Child abuse prevention efforts should reach beyond parents

Non-accidental injuries of children by a parent are more common but are likely to be less severe than those caused by a parent’s male partner, a babysitter or a daycare worker, according to a Children’s National study presented during the 2017 American Academy of Pediatrics (AAP) national conference. Based on their findings, the researchers recommend that efforts to prevent child abuse be extended to these additional types of caregivers.

The study performed by Omar Z. Ahmed, M.D., retrospectively reviewed the records of children admitted from 2013 to 2015 to evaluate and treat non-accidental trauma and identified 225 cases of child abuse. The 150 cases for which the perpetrator was identified were included in their analyses. The research team performed multivariate analyses to determine the association between the gender of the alleged perpetrator, the perpetrator’s relationship to the child and the severity of the child’s injuries.

“Among the 150 children hospitalized after suffering non-accidental trauma during the study period, 68.4 percent were injured by a parent; 14 percent were injured by a stepparent, boyfriend or girlfriend; 9.7 percent were injured by a daycare staff member or babysitter; and 4.6 percent were injured by a relative,” says Dr. Ahmed, a research fellow in Children’s Division of Trauma and Burn Surgery. “By far, parents were more likely to be perpetrators of the confirmed or suspected child abuse. However, children injured by a parent’s partner – a group that was overwhelmingly male – were more likely to be more severely injured, to experience severe head injuries and were more likely to require intubation compared with children who were abused by a parent.”

The research team says that the findings should prompt widening the net when attempting to prevent child abuse.

“It confirmed a lot of what we already knew and what was suspected,” Dr. Ahmed says. ”By taking the research a step further – characterizing the severity of injuries and treatments provided within the hospital – we identified caregiver types who are associated with severe child abuse. It gives parents a warning as to what to look out for when children are cared for by other people in the child’s life.”

A next step for the research group: Pre-emptive approaches to target the caregiver groups more likely to place children at risk of injury, he adds. These strategies could include educating caregivers, teaching coping mechanisms and modeling behavior for a wider group of individuals caring for young children, such as how to manage children appropriately when things get difficult, rather than letting anger take over.

“Parents rely on daycare, babysitters and significant others to provide child care while they work; it is not realistic to expect that to change. But we can target these groups for behavior modification in order to decrease the risk of children being injured,” Dr. Ahmed adds.