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More Child Abuse Suspected in Minorities

Underreporting of White Parents Part of Problem
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Oct. 1, 2002 -- Hospitals are more likely to look for child abuse among minority children. The finding helps explain why black and Hispanic children are more often referred to child welfare agencies -- even though national surveys show they are no more likely to be abused.

Wendy G. Lane, MD, MPH, of Children's Hospital of Philadelphia, and colleagues note that previous research suggests there are racial differences in abuse reporting. They set up a study to look at the situation in their own inner-city hospital.

Their study, reported in the Oct. 2 issue of TheJournal of the American Medical Association, examined medical records for children younger than 3 years who were hospitalized between 1994 and 2000 for skull injuries or broken bones.

The findings: suspected abuse reports were more than twice as common for minority children. These reports were filed for more than one in two minority kids, but for fewer than 1 in 4 white kids. Though actual abuse was found for more of the minority children, it did not explain the size of this difference.

"These results are concerning, but not surprising, as a number of other studies have identified differences in health-care provision between minorities and non-minorities," Lane and colleagues write.

To look at what might be happening, a senior medical student removed information on race, income, and insurance status from the children's records. Then an independent expert on child abuse evaluated the records to see whether the children should be given a skeletal exam to look for signs of abuse.

For almost all cases where it wasn't clear how the child was injured, the expert recommended the skeletal exam. In practice, 29 of 34 minority children in this category -- but only 9 of 23 white children -- got this test.

"It is quite possible that cases of abuse were overlooked in white children because no study was performed," the authors note.

All three National Incidence Studies of Child Abuse and Neglect have found no racial differences in actual maltreatment of children. Nevertheless, black and Hispanic children are more likely to be sent to child welfare services.

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