A significant 31% downturn in hospitalizations for child abuse among individuals under the age of two was observed during the initial 16-week COVID-19 pandemic lockdown. These admission rates subsequently reverted to their pre-pandemic baseline once public health mandates were relaxed, as revealed by novel research published in the Canadian Medical Association Journal (CMAJ) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.251317.
Conversely, following this 16-week period of restricted healthcare accessibility, there was an 80% surge in intensive care unit (ICU) admissions attributable to child maltreatment.
“We surmise that the noted reduction and subsequent stabilization in the rate of hospital admission incidence during the pandemic may stem from delayed identification of cases or a lack of admissions for the investigation of less severe injuries, rather than a genuine decrease in the population’s incidence of child maltreatment. Young children experiencing maltreatment that might have necessitated hospital admission did not appear to seek care during the phase of curtailed healthcare access,” stated pediatrician Dr. Matthew Carwana of the BC Children’s Hospital Research Institute in Vancouver, British Columbia, alongside his coauthors. “This early underdetection, coupled with persistent pandemic-related stressors, could have precipitated the subsequent rise in ICU admissions.”
The stringent public health protocols implemented during the pandemic’s initial phase disrupted established routines, leading to school closures, limited access to primary care physicians, and increased household stressors and parental isolation. While these circumstances have the potential to exacerbate child maltreatment, there has been a paucity of studies investigating the pandemic’s impact on this issue.
Investigators affiliated with POPCORN (Pediatric Outcomes Improvement Through Coordination of Research Networks) conducted a comparative analysis of hospital admissions during the pandemic period, spanning from March 1, 2020, to March 25, 2023, against the prepandemic timeframe (April 3, 2016, to February 29, 2020). This evaluation utilized data from the Canadian Institute for Health Information (CIHI) for all provinces and territories with the exception of Quebec, and from l’Institut national d’excellence en santé et en services sociaux (INESSS) for Quebec. A total of 1518 hospital admissions for child maltreatment were recorded for children under the age of 2, out of an estimated 750,000 children within this demographic across the nation.
The observed increase in ICU admissions after the conclusion of the 16-week health care restrictions may serve as an indicator of child maltreatment during this particular phase of the pandemic.
“This finding raises apprehension that children might have been subjected to unsafe living conditions or abuse that went unrecognized during the period of the most rigorous public health measures. It also underscores the potential significance of hospital admissions for the assessment of sentinel injuries indicative of child maltreatment, which could trigger interventions to avert more severe outcomes,” the authors contend.
They propose that in anticipation of potential future pandemics, planners should establish robust mechanisms for the identification of child maltreatment cases, even during periods characterized by public health restrictions.
McDowell, H., et al. (2026). Sentinel injuries and indicators of child physical abuse. Canadian Medical Association Journal. DOI: 10.1503/cmaj.251219. https://www.cmaj.ca/content/198/6/E220
