We know that infants who have been reported for maltreatment are at higher risk for a sudden unexplained infant death or an injury related death. However, what about medical causes of death?
Drs. Janet Schneiderman, John Prindle, and Emily Putnam-Hornstein from the University of Southern California analyzed data from birth, death, and child protection system records for all children born in California between 2010 and 2016 to determine if infants who had at least one report of maltreatment were at higher risk for a medical cause of death. Their findings have been reported in an article that is being early released this week by Pediatrics (10.1542/peds.2020-048389).
The authors found that infants with one report of maltreatment were 77% more likely to die of a medical cause, and those with more than one maltreatment report were more than 300% more likely. The most common causes of death were respiratory and infectious.
They also found that foster care had a protective effect, in that infants who were placed in foster care had half the risk of death. The authors speculate that this finding could reflect the need for additional case management, health care support, and social support for families with a report of maltreatment.
What do we do with this alarming information? Dr. Desmond Runyan from the University of Colorado wrote a thoughtful commentary (10.1542/peds.2021-051829). He wondered if this was a chicken or the egg situation: are infants with medical conditions more likely to experience maltreatment? Or is maltreatment more likely to be detected for infants with serious medical conditions and thus many more touch points with physicians, therapists, home health nurses, etc.? He also believes that any intervention will need to be multi-faceted.
Please read the article and commentary. We all take care of children for whom we may have concerns about maltreatment, and this is important information for all of us to have.