Child Abuse Injuries More Severe Than Accidental Injuries

From the WebMD Archives

Jan. 20, 2000 (Minneapolis) -- Traumatic injuries caused by child abuse are more severe than accidental injuries, and the victims are younger, according to an article published recently in the journal Archives of Pediatric and Adolescent Medicine. The authors report that the circumstances, characteristics, and outcomes of these types of injuries differ markedly for preschool children.

Researchers reviewed the records of the nearly 19,000 children younger than five who had been hospitalized for acute injury from 1988 to 1997 and had therefore been entered in the National Pediatric Trauma Registry (NPTR). Of these, close to 2,000 had been injured as the result of abuse.

Children in the abused group had more severe injuries and were more likely to be admitted to intensive care. Their average hospital stay was 9 days, compared with 4 days for those accidentally injured. In the abuse group, the death rate was 13%, compared with 3% for accidental injuries. Eight-eight percent of the abused children were injured at home compared with 55% of those hurt in accidents.

Despite the establishment of the National Center on Child Abuse and Neglect and improved public awareness of child abuse, among children younger than five who are hospitalized for blunt trauma, abuse is the cause in 10% of cases.

"Children injured by child abuse were significantly younger," the authors write. The mean age in the abuse group was 13 months, compared to 26 months for those who had been accidentally injured. "The majority of children (63%) in the abuse group were infants," the authors write.

Among the abused children, several risk factors were present. For example, 53% had prior medical problems, compared with 14% of those accidentally injured. Those hospitalized for abuse were also 7 times as likely to have been born prematurely. They also often had signs of prior maltreatment, such as fractures in different stages of healing, chronic hematomas ("blood blisters"), retinal hemorrhages or bleeding in the inner eye, and skin infections associated with poor hygiene.

"Our study confirms other findings. Although [abuse of young children] is rather common, parents may be surprised and reassured to see how rare injuries are in daycare setting," lead author Carla DiScala, PhD, tells WebMD.


The authors found that only 0.9% of accidental injuries and 0.1% of abuse injuries occurred in daycare. DiScala is director of the National Pediatric Trauma Registry and is affiliated with Tufts University School of Medicine in Boston.

"This is a very valuable article that gives a fairly objective picture of [the impact of child abuse]," says Janet E. Squires, MD, who reviewed the article for WebMD. "We need to realize that some parents, such as those with premature infants and children with special medical needs, are more in need of support." Squires is an associate professor of medicine at the University of Texas-Southwestern Medical Center in Dallas, where she is the program director of the Child Abuse Program at the Children's Medical Center.

The study was funded partially by grants from the National Institute on Disability and Rehabilitation Research and the CDC.

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