Pennsylvania doctors who treat child abuse say they are seeing a wave of more serious injuries in younger victims. It’s part of a disturbing trend they first observed in the spring: as the coronavirus continues to spread across the state, so does the number of severe injuries in abused children.
The virus didn’t recede in the summer as anticipated, nor did the abuse.
Penn State Children’s Hospital saw a wave of serious injuries that began in mid-June, according to Dr. Lori Frasier, chief of the hospital’s child abuse pediatrics division. “We’re seeing a surge of some kind,” she said last month. The hospital doesn’t provide specific patient numbers, but it is “seeing pretty serious physical abuse injuries,” Frasier said.
The children range in age from “young to very young,” she said, and often end up in critical condition in the intensive care unit. “What really kills kids is head and abdominal trauma,” Frasier said. “That’s what they die from in those early 1- to 7-day periods.”
Fatal and nearly fatal
At least 155 children died or nearly died this year in Pennsylvania as a result of suspected child abuse or neglect, according to state data from Jan. 1 to July 15. Those cases were referred to child welfare investigators, according to Ali Fogarty, communications director at the state Department of Human Services. There were 144 children who died or nearly died in all of 2019 because of substantiated abuse or neglect, according to state data. But, to clarify, measuring the differences between suspected cases and substantiated cases is not an apples-to-apples comparison.
In the cases last year, most abuse came at the hands of a parent, according to state data. The majority of victims were younger than 4 years old. Overall, there were more than 5,200 substantiated cases of child abuse in Pennsylvania last year, with more than 40 percent of those cases attributed to sexual abuse. The rate of abuse in rural counties was more than double the rate in urban counties. During the past five years, the number of fatalities and near fatalities in children has steadily increased from 95 in 2015 to 144 in 2019.
Waves of trauma
Penn State Children’s Hospital has seen waves of child abuse trauma in the past, even before a public health crisis changed American life. But families are facing added pressure as the virus has a systemic effect in Pennsylvania, and that’s leading to more abuse, Frasier said. Unemployment or having one parent at home to take care of the kids is a big source of stress, she said. “They don’t feel like the pandemic has passed,” Frasier said.
There were 835 additional positive cases of Covid-19 and 20 deaths reported in Pennsylvania on Friday, bringing the statewide total to nearly 132,000. More than 7,600 state residents have died. The state can track the number of positive cases and deaths, but the overall effect the virus is having on vulnerable children is unclear. I don’t think we’ll have the full picture for a year,” Frasier said. “We’re right in the middle of it.”
‘A lot of stress’
St. Christopher’s Hospital for Children in Philadelphia saw an increase in severe injuries in the spring. In July, Dr. Norrell Atkinson, section chief of the child protection program at the Level 1 trauma and burn center, started seeing an increase of toxic ingestions in young children. “They come in with illegal substances in their system — opiates, marijuana, amphetamines,” she said. Close to a third of the hospital’s cases are ingestions, and the patients are generally younger than 5 years old, Atkinson said. “I’ve been at this hospital for two years,” she said, “and I haven’t seen a cluster like this.”
In most cases, the child lives in a home where the drugs are present and they are left unsupervised long enough to ingest the substances. During June and July, the hospital saw cases often in which there were “supervision issues, and (parents and guardians) were more stressed and medicating differently,” Atkinson said. The hospital doesn’t disclose the number child trauma cases treated, but all of the ingestion patients have survived, she said. “We’re busier this year, and that could be due to a variety of factors, including the pandemic,” Atkinson said. “We’re not seeing decreased rates of abuse or neglect. We see a lot of stress.
The trend in Pennsylvania is in line with what’s occurring nationwide. Doctors across the country are seeing more severe injuries in children in a week than they’re used to seeing in a month, according to medical providers at the American College of Emergency Physicians. “The current pandemic is changing all of our lives in ways we can see, but the unseen may be even more vital than the seen,” said Dr. Jacque Johnsen, vice chair of the American College of Emergency Physicians. “Knowing additional risks to the most vulnerable patient populations at this time may save even more lives.”
The U.S. Centers for Disease Control and Prevention cited safety issues among its reasons that students should return to school in the fall. “Extended school closures deprive children who live in unsafe homes and neighborhoods of an important layer of protection from neglect as well as physical, sexual, and emotional maltreatment and abuse,” the CDC reported. Teachers and educational staff report suspected child abuse more than any other type of mandated reporter, according to state and federal data.
When students weren’t in classrooms in the spring, child abuse reports decreased. But severe child injuries increased, according to emergency room doctors. The CDC cited an example of that in Washington, D.C.: The Washington, D.C. Child and Family Services Agency recorded a 62 percent decrease in child abuse reporting calls between mid-March and April this year compared to the same time period in 2019, but saw more severe presentation of child abuse cases in emergency rooms.
In Pennsylvania, Frasier said she’s “hoping against hope” the trend changes soon. “I hope families reach out to resources and know they’re not alone,” she said. “I don’t want families to feel so isolated and stressed.” And she doesn’t want to see another child with an injury that can’t be healed.
Candy Woodall is a reporter for the USA Today Network. She can be reached at 717-480-1783 or on Twitter at @candynotcandace.