Canadian study reveals how COVID-19 lockdowns masked child maltreatment

Hospital admissions for maltreatment of children under the age of 2 years declined 31% during the 16-week lockdown at the start of the COVID-19 pandemic, returning to prepandemic levels after restrictions lifted, according to new research published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251317.

However, after the 16-week period of restricted health care access, rates of admission to the intensive care unit (ICU) for child maltreatment increased by 80%.

"We consider that the observed decrease and subsequent stabilization in hospital admission incidence rate during the pandemic may be attributable to delayed case identification or lack of admissions to investigate more minor injuries, rather than a true decline in the population incidence of child maltreatment - young children experiencing maltreatment that may have warranted hospital admission did not appear to present to care during the period of restricted health care access," writes pediatrician Dr. Matthew Carwana, BC Children's Hospital Research Institute, Vancouver, British Columbia, with coauthors. "This early underdetection, as well as ongoing pandemic-related stress, may have led to the subsequent increase in ICU admissions."

The strict public health measures enacted during the first period of the pandemic disrupted normal routines, closing schools, restricting access to primary care physicians, and increasing household stress and parental isolation. These factors could lead to increased child maltreatment, yet few studies have examined the impact of the pandemic on child maltreatment.

Researchers from POPCORN (Pediatric Outcomes Improvement Through Coordination of Research Networks) compared hospital admissions in the pandemic period from Mar. 1, 2020, to Mar. 25, 2023, with the prepandemic period (Apr. 3, 2016, to Feb. 29, 2020) using data from the Canadian Institute for Health Information (CIHI) for all provinces and territories except Quebec, and from l'Institut national d'excellence en santé et en services sociaux (INESSS) for Quebec. A total of 1518 hospital admissions for child maltreatment occurred in children younger than 2 years out of about 750 000 children in this age range in the country.

As admissions to ICUs increased after the 16-week period of health care restrictions ended, it may indicate child maltreatment during this phase of the pandemic.

"This raises concern that children may have been living in unsafe situations or experiencing abuse that went undetected during the period of the most stringent public health measures. It also highlights the potential importance of hospital admissions for assessment of sentinel injuries consistent with child maltreatment that could prompt action to prevent more severe presentations," the authors write.

They suggest that, in preparing for potential future pandemics, planners should ensure there are mechanisms to identify cases of child maltreatment, even during periods of public health restrictions.