Abuse-related head injuries in kids rose during recession

Rates of abusive head trauma in children under age 5 rose during the last recession, suggesting that economic woes may have led parents to lash out against their kids, researchers reported Monday in the journal Pediatrics.

The data also suggest that physicians today may want to be extra vigilant for signs of child abuse as economic conditions remain in the doldrums, the team wrote.

The notion that economic hardship leads to increases in child abuse is not new -- scientific research and anecdotal reports have long shown a relationship. For example, the Los Angeles Times reported during the recession in 1994 about increases in child abuse and neglect in Los Angeles County. In recent years, the co-authors noted in the Pediatrics study, articles in the popular press including this one and this one have again stoked concerns that abuse was on the rise as the economy worsened.

Hoping to better understand the relationship, Dr. Rachel Berger of the Children’s Hospital of Pittsburgh and her co-authors reviewed medical records of children under 5 years old with abusive head trauma in three regions -- six counties in the Seattle area, 23 counties in western Pennsylvania, and 45 counties in Ohio and northern Kentucky -- between Jan. 1, 2004, and June 30, 2009. Roughly the first four years of that period preceded the recession; the last 19 months coincided with it.

A total of 422 children in the studied regions, 58% of them boys, were treated for abusive head trauma during the research period. Their average age was 8.9 months; more than three-fourths were less than a year old. Sixty-three percent went to a pediatric ICU. Sixteen percent died.

All three areas had significant increases in abusive head trauma during the recession. Put together, the annual rate of the injuries went up from 8.9 per 100,000 before the recession to 14.7 per 100,000 during the recession, the team reported.

The researchers did not find any correlation between unemployment rates in the counties and abusive head trauma. They speculated that this might be because official unemployment figures exclude people who are underemployed, people who are discouraged in their job searches and others who might be under economic pressure.

“Although it is not possible to prove a causal relationship between the AHT rate and the economy with our analysis, we believe the data are compelling enough to influence policy and clinical decisions,” the researchers wrote.

Possible approaches might include discussion of the ways economic stressors could be mediated to prevent the abuse, as well as increased vigilance for signs of abuse during times of economic stress -- much the way physicians might pay closer attention to a cough during a pertussis outbreak, they added.