI 1·56-1·63 for any reoffending; 1·60, 1·54-1·66 for violent reoffending) and women (1·71, 1·61-1·82 for any reoffending; 2·19, 1·88-2·54 for violent reoffending). Risk estimates remained elevated after adjustment for familial confounding. Schizophrenia spectrum disorders, personality disorders, and substance use disorders had stronger associations with violent reoffending than did other psychiatric disorders. Assuming causality, the adjusted population attributable risk of psychiatric disorders on violent reoffending was 8·3% (95% CI 6·6-10·0) in the first 2 years of community follow-up in men and 30·9% (22·7-39·0) in women.

INTERPRETATION

Psychiatric disorders were associated with an increased risk of any reoffending and violent reoffending in the community-sentenced population. The magnitude of the association between psychiatric disorders and reoffending varied by individual diagnosis. Substance use disorders had the highest absolute and relative risks. Most of the increased risk for any reoffending in individuals with psychiatric disorders could be attributed to comorbid substance misuse. Given their high prevalence, substance use disorders should be the focus of treatment programmes in community-sentenced populations.

FUNDING

Wellcome Trust.