Why child welfare experts fear a spike of abuse during COVID-19

Over the course of five consecutive days last month, Dr. Jamye Coffman saw seven children and infants who had been abused so severely that they required hospitalization at Cook Children’s Medical Center in Fort Worth, Texas. At the time, the city, along with the rest of Texas, had recently declared an emergency over the rapid spread of novel coronavirus. Typically, the hospital sees fewer than 10 cases of fatal child abuse in a year, but that week, two died from their injuries.

It is too early to link this single — and anecdotal — spike in severe child abuse to the COVID-19 pandemic and the stress it’s causing, said Coffman, who serves as medical director of the Cook Children’s Center for Prevention and Child Abuse and Neglect. In fact, it will take more than a year to get a clearer picture of what’s happening nationwide, due to the lag in collecting and sharing child welfare data.

But Coffman said she is concerned that a trend she has seen before will play out again as the nation reels from the profound effects of the virus and the stresses brought on by mass unemployment, food insecurity and illness. During the last financial recession, which rolled out much more slowly than the current crisis, the rate of physical abuse and child deaths linked to abuse both increased at her hospital, she said.

“It all just adds stress on top of stress,” she said. “Any time there’s increased stress increases the risk of abuse on children.”

So she said she alerted the Fort Worth community through the local news to raise awareness of a possible rise in child maltreatment and prevent more children from dying, if the trend bears out. “It is hard to know if the numbers have gone up in the last few days or if medical providers are looking carefully and reaching out,” she said. “It’s too soon to tell if what we’re doing is making a difference.”

But even when federal data is available for this period, it may not show the full extent of abuse because of the ways crises also inhibit reporting.

Why the pandemic could play a role

No one knows how long this pandemic will last, and that uncertainty can cause anxiety, tension and irritability for children and caregivers. The United Nations has already raised the alarm that reports of domestic violence have soared around the world, underscoring how unsafe homes can be during a pandemic.

In the extreme, child abuse may happen when a caregiver is “pushed over the edge” by circumstances often outside their control, said Dr. Robert Sege, who directs the new Center for Community-Engaged Medicine at Tufts Medical Center.

Child welfare experts are most concerned about three conditions happening right now.

Routines are being disrupted. With businesses, schools and daycares shuttered, parents and children are in each other’s constant company, sometimes in close quarters. That may be welcome time spent together, but it can also be incredibly stressful when coupled with the demands of work, bills and other anxieties. Children, too, may act out when they are under stress.

Jobs have evaporated. By March 28, 6.6 million Americans had filed first-time jobless claims in a single week. Before that, nearly a fifth of Americans said they’d lost wages or jobs due to COVID-19, in a PBS NewsHour/NPR/Marist poll conducted March 13-14. That means more households are straining under the weight of debt and economic insecurity.

Children are isolated from others who care. Before the COVID-19 pandemic, the act of going to school and being seen by teachers, staff and fellow students stretched a modest net to help catch children who might be mistreated. Before, someone outside the home might spot a bruise and ask how things were going. Amid social distancing, that oversight is gone.

“These are all conditions that set up what might lead to child abuse and neglect,” said Sege, who served on the American Academy of Pediatrics’ Committee on Child Abuse and Neglect.

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Under normal circumstances, the highest risk period for a child to die after being abused or neglected is during the first year of life, he said. Given the stress summoned by a pandemic, Sege said that risk for the youngest children only rises.

“It’s that additional toll on vulnerable families that we’re worried about,” said Jessica Bartlett, who directs early childhood research for Child Trends, a nonpartisan organization that studies children’s well-being. “It can be the straw that broke the camel’s back.”

What the data says (and what it may miss)

For care professionals, a 15-month lag in data can hinder their ability to combat maltreatment. Bartlett said that the more real-time data they have about abuse, the better they can “respond appropriately.” But getting national data more quickly is tricky, said Sharon Vandivere, senior research scientist at Child Trends.

Twice a year, states and localities submit data that tracks child abuse and neglect to the federal government, she said, where it is then compiled, cleaned, analyzed and published. The most recent data available is from 2018. For years, child advocates and researchers have explored new ways to update child welfare data systems, but haven’t made substantial progress.

When life is disrupted by a natural disaster, research has shown that incidents of abuse have increased, and children in dangerous situations can fall through the cracks in the system. That may be happening now, since teachers, early childhood education providers and home health clinicians are obligated to file reports of suspected child maltreatment, Bartlett said, but the COVID-19 pandemic has interrupted or suspended those services.

When it comes to the Great Recession, the official government data do not reflect an increase of abuse. In 2007, at the outset of the financial crisis, 794,000 children in the U.S. were abused or neglected, according to the federal Administration for Children and Families. Amid the throes of the banking crisis in 2008, that estimate appeared to dip to 772,000 children and in 2009, official estimates said 702,000 children were maltreated. But a 2015 report by a children’s advocacy group found that hospital admissions for serious child abuse and traumatic brain injuries did increase during the time period, and found that these upticks were geographically aligned in areas with higher home foreclosure rates and unemployment rates.

There has been a push to explore ways social media or online searches can fill in gaps and offer more immediate insights about how and where children might be suffering, but questions must be weighed, about how reliable and accurate those data points might be, Vandivere said.

What to do when stress takes over

The daily stress of the current pandemic, and the isolating measures taken to combat it, make impulse control increasingly difficult, said Dr. Steven Berkowitz, a child psychiatrist at the University of Colorado School of Medicine.

To those who feel at risk of causing harm to their children, Sege suggests:

• Call a friend.
• Call a pediatrician.
• Send your child to a quiet corner.
• Take a walk outside (while maintaining a safe social distance of at least six feet from anyone who doesn’t live in your household).
• For infants, place them in a crib, step away and draw deep breaths to cool off.
• Call or text a helpline.

There is no shame in asking for help during times of unprecedented stress, Coffman said, adding that community members need to watch out for their friends and step in if they think someone needs help.

“Social distancing doesn’t have to be social isolation,” she said.

It is more important that people support families who may already have been struggling with child maltreatment, domestic violence, substance use or other issues to prevent trauma from happening in the first place, Bartlett said, rather than simply identifying families where a child has been hurt or overlooked.

For those who identify a family who may be struggling and want to help, Sege suggests calling, texting or video-conferencing with them to ask how they’re doing, or offering to pick up groceries, diapers or other essential supplies.

“Sooner or later, the viral infection will pass,” Sege said. “We want to make sure our children are physically and psychologically safe through all this.”