Increased physician awareness needed to reduce injuries and neglect in children

The researchers say the majority of injuries are not the result of physical abuse but unintentional injuries, possibly resulting from inadequate supervision. The researchers encourage increased awareness by emergency personnel to identify children at risk of maltreatment and provide interventions to help parents reduce injuries.

"Not all children with multiple injury-related ED visits are victims of physical child abuse; physicians should consider the possibility of inadequate supervision as a cause of multiple injuries in young children," said Patricia Schnitzer, assistant professor in the MU Sinclair School of Nursing. "When treating young children who have had medical treatment for multiple injuries, physicians should seek information about previous injury-related ED visits, and ask parents about supervision techniques, their child's injuries and home environment. This information can help identify risk factors for injuries, and determine if interventions are needed."

Researchers from MU and Washington University identified 50,000 Missouri children ages 0-4 with at least one injury-related ED visit in 2000. They found that children with two or more injury-related ED visits in one year are more likely to be reported for child maltreatment compared to children with one injury-related ED visit. The risk of having a CPS report increased from twofold for children with two ED visits to fivefold for children with four or more visits.

"Physicians, social workers and other care providers can provide supervision guidelines, recommend parenting services and consider making reports to social services or family support agencies if inadequate supervision is suspected," Schnitzer said. "Regardless of the number of injuries, physicians who have concerns about a child's safety or suspect his/her injuries are related to physical abuse or neglect should immediately make a report to CPS."

Currently, it can be difficult for physicians to obtain information about prior ED visits, Schnitzer said. The researchers believe that the implementation of electronic medical records and other advanced technology will enable physicians and care providers to better identify frequent injury-related ED visits and other risk factors for injury and maltreatment in children.

The study, "Association of Injury Visits and Child Maltreatment Reports," is published in the February issue of the Journal of Emergency Medicine. It was co-authored by Maria Spivey and David Jaffe in the Washington University School of Medicine Department of Pediatrics; Robin Kruse in the MU Department of Family and Community Medicine; and Paula Slusher in the MU School of Medicine.