Rise in Child Head Trauma During COVID-19 Lockdowns May Point to Domestic Violence Spike

By Linda Carroll

July 07, 2020

(Reuters Health) - Stresses associated with COVID-19 lockdowns may be fueling increases in domestic violence, British researchers suggest, based on a jump in the rate of head injuries experienced by children.

An analysis of data from one UK institution shows an increase, compared with previous years, of nearly 1500% in abusive head trauma during the month the UK entered a period of national self-isolation, according to the report in the Archives of Disease in Childhood.

"More awareness is needed in the medical community so that we ensure that all of these injuries are detected," said Dr. Kshitij Mankad, clinical lead for pediatric neuroradiology at the Great Ormond Street Hospital for Children in London.

"This is particularly highlighted by our paper as children with what would otherwise be acute presentations have delayed their presentation and are being seen in the hospital several days later with unexplained/occult/old injuries," Dr. Mankad said in an email. "And so an adequate level of in built suspicion is needed in the physician; a type of professional curiosity."

Parents also need to have a greater awareness of what constitutes abuse, Mankad said, adding that society as a whole should be on the lookout for signs of abuse.

"No one can be a bystander," he said. "Other carers, teachers for example, have a massive role to play in this. If they notice a child is frequently coming to school with bruises this should raise flags."

Mankad blames the increase in abuse on the COVID-19 lockdowns. "This is a boiling box type of situation," he said. "Pressure is increasing - though we are in the same place, lockdown is not a static environment."

Suspecting that domestic abuse might be on the rise, Mankad and his colleagues compared the number of new cases of head injury caused by physical abuse among very young children seen between March 23 and April 23 of this year to the same time period in 2017, 2018 and 2019.

Ten children - six boys and four girls aged 17 days to 13 months - with suspected abusive head trauma presented for treatment during the one-month period in 2020. That's compared with an average of 0.67 cases per month for the same time period in the three previous years, representing an increase of 1,493%, the researchers report.

The symptoms leading to hospital visits included colic, breathing issues, loss of consciousness, seizures, and extensive bruising. Examinations of the children revealed subdural hemorrhage in six infants, brain swelling in four, parenchymal contusion in four, skull fractures in four subarachnoid hemorrhage in three and bone fractures elsewhere in three of the infants.

"This provocative study should increase concern," said Dr. Albert Wu, an internist and a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, who wasn't involved in the study.

"The early information has been mixed," Wu said. "There are alarming reports from the U.S. about a sharp decrease in the number of calls about child abuse. No one thinks this is because there has been a corresponding drop in actual abuse. The nightmare scenario is that because of the lockdown some children have been virtually trapped by abusive parents."

Dr. Wu notes that the new study is small. "And no statistical analysis was presented," he added. "So, until we get more conclusive evidence we are still left to fear the worst."

The new findings "are extremely alarming," said Lisa Bates, an assistant professor in the department of epidemiology at Columbia University's Mailman School of Public Health in New York City and a member of the advisory board of the COVID-19 Task Force on Domestic Violence.

"We need data like this study provides," Bates said. "This is probably the tip of the iceberg. We're just seeing the extreme cases. An incredible amount of abuse doesn't rise to the level of requiring immediate medical attention."

"We've been seeing dramatic increases in domestic violence," Bates said. "There's been an uptick in New York homicides classified as domestic in nature. These extreme outcomes are just the tiniest portion."

Bates points to the fallout from the 2008 recession. "There was lots of unemployment, lots of financial loss and economic precariousness," she said. "And there was systemic suspected child abuse showing up at hospitals around the country."

Lockdowns are particularly problematic for those living in abusive homes. "Lots of abuse is picked up in the schools," she said. "Similarly, women and other adult victims are prevented from being able to have access to support through their workplaces."

"The virus itself can be weaponized as a tool of abuse," Bates said. "In an abusive dynamic in a household where there are lots of issues around control and also the threat of violence, the virus becomes an instrument of control. People are told: 'You can't leave the house. I don't want you to bring the virus home. You can't have any money because we're under economic strain.'"

SOURCE: https://bit.ly/2Z5gBsc Archives of Disease in Childhood, online July 2, 2020.