Anthony Fabio's Research Highlights the Rise of Child Abusive Head Trauma During Recession

An increase in child abuse, mostly in infants, is linked with the recent recession in new research that raises fresh concerns about the impact of the nation's economic woes. The results are in a study of 422 abused children from mostly lower-income families, known to face greater risks for being abused, and the research involved just 74 counties in four states. However, the results confirm anecdotal reports from many pediatricians who've seen increasing numbers of shaken baby cases and other forms of brain-injuring abuse.

Anthony Fabio, PhD, assistant professor, University of Pittsburgh Graduate School of Public Health Department of Epidemiology, is the senior author of the study, which was released online Monday, September 19, in Pediatrics, the official journal of the American Academy of Pediatrics.

Researchers decided to study this type of injury, known as abusive head trauma, after noticing an increase in hospital cases from late 2007 through June 2009. One hospital averaged 30 cases per year during those recession years versus 17 yearly before 2007.
Though this abuse is still uncommon, the number of cases in the counties studied increased sharply, rising from about 9 cases per 100,000 children in pre-recession years, to almost 15 per 100,000 kids during the recession - a 65 percent increase.

By contrast, juvenile diabetes—a better-known condition—affects about 19 per 100,000 children younger than age 10.
Children studied were younger than 5, and most were infants. Most suffered brain damage and 69 died, though the death rate didn't rise during the recession.

Unemployment rates in the 74 counties rose during the five-year study. The proportion of children on Medicaid in those counties also increased from 77 percent before the recession to 83 percent. However, insurance and family employment information were not reported for the abused children in the study. Combine the stress of raising a young child with wage cuts or lost jobs and you get a toxic brew in terms of thinking about possible physical violence.

Along with U.S. Census data released last week indicating that a record 46 million Americans are poor, the study shows that as poverty goes up and economic stagnation continues, there are really human costs involved.

The counties studied included Pittsburgh and western Pennsylvania; central and southern Ohio; and a handful of counties in northern Kentucky and in the Seattle area. The researchers examined medical records and national labor statistics for 2004 through November 2007 and compared them with data from the recession.

Of the 422 children diagnosed with abusive head trauma during the study, roughly 65 cases occurred each year before the recession, versus about 108 yearly during the recession.

Federal government data suggest that the recession did not affect child abuse rates. But the study authors said those numbers are based on reports from child protective services, not medical diagnoses, and did not address brain injuries specifically.

The research doesn't prove that the recession caused the abuse. Studying different regions and children from more middle-class families would help clarify if the recession really played a role. Most children studied were publicly insured even before the recession, suggesting that their families were already struggling financially. Still, the recession affected many lower-income families, and the study highlights a very important issue.

It is suggested that pediatricians could help with prevention by asking families about difficulties paying for food or shelter and referring those in need to social service agencies. Sometimes just asking parents about stresses in their lives and acknowledging their struggles can help.

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