The stress on families due to the COVID-19 pandemic has increased the risk for child abuse and neglect, which already were at alarming levels. In 2018, an estimated 678,000 children were victims of abuse or neglect, according to the U.S. Children’s Bureau.
Certain subsets of the pediatric population are more likely to be victimized, including children with disabilities, who suffer rates of abuse at least three times higher than typically developing children (Jones L, et al. Lancet. 2012;380:899-907). These higher rates can be driven in part by increased financial, emotional, physical and social demands on families.
An updated AAP clinical report, Maltreatment of Children With Disabilities, offers the latest research on conditions that pose greater risk for abuse. It also discusses how the medical home plays a crucial role in identifying suspected abuse and neglect, and advocating for these children.
The report, from the Council on Child Abuse and Neglect and Council on Children with Disabilities, is available at https://doi.org/10.1542/peds.2021-050920 and will be published in the May issue of Pediatrics.
Who is most vulnerable and why?
One of the less intuitive findings in the research is that children with more severe disabilities are actually at a lower risk of abuse and neglect than delayed, verbal children (Helton JJ and Cross TP. Child Maltreat. 2011;12:126-136). The thought behind this finding is that children with less impairment do not necessarily appear disabled, which can impact how caregivers respond when the children do not meet their expectations.
Pediatric health care providers should be aware that this population is at increased risk. When providing anticipatory guidance to caregivers, they can discuss expectations based on the child’s limitations and developmental status, and offer strategies to respond to developmentally based challenges.
Children with disabilities are at increased risk not only for physical abuse. They also are three times more likely to be victims of sexual abuse than typically developing children (Caldas SJ and Bensy ML. J Child Sex Abuse. 2014;23:345-366). Pediatric providers should make caregivers aware of the increased risk and discuss ways to eliminate situations where the children are alone with one adult or older child.
The report also details how different types of disability correlate with different forms of abuse. Behavioral difficulties increase the risk for physical abuse. Nonverbal and hearing-impaired children have a higher risk for being neglected or sexually abused. Emotional abuse is more common among children with conduct disorders, non-conduct psychological disorders, speech and language difficulties and attention-deficit/hyperactivity disorder.
Role of the medical home
The medical home, which provides coordinated care to the child and family, is particularly beneficial to children with disabilities. Child abuse prevention and identification should be included in the resources and education that are inherent in the medical home.
The medical home can help reduce the risk for child abuse and neglect by working with multidisciplinary teams to address families’ financial struggles, stress and the child’s long-term needs.
Guidance for pediatricians
- Recognize the signs and symptoms of child maltreatment and understand mandatory, state-specific reporting requirements for child and adult protective services.
- Assess family well-being at each medical visit.
- Refer families of children with disabilities to community resources and agencies.
- Structure discussions about appropriate discipline within well-child visits for the child with a disability.
- Be involved with both educational and medical treatment plans and participate in collaborative team approaches.
Dr. Messner, a co-author of the clinical report, is a member of the AAP Council on Child Abuse and Neglect.
