Child Abuse Head Injuries Rise as Economy Falls

The number of abusive head traumas among infants and young children
appears to have risen dramatically across the United States since the
onset of the current recession in 2007, new research reveals.
The observation linking poor economics to an increase in one of the
most extreme forms of child abuse stems from a focused analysis on
shifting caseload numbers in four urban children's hospitals. But the
finding may ultimately touch upon a broader national trend."Abusive
head trauma -- previously known as 'shaken baby syndrome'
-- is the leading cause of death from child abuse, if you don't count
neglect," noted study author Dr. Rachel P. Berger, an assistant
professor of pediatrics at the University of Pittsburgh School of
Medicine. "And so, what's concerning here is that we saw in four cities
that there was a marked increase in the rate of abusive head trauma
among children during the recession compared with beforehand.""Now
we know that poverty and stress are clearly related to child abuse,"
added Berger. "And during times of economic hardship one of the things
that's hardest hit are the social services that are most needed to
prevent child abuse. So, this is really worrisome."Berger, who
also serves as an attending physician at the Children's Hospital of
Pittsburgh, is slated to present her findings with her colleagues
Saturday at the Pediatric Academic Societies' annual meeting in
Vancouver, British Columbia, Canada.To gain insight into how the
ebb and flow of abusive head trauma cases might correlate with economic
ups and downs, the research team looked over the 2004-2009 records of
four urban children's hospitals.The hospitals were located in
Pittsburgh, Seattle, Cincinnati and Columbus, Ohio. Only cases of
"unequivocal" abusive head trauma were included in the data.The
recession was deemed to have begun on Dec. 1, 2007, and continued
through the end of the study period on Dec. 31, 2009.Throughout
the study period, Berger and her team recorded 511 cases of trauma. The
average age of these cases was a little over 9 months, although patients
ranged from as young as 9 days old to 6.5 years old. Nearly six in 10
patients were male, and about the same proportion were white. Overall,
16 percent of the children died from their injuries. The
authors found that the changing economic situation did indeed appear to
be associated with a shifting rate of abusive head trauma. While the
average number of such cases per month had been just shy of five, that
figure rose to more than nine cases per month once the downturn got
underway.The researchers further noted that as the economy
tanked, the trend towards an increase in cases was most strongly
evidenced in Seattle and Pittsburgh.Berger and her colleagues
were not able, however, to draw a specific link between certain aspects
of the economy and the apparent abuse case spike.The authors did
not, for example, uncover any direct correlation between monthly
unemployment rates in each hospital's local county and local trauma
caseload figures. Yet, because 90 percent of the young patients were
already on Medicaid when treated -- even before the recession -- the
researchers suggested that already-high local unemployment rates might
not have been the best measure of a dipping economy's real impact on
trauma rates.By contrast, the authors predicted that an analysis
of alternative recession indicators -- such as social service cuts and
psychological stresses propelled by tough times -- might ultimately get
at the precise underpinnings of the apparent association."We did a
very sophisticated type of analysis," Berger nonetheless stressed. "So,
this finding is not just attributable to chance, which means these
findings should really give us pause."Jay G. Silverman, an
associate professor of society and human development and health at the
Harvard University School of Health in Boston, expressed little surprise at the findings."We've seen at
the state and local levels services cut repeatedly over the last two to
three years," he noted. "And that, combined with a likely increase in
the number of people in need of these services, would lead to a smaller
percentage of these folks getting what they need, and perhaps leading to
greater numbers of these kinds of situations escalating to the point
where we're observing more head trauma."Silverman, who also serves as director of Harvard's Violence Against
Women Prevention Research, added that where there's a significant bump
in rates of abusive head trauma, there's most probably also an increase
in less easily tracked forms of abuse."Abusive head trauma is one
of the most observable indicators of child abuse, because they result
from the most extreme domestic violence that requires hospitalization,"
he noted. "But there are many, many, many more child abuse cases that we
wouldn't expect to show up as traumatic brain injuries in the ER. So an
increase seen in head trauma is probably indicative of an even larger
problem. And that means that this finding should really be a major public concern."
More information For more on child abuse, visit Prevent Child Abuse America.