(RxWiki News) An important step toward preventing child abuse is identifying those children who are at the greatest risk for being abused. Looking at the household as a whole can provide clues.
A small study involving children who shared a home with an abused child reveals that medical professionals should examine these "contact" children for evidence of abuse as well, even if there are no obvious outward signs of maltreatment.
"Report any suspected child abuse you notice."
In the study, led by Daniel M. Lindberg, MD, of the Department of Emergency Medicine at Brigham and Women's Hospital in Boston and the ER division at Children's Hospital in Boston, researchers sought to determine the risk of abuse for those who share a home with children known to be abused.
The researchers noted that violence often affects an entire household and that child abuse often occurs alongside violence between romantic partners and even abuse of pets. Therefore, siblings of children who are abused are at a higher risk for abuse than children who do not live in a home with a history of abuse.
The researchers worked with 20 US child abuse teams who used a common screening tool to identify possible abuse among the children who lived with an abused child.
A total of 2,901 children were assessed by these teams, and 627 ultimately met the researchers' definition of being "physically abused," which was having a high likelihood of abuse (based on a child abuse doctor's assessment) and having had at least one serious injury.
Among these abused children, there were 479 "contacts," or kids who had shared a household with them, and 134 of these children were under age 2.
Being a "contact" included children who attended an in-home daycare with an abused child but not children who already showed outward evidence of abuse themselves.
The children under age 2 were given a physical exam and a skeletal survey, and babies under 6 months old received a physical exam, a skeletal survey and a brain scan.
The examinations revealed that at least one abusive fracture was found in 16 of the 134 children who received skeletal surveys - and none of these children showed evidence of abuse in their physical exams in terms of bruising, swelling or tenderness. Eight children had multiple fractures.
Kids between birth and a year old were more likely to have fractures than the toddlers aged 1 to 2.
None of the 19 babies who received head scans were identified as having any injury, though the researchers noted that 19 was too low a number for them to be able to draw any conclusions about this data.
Among children over age 2 and under age 5, there were 343 that child abuse teams recommended for a physical screening for abuse.
Only 259 were screened and 22 of these children had at least one injury, including bruises and two burns, though some of the bruises were attributed to accidents.
Overall, the researchers found evidence confirming that siblings and children sharing a home with an abused child are at a higher risk for being abused themselves and should therefore receive a skeletal survey even if a physical examination does not reveal abuse.
They noted, however, that their sample size was smaller than they had hoped for, and that there are other forms of physical abuse, such as shaking or suffocation, that may not leave any visible injuries.
They found that twins were 20 times more likely to experience abuse if their twin was being abused, though the small sample size of the study may have inflated this risk, making it seem larger than it would be in a study with a larger number of children.
Among the 4,828 children who were connected to the study - either who were suspected of being abused or who were contacts of an abused child - there were 80 pairs of twins and two sets of triplets.
The researchers concluded that any children 2 years old or younger who live with an abused child should be examined by medical staff, including a skeletal survey, even if a physical exam does not appear to show any abuse.
LuAnn Pierce, a licensed clinical social worker, told dailyRx that she has never understood the current standard policy of only evaluating one child in a family for suspected abuse.
"I have witnessed countless examples of this when one child was removed from home for protective custody, and others stayed until each had obvious injuries that warranted investigation and removal from the home," Pierce said. "We have a long way to go in balancing the rights of adults against the protection of children in the US."
Even if a child does not show outward signs of abuse, children living with an abused person "should fall under the 'threat of harm' mandate," she said.
"Until we as a nation understand the long-term damage to children who are abused, including witnessing violence and emotional abuse, our prisons will continue to be over capacity with adults who did not get the protection and treatment they needed to break the cycle of violence," Pierce said.
The study was published July 9 in the journal Pediatrics. The research was funded by a grant from the Health Resources and Services Administration/Maternal and Child Health Bureau as part of the Emergency Medical Services for Children Program.
Dr. Lindberg also received funding through his Eleanor and Miles Shore Fellowship for Scholars in Medicine from Harvard Medical School. Three of the authors declared that they had provided paid expert testimony in court cases related to possible child abuse. Three other authors declared no conflicts of interest.