Background: The COVID-19 pandemic and the subsequent shutdown of regular activities has resulted in an unprecedented and abrupt rise in stressors for families, including lost support systems and financial hardships. Previous studies have shown that caregiver stress elevates the risks associated with an increase in child abuse and neglect. Hypothesis: The COVID-19-induced shutdown of regular activity will result in an increase in child abuse cases. Objective: To assess the impact of the COVID-19 pandemic on the number of child abuse cases presenting to a Child Advocacy Center (CAC). Methods: A data review of the CAC client tracking database done to determine the volume of new child abuse cases presenting to the CAC during an eight-week period in 2020 (3/3 – 4/25) and compared with data derived during the same time frame in 2019 (historical controls). The busiest CAC (Census in 2019=3424) in the state provides comprehensive multidisciplinary services to children and families in the county with reported allegations of severe physical abuse (ages 10 years and younger) and sexual abuse (ages 12 years and younger). Statistical analysis was done using SPSS for Windows version 26. Results: The total number of cases for the 8-week study period in 2019 was 573, compared to 297 in 2020, indicating a 48% (p=0.009) decline in volume. The weekly trend (with associated events) is illustrated in the figure. On-site child abuse medical evaluations were 156 in 2019, and 52 exams in 2020, a decline of 66% (p=0.003). There were 89 (F=61, M=28) sexual abuse examinations in 2019, and only 33 (F=21, M=12) in 2020, a 63% decline. Similarly, the number of physical abuse examinations declined from 67 (F=30, M=37) in 2019 to 19 (F=7, M=12) in 2020, a 72% decline. No significant associations were detected between the two time periods in terms of the type of abuse or the sex or age of the child. Discussion: There were significantly fewer reports of child abuse during this COVID pandemic time belying expectations. Usually, the highest percentage of reports are from schools (20%) and with school closures and shelter at home orders, access to mandated reporters is limited. It is critical that mechanisms for surveillance, reporting, and intervention are in place, particularly related to domestic violence and child abuse. It is speculated that when Covid-19 related measures are lifted, there may be an enormous spike in referrals. Conclusion: Despite the concurrent elevation in multiple risk factors, there was a significant decline in the number of child abuse cases and medical evaluations at our child advocacy center during the COVID-19 pandemic. This may be a result of under reporting due to school closures and shelter at home orders.

Weekly trend with COVID related events