Child physical abuse (CPA) is a leading cause of injury-related death among infants and young children. Common indicators include bruises, fractures, and particularly retinal and intracranial hemorrhages. During crises such as the COVID-19 pandemic, stressors like isolation, economic hardship, and limited access to support networks are known to elevate abuse risks. However, school closures and reduced in-person medical visits may also hinder detection. Studies report inconsistent findings: some suggest increased severe cases, others show decreased reports likely due to underreporting. Based on these challenges, there is a pressing need to investigate how the pandemic influenced not just the frequency, but the patterns of injury and diagnosis in child abuse cases.
Researchers from Children's Hospital Los Angeles and the University of Southern California published a new study (DOI: 10.1002/pdi3.2526) on February 26, 2025, in Pediatric Discovery examining the impact of the COVID-19 pandemic on CPA detection through skeletal surveys. The team compared injury types and incidences in suspected abuse cases before and during the pandemic, uncovering a striking drop in severe head injuries—even as overall abuse rates stayed constant. This study sheds new light on how shifts in healthcare access and reporting dynamics may have shaped the visibility and manifestation of abuse.
In this retrospective analysis of 479 pediatric patients who underwent skeletal surveys between 2019 and 2020, 10.5% before and 11.6% during the pandemic showed high suspicion for CPA—indicating no significant change in overall abuse rates. However, the proportion of intracranial hemorrhage dropped from 59% to 25%, and retinal hemorrhage from 38% to just 5% during the pandemic. All retinal hemorrhage cases were accompanied by brain trauma and occurred only before the pandemic. Meanwhile, skeletal fracture patterns, demographic variables, and mortality remained unchanged. These findings point to a potential shift in how abusive injuries were inflicted or detected, rather than a reduction in abuse itself.
"Our study reveals a concerning paradox—while abuse didn't decrease during the pandemic, the types of injuries we typically associate with the most severe cases became less common," said Dr. Joseph M. Rich, co-author and radiologist at the Keck School of Medicine, USC. "This raises the possibility that serious injuries are either being missed or not brought to medical attention due to disrupted care systems and reduced mandatory reporting."
The study reviewed electronic medical records of children who underwent skeletal surveys for suspected CPA at a California children's hospital between January 2019 and December 2020. Researchers compared demographic data and injury types—including brain hemorrhages, fractures, and bruises—before and after March 19, 2020, when California's stay-at-home order began. Statistical tests such as Pearson's chi-square and Fisher's exact were used to identify significant differences in injury patterns across time periods.
The findings underscore the need for enhanced child abuse detection strategies during public health emergencies. Researchers suggest increasing remote monitoring capabilities for physicians and educators, expanding training in telehealth abuse indicators, and strengthening support networks for families. Longitudinal studies across different regions and post-pandemic periods will be vital to fully understand the evolving patterns of child harm and to ensure protective measures keep pace in crises. As schools and clinics resume normal operations, monitoring long-term trends will help fill current knowledge gaps and inform better intervention protocols.
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References
DOI
10.1002/pdi3.2526
Original Source URL
https://doi.org/10.1002/pdi3.2526
About Pediatric Discovery
Pediatric Discovery is a Gold Open Access publication and officially sponsored by The National Clinical Research Center for Child Health and Disorders of China, and Children's Hospital of Chongqing Medical University. The journal does not charge any submission fees. The Article Publication Charge (APC) is currently waived for accepted manuscripts. Pediatric Discovery is an open access and peer-reviewed international journal. The journal aims to advance the health and well-being of infants, children, and adolescents by disseminating cutting-edge discovery and knowledge in the field. It provides a platform for publishing and discussing the most important and state-of-the-art basic, translational and clinical discoveries affecting child and adolescent health and disorders in all aspects of pediatric medicine. Directory of Open Access Journals (DOAJ).