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Decreased Emergency Department Encounters for Child Physical Abuse during the COVID-19 Pandemic – Reassuring or Alarming?

June 16, 2022

The COVID-19 pandemic amplified stress on many levels for children and their families, from school closures, lockdowns, to loss of work, among other stressors. This stress was particularly high during the first year of the pandemic, resulting in an ongoing mental health crisis. Due to these factors, there has been great concern that child maltreatment would increase. However, studies on rates of child maltreatment during the pandemic have produced mixed results.

Adding to this growing body of literature is an important article in this month’s issue of Pediatrics, Chaiyachati et al (10.1542/peds.2022-056284) used the Pediatric Emergency Care Applied Research Network (PECARN) Registry, which included electronic health record data for all emergency department (ED) encounters from 9 health systems, to evaluate changes in ED encounters for physical abuse pre-pandemic compared with the first year of the pandemic, as well as changes based on age and injury severity. A real strength of the study is that three methods were used to identify ED encounters related to physical abuse in the PECARN Registry to overcome potential limitations of any single search strategy.

Overall, ED encounters for physical abuse decreased during the pandemic, though this decrease was most notable during the first 3 months of the pandemic. This decrease in encounters was primarily due to a decrease in visits for low severity injuries with no changes in encounters for higher severity injuries. Additionally, the decrease was noted in children ages 2 to 13, but not in younger or older age groups.

How do we interpret these findings? The authors use the discussion section of their article to present several hypotheses. One hypothesis is that physical abuse truly decreased during the pandemic due to several protective factors, such as increased caregiver presence at home. In contrast, another hypothesis is that physical abuse resulting in lower severity injuries didn’t decrease at all, but instead was under-reported during the pandemic. Although the authors cannot determine which of these hypotheses is correct using registry data, the study raises important questions that need further investigation to better understand rates and reporting of physical abuse during this pandemic. This information will not just help us understand the impact of the COVID-19 pandemic on child maltreatment, but also will help inform policy, reporting, and clinical care during future pandemics.

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