The Challenge of Identifying Pediatric Abusive Head Trauma During the COVID-19 Pandemic

Researchers: Dr Laura Elizabeth Cowley (Public Health Wales/National Centre for Population Health & Wellbeing Research) and Dr Andrew Adesman (Department of Pediatrics, Steven and Alexandra Cohen Children’s Medical Center, New York/ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY)

In their publication, the researchers provide a commentary on the following research study: Hospital Admissions for Abusive Head Trauma at Children’s Hospitals During COVID-19 | American Academy of Pediatrics (aappublications.org). The full commentary can be accessed here: The Challenge of Identifying Pediatric Abusive Head Trauma During the COVID-19 Pandemic | American Academy of Pediatrics (aappublications.org).

The Challenge

Abusive head trauma (AHT) is a leading cause of traumatic death in infants and young children. Timely identification is crucial because children who suffer AHT are often subjected to sustained episodes of abuse. However, identification of AHT is challenging because clinical signs and symptoms can vary and be subtle, meaning AHT can often be missed be practitioners.

The COVID-19 pandemic has had a profound impact on families and households. As a result, there is concern that children may be at increased risk for physical abuse and that some cases may go undiagnosed.

The Research

A national study was conducted in the United States that examined changes in the frequency of AHT hospitalisations during the COVID-19 pandemic. Using data from the Pediatric Health Information System database, the authors compared mean hospital admission rates for AHT and key demographic and admission characteristics at 49 children’s hospitals during March to September 2020 with those across the same months of the preceding 3 years.

The Findings

• There was a statistically significant decrease in hospital admissions for AHT during the COVID-19 pandemic compared with each previous year.
• There were no statistically significant differences in the proportion of children who were admitted to an ICU, required a ventilator, presented with subdural haemorrhage (irritation that causes bleeding to the brain) or retinal haemorrhage (bleeding in the retina of the eye), or died of their injuries.

The Impact

Evidence suggests that even when medical care is sought, many AHT cases go unrecognised by medical professionals, even without the additional challenges posed by the pandemic. If milder cases of AHT are being missed, we might expect more severe hospitalisations for AHT and/or physical abuse in the COVID-19 period compared with earlier time periods, but this is not the case. This indicates that while hospital admission data is undeniably useful for assessing the scope of AHT, it represents only 1 piece of the puzzle. For this reason, it is important to consider all possible explanations in these unprecedented times, and emerging theories must be explored going forward.

Future research should be focused on untangling the factors driving changes in health care use and designing and implementing interventions to better understand and reduce the short- and long-term effects of COVID-19 on violence and abuse in children.

Publication – Cowley L, Adesman A. ‘The Challenge of Identifying Pediatric Abusive Head Trauma During the COVID-19 Pandemic’. Pediatrics July 2021, 148 (1) https://pediatrics.aappublications.org/content/148/1/e2021050612