The Effect of Socioeconomic Status and Parental Demographics on Activation of Department of Child and Family Services in Pediatric Burn Injury

Abstract

Burns resulting from child maltreatment are tragic causes of significant morbidity and mortality, most commonly affecting children under 3 years of age. More than one third of nonaccidental burns occur in single-parent homes or have parents with history of mental illness, substance abuse, incarceration, or Department of Children and Family Services (DCFS) involvement. The authors sought to profile pediatric burn injuries associated with DCFS investigations. They performed a retrospective chart review of pediatric burn patients, admitted between January 1, 2011 and December 31, 2014. They analyzed patient and household demographics, family composition, employment, zip code, insurance, etiology, percent TBSA burned, surgical interventions, length of hospital stay, disposition, prior DCFS involvement, and DCFS investigation outcomes. There were 126 DCFS investigations involving patients with average age of 2.6 ± 3.2 years and 5 ± 5.6% TBSA burn. Scalds were the most prevalent etiology at 76%. Parents involved with DCFS were 5 years younger than those without DCFS. Factors associated with increased odds of DCFS investigation were non-Caucasian race, single-parent homes, unemployed primary caretaker, Medicaid utilization, and prior DCFS involvement. A majority of DCFS investigations were initiated at outside hospitals, and they found one third to be substantiated cases of abuse. Non-Caucasian children, under 3 years of age, from lower socioeconomic or single-parent homes, are associated with higher rates of DCFS investigations. The majority of DCFS investigations were unsubstantiated and there were no significant epidemiological differences between unsubstantiated and substantiated cases of abuse. Improved understanding of sociodemographic risk factors for children at higher risk for negligence or intentional abuse warrants focused public health programs on regional prevention and education.

Treatment algorithm in 960 pediatric burn cases: A review of etiology and epidemiology

“… 7 In earlier studies on burns etiology carried out by many researchers, hot liquid burns have been found to be most common, whereas burns from direct contact with flames take second place. 1 , 3 , 7 , 9 - 11 In our study, hot water and tea burns took first place (85%), with dairy product burns taking second place (11%), in contrast to many earlier studies in which direct flame burns take second place. This finding may be attributed to that the majority of our burn cases (85%) were from families living in rural areas where animal husbandry is common, and where the relationship between dairy products and floor furnace burns and females was found to be statistically significant (p <0.05).…”

Risk factors for nonaccidental burns in children

“…Lane et al retrospectively reviewed children admitted for skull or long bone fractures and found that minority children between 1 and 3 years old were significantly more likely to be referred to CPS compared with their non-Hispanic white counterparts (adjusted OR 4.32, 95% CI 1.63–11.43, P = .003) [ 11 ]. The burn literature mirrors this finding: Campos et al reported that nonwhite race/ethnicity was associated with increased odds of CPS referral in pediatric burns [ 9 ].…”

“…Hodgman et al narrowly categorized NABs as burns secondary to intentional injury inflicted by another person and therefore reported a low rate of 5.3% [ 8 ]. Campos et al broadly defined NABs as a burn with concurrent CPS involvement and, therefore, reported a much higher rate of 22.5% [ 9 ]. As expected, our rate falls in between these estimates because burns secondary to neglect were included in our definition of NAB.…”

“…Although previous studies corroborate our observation of increased screening among non-Hispanic black children, our finding of a corresponding higher rate of NABs conflicts with some prior literature. Campos et al reported that, although non-Hispanic black children were twice as likely to trigger CPS involvement, they were not more likely to be involved in substantiated cases of abuse or neglect [ 9 ]. The disparity observed by Campos et al suggests a reporting bias rather than a true difference between groups.…”

“…Race/ethnicity appears to interact with SES in both CPS referral patterns and determination of abuse. Medicaid utilization has also been specifically cited as a risk factor for CPS involvement [ 9 ]. Poverty has been linked to a higher proportion of unmarried and teenaged parents, and single-parent households have been associated with abuse [ 15 ].…”