PECARN Pie: COVID and Child abuse

Pandemic-era emergency department child abuse evaluations fell overall, but the decline was concentrated in lower-severity injuries and school-aged children. In infants and toddlers under 2 years, severe presentations and skeletal survey use stayed steady, underscoring that abuse screening remained essential during COVID-19.

Child Abuse Evaluations During COVID

• Overall ED abuse volume: Multicenter PECARN data showed a 19% drop in child abuse encounters during COVID-19, a headline decline that risks masking what did and did not actually change.
• Age-specific pattern shift: The reduction was concentrated in school-aged children, while abuse evaluations were unchanged in children under 2 years and in adolescents older than 13 years.
• Severity signal stability: Lower-severity abuse injuries fell the most across measures, but higher-severity injuries did not change, suggesting the pandemic altered detection more than the worst harm.
• Skeletal survey consistency: Skeletal survey rates did not change despite pandemic resource concerns, an important marker that clinicians maintained core screening practice under strain.
• Screening amid disruption: The key takeaway is not that abuse disappeared, but that presentation patterns shifted during COVID-19 and bedside suspicion still had to stay high. We get into the practice implications in the episode.

References: 

• Chaiyachati BH, Wood JN, Carter C, Lindberg DM, Chun TH, Cook LJ, Alpern ER; PECARN Registry Study Group and PECARN Child Abuse Special Interest Group. Emergency Department Child Abuse Evaluations During COVID-19: A Multicenter Study. Pediatrics. 2022 Jul 1;150(1):e2022056284. doi: 10.1542/peds.2022-056284. PMID: 35707943.
• Sidpra J, Abomeli D, Hameed B, Baker J, Mankad K. Rise in the incidence of abusive head trauma during the COVID-19 pandemic. Arch Dis Child. 2021;106(3):e14. 
• Kovler ML, Ziegfeld S, Ryan LM, et al. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. Child Abuse Negl. 2020:104756. 
• Sharma S, Wong D, Schomberg J, et al. COVID-19: Differences in sentinel injury and child abuse reporting during a pandemic. Child Abuse Negl. 2021;116(Pt 2):104990. 
• Salt E, Wiggins AT, Cooper GL, et al. A comparison of child abuse and neglect encounters before and after school closings due to SARS-Cov-2. Child Abuse Negl. 2021;118:105132. 
• Bullinger LR, Boy A, Messner S, Self-Brown S. Pediatric emergency department visits due to child abuse and neglect following COVID-19 public health emergency declaration in the Southeastern United States. BMC Pediatr. 2021;21(1):401. 
• Kaiser SV, Kornblith AE, Richardson T, et al. Emergency Visits and Hospitalizations for Child Abuse During the COVID-19 Pandemic. Pediatrics. 2020. 
• Maassel NL, Asnes AG, Leventhal JM, Solomon DG. Hospital Admissions for Abusive Head Trauma at Children's Hospitals During COVID-19. Pediatrics. 2021. 
• Swedo E, Idaikkadar N, Leemis R, et al. Trends in U.S. Emergency Department Visits Related to Suspected or Confirmed Child Abuse and Neglect Among Children and Adolescents Aged <18 Years Before and During the COVID-19 Pandemic - United States, January 2019-September 2020. MMWR Morb Mortal Wkly Rep. 2020;69(49):1841-1847.