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Child Maltreatment Hospitalizations and the Role of Poverty

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We are all required to report concerns about child abuse or neglect to our local Child Protective Services (CPS) agency. However, what we actually do may not be what we are required to do, as illustrated in a concerning study by Rebbe et al (10.1542/peds.2021-053346) being early released this month in Pediatrics. The authors use a population-based linked database of birth information, hospitalizations, and CPS reports from one state to determine whether rates of reporting varied by Medicaid enrollment, race, or ethnicity. 

The authors present 14 years of data involving 3,907 children hospitalized for child maltreatment and found a higher rate for those with Medicaid enrollment compared with private insurance. In addition, after controlling for insurance status, Native American mothers were more likely to have a specific diagnostic code assigned for child maltreatment than all other races and ethnicities and Asian/Pacific Islander mothers were least likely to be reported to CPS for possible child maltreatment. These findings suggest that clinician biases are playing a role in determining which children are hospitalized for concerns about abuse.

But are provider biases the only reason for these differences? Not necessarily according to an accompanying commentary from Dr. Mary Clyde Pierce, Ms. Kim Kaczor, and Dr. Aleksandra Olszewski from Northwestern University and Lurie Children’s Hospital (10.1542/peds.2022-056501). The commentary authors remind us that we cannot neglect the true increased risk of maltreatment associated with poverty. As pointed out by the study authors, we must advocate for closing the gaps in the inequities that increase the risk for child maltreatment. Check out both the study and commentary to learn more.

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