Association of Child Maltreatment With Risk of Death During Childhood in South Australia

Abstract

IMPORTANCE Child maltreatment is a prominent public health concern affecting 20% to 50% of children worldwide. Consequences for mental and physical health have been reported, but population-level estimates of risk of death during childhood that are adjusted for confounders have not been published to date. OBJECTIVETo estimate the association of documented child protection concerns regarding maltreatment with risk of death from infancy to 16 years of age. DESIGN, SETTING, AND PARTICIPANTS This case-control study was nested in a population birth cohort of 608 547 persons born in South Australia, Australia. Case children were those who died between 1 month and 16 years of age (with the death registered by May 31, 2019). Control children were randomly selected individuals from the same population who were alive at the age at which the case child died, matched 5:1 for age, sex, and Aboriginal status. Data were analyzed from January 2019 to March 2021. EXPOSURE Children were assigned to 1 of 4 child protection concern categories (child protection system notification[s] only, investigation[s] [not substantiated], substantiated maltreatment, and ever placed in out-of-home care) based on administrative data from the South Australia Department for Child Protection or were classified as unexposed. MAIN OUTCOMES AND MEASURES Mortality rate ratios for death before 16 years of age, by child protection concern category, were estimated using conditional logistic regression, adjusted for birth outcomes, maternal attributes, and area-based socioeconomic status. Patterns of cause of death were compared for children with vs without child protection concerns. RESULTS Of 606 665 children included in the study, 1635 were case children (57.9% male [when sex was known]; mean [SD] age, 3.59 [4.56] years) and 8175 were control children (57.7% male; mean [SD] age, 3.59 [4.56] years [age censored at the time of death of the matched control child]). Compared with children with no child protection system contact, adjusted mortality rate ratios among children who died before 16 years of age were 2.69 (95% CI, 2.05-3.54) for children with child protection system notification(s) only; 3.16 (95% CI, 2.25-4.43) for children with investigation(s) (not substantiated); 2.93 (95% CI, 1.95-4.40) with substantiated maltreatment; and 3.79 (95% CI, 2.46-5.85) for children ever placed in out-of-home care. External causes represented 136 of 314 deaths (43.3%) among children with a documented child protection concern and 288 of 1306 deaths (22.1%) among other children. Deaths from assault or self-harm were most overrepresented, accounting for 11.1% of deaths in children with child protection concerns but just 0.8% of deaths among other children. (continued) Key Points Question What is the differential risk of death before age 16 years among children with documented child protection concerns compared with children with no child protection system contact in South Australia? Findings In this case-control study of 606 665 children in Australia, those with documen...

Nonaccidental Pediatric Trauma: Which Traditional Clues Predict Abuse?

“…The difficulty in identifying child abuse as the etiology of an injury remains a major concern for emergency health care providers, [19][20][21][22][23] who fear a missed opportunity to prevent the death of a child. 24 However, the potential devastating effect on innocent care providers falsely accused of child maltreatment must also be considered. The incidence of false accusations of child maltreatment is approximately 4% of cases overall, and up to 12% of cases when child custody is at issue.…”

Health outcomes of children in state care in Aotearoa New Zealand

“…Population-based studies in Finland and California have both found that mortality is around three times greater among children in care when compared to children not in care. 19,20 For children in foster care, the risk of mortality was around 3.8 times greater than for children with no child protection system involvement. 20 The finding of the present study sits at the upper end of the range presented by international literature.…”

“…19,20 For children in foster care, the risk of mortality was around 3.8 times greater than for children with no child protection system involvement. 20 The finding of the present study sits at the upper end of the range presented by international literature. Kalland et al 19 proposes that child care and protection systems do not cause hospitalisation and mortality, but are at fault in not preventing them despite children in their care being recognised as being at a greater risk of suffering harm.…”

“…The finding that children in care also experience mortality at a greater rate than other children in the resident population is corroborated by international literature. Population‐based studies in Finland and California have both found that mortality is around three times greater among children in care when compared to children not in care 19,20 . For children in foster care, the risk of mortality was around 3.8 times greater than for children with no child protection system involvement 20 .…”

Typical median effective radiation doses using an anthropomorphic bone fracture phantom for initial radiographic skeletal surveys in the investigation of suspected physical abuse

“…Australian research using hospital morbidity data has shown that 32% of children admitted to hospital in Queensland between January 2003 and December 2006 with an unintentional injury were known to the child protection authorities [12], suggesting that a number of admissions likely to be associated with SPA are not recognised as such [13]. In a recent study in South Australia, it was shown that children known to child protection services had higher mortality rates, but only 2 of the 1,635 deaths listed child maltreatment as a contributing cause [14]. Research has consistently found that the youngest children are the most vulnerable to abuse-and neglect-related deaths [13].…”