COVID Stress and Child Abuse

ABSTRACT: Children are widely recognized as a vulnerable population during disasters and emergencies. In BC there are growing concerns that children may be at higher risk of abuse and neglect as a consequence of the current COVID-19 pandemic and the public health measures to limit its spread. Increased family and financial stress, disrupted routines, and lack of access to community supports can all contribute to child maltreatment. At the same time, physical distancing has restricted contact between children and the protective adults, such as teachers, who most commonly report cases of suspected child maltreatment. Despite the pandemic, physicians continue to interact with children and families and are uniquely situated to identify cases of suspected child maltreatment. All physicians have a role to play in ensuring the safety and protection of children. Specific approaches to clinical practice in the pandemic era and resources adapted for the pandemic can help physicians assess risk of child maltreatment, support children and families, and recognize and respond to child abuse and neglect.

By: Kristopher T. Kang, MD Nita Jain, MD, FRCPC     B.C.Medical Journal 

Experts sound the alarm over child abuse during the global pandemic, NBC News

A study documenting an alarming rise in abuse-related head injuries among children in the United Kingdom adds to increasing evidence that the novel coronavirus pandemic and efforts to contain it are taking a serious toll on children.

The study found that between March 23 and April 23, 2020—the first month of self-isolation in the United Kingdom—10 children were treated for suspected abusive head trauma at the Great Ormond Street Hospital for Children in London. The injuries included brain bleeding and skull fractures. The hospital’s monthly average of such injuries was 0.67 during the previous 3 years. Two parents reported delaying care because they feared infection with the novel coronavirus. The authors expressed concern that children with less profound abuse-related injuries may be going untreated.

A World Health Organization report on global child abuse noted that schools were closed to 1.5 billion children worldwide because of the pandemic, and their parents face heightened stress and anxiety from lost income, social isolation, and potential crowding in the home. Additionally, more time online may expose children to an increased risk of online sexual exploitation or bullying.

“Violence against children has always been pervasive, and now things could be getting much worse,” Henrietta Fore, executive director of UNICEF, said in a statement about the report. “Lockdowns, school closures and movement restrictions have left far too many children stuck with their abusers, without the safe space that school would normally offer. It is urgent to scale up efforts to protect children during these times and beyond.”

Bridget M. Kuehn, MSJ   JAMA Network

"In my 16 years at CHEO [Children's Hospital of Eastern Ontario], I have never seen this many infants with serious maltreatment injuries. It is a stressful time for parents and caregivers. We all know it takes a village to raise a child. With staying at home during the pandemic, it can feel like the village is gone. Be reassured, it is not."

"I think everyone is struggling right now, everyone's stress level is higher and their coping skills are less."

"These things typically happen when people are at the end of their ropes and their coping skills fail. It happens to people with all levels of education and from all socioeconomic backgrounds."

"Parenting is hard. And it's normal for parents to feel overwhelmed sometimes. But serious injuries can happen in just a few seconds of frustration."

Dr.Michelle Ward, pediatrician, medical director, child and youth protection, CHEO

Many families have had a hard time since schools and day care centers had to shut their doors. Westend61/Getty Images

For most people at all times the very suggestion of child abuse, aggression and violence, verbal and physical, directed against children is an intolerable thought. Impossible to imagine as it is, it occurs. And not only among people who have a short temper fuse, but among those who normally are capable of managing the multi-dimensional task order involved in looking after children, who suddenly find themselves without the 'normal' backups they've become accustomed to, in this era of lockdowns when childcare, school attendance, visits with grandparents have surrendered to the imperative of COVID avoidance.

 

One hospital in Ontario, in the nation's capital of Ottawa saw fit to issue a desperate appeal to parents asking them to seek help wherever they can to ease their burden of stress. This, for the simple enough reason that doctors have seen an increasingly larger number of presentations of children with broken bones, infants with head trauma, than they have been accustomed to. Presentations of shocking reminders that not all childhood experiences are happy, nurturing ones. Health workers steel themselves against recoiling at the presence of infants in pain and physical trauma.

It is the sheer growing numbers of these presentations that terrify them, however. At the Children's Hospital of Eastern Ontario a trend appeared to be building momentum which began in the fall and continued into the winter months, of infants arriving at the hospital with symptoms of "serious maltreatment injuries", such as bleeding around the brain, and broken bones. CHEO, according to Dr.Michelle Ward, is seeing over twice as many babies with serious trauma injuries and maltreatment concerns than during a like period of the year before.

During the past five months, concurrent with some of the toughest times of the second wave of the pandemic, 20 infants under one year of age have been treated for injuries that include head trauma and broken bones; the injuries obviously the result of peaking parental stress levels. Last year at the same time eight infants were treated with similar injuries, by comparison. Ottawa Public Health paired with CHEO in joining the Children's Aid Society of Ottawa to issue an extraordinary public announcement to urge pandemic-stressed parents and caregivers that help can be found.

Physicians in other areas of the country have reported seeing similar increases in maltreatment injuries to infants. On the other hand, fewer child abuse referrals have taken place among school-aged children during the pandemic. An educated hypothesis is that this could be linked to the fact that children have been unable to attend school during lockdowns amid school closures, with remote Internet teaching in effect, so school officials and teachers who are frequently those who spot child abuse are now out of the picture.

 

Dr.Ward is intent on communicating to people that community supports are available -- with community resources and support services listed on Public Health websites and that caregivers who require support can find what they need to help them weather a storm of unprecedented proportions in home life through health care support services to gain grater coping skills and endurance during the pandemic.

 

Study: Reporting of child maltreatment during the SARS-CoV-2 pandemic in New York City. Image Credit: Africa Studio / Shutterstock