Maltreatment of Children Under Age 2 With Specific Birth Defects: A Population-Based Study

Abstract

BACKGROUND AND OBJECTIVES: Children with disabilities are at an increased risk for maltreatment. However, the risk of maltreatment is unknown for children with specific types of birth defects. This study was conducted to determine whether the risk and predictors of maltreatment differ between children with and without 3 birth defects: Down syndrome, cleft lip with/without cleft palate, and spina bifida. METHODS: This population-based study of substantiated childhood maltreatment was conducted in Texas from 2002 to 2011. Linked data were used to describe the risk and types of maltreatment that occurred before age 2 years in children with and without specific birth defects. Poisson regression was used to identify predictors of maltreatment and assess differences in those predictors between children with and without these specific birth defects. RESULTS: The risk of maltreatment (any type) in children with cleft lip with/without cleft palate and spina bifida was increased by 40% and 58%, respectively, compared with children with no birth defects. The risk of any maltreatment was similar between children with Down syndrome and unaffected children. Across birth defect groups, the risk of medical neglect was 3 to 6 times higher than in the unaffected group. Child-, family-, and neighborhood-level factors predicted maltreatment in children with and without birth defects. CONCLUSIONS: The overall risk of substantiated maltreatment was significantly higher for some but not all birth defect groups. The factors associated with increased risk were similar across groups. Enhancement of existing maltreatment prevention and early intervention programs may be effective mechanisms to provide at-risk families additional support.

Potential Opportunities for Prevention or Earlier Diagnosis of Child Physical Abuse in the Inpatient Setting

“…Abused children had higher rates of perinatal-related (eg, prematurity) diagnoses compared with controls, and perinatal-related conditions accounted for ∼1 in 6 previous inpatient visits among abused children. Our results are in agreement with previous findings that prematurity and low birth weight are associated with increased risk for physical abuse 10,[27][28][29][30] but that congenital anomalies (eg, spina bifida) may not be. 28 Our results support NICUs as areas at children' s hospitals that may particularly benefit from abuse prevention efforts.…”

“…Our results are in agreement with previous findings that prematurity and low birth weight are associated with increased risk for physical abuse 10,[27][28][29][30] but that congenital anomalies (eg, spina bifida) may not be. 28 Our results support NICUs as areas at children' s hospitals that may particularly benefit from abuse prevention efforts. It is disappointing that primary abuse prevention efforts (The Period of PURPLE Crying and the Pennsylvania Shaken Baby Syndrome Prevention Program) employed during newborn hospitalizations have not clearly lead to reductions in AHT.…”

Maltreatment Risk Among Children With Disabilities

“…4,9 However, our finding of no increased risk for spina bifida or cleft lip and/or palate after adjustment was the opposite of previous findings. 15 Possible explanations for the lower risk for children with DS and autism include that these disabilities are comparatively well recognized, understood, and supported. Parents tended to be older, better off socioeconomically, and for DS, the ready availability of prenatal screening in WA means most parents have had the opportunity for prenatal diagnosis and the choice to continue with the pregnancy.…”

Pectus excavatum from a pediatric surgeon’s perspective

“…Children and teenagers have a natural aversion to deformities and therefore patients with pectus excavatum may experience severe psychological trauma both in and out of school (29). The persecution starts early as noted in the following account:…”