A Systematic Review of Pediatric Nonaccidental Burns: Protecting the Children Through Knowledge, Vigilance, and Prevention.

BACKGROUND: Inflicted burns on children are a particularly difficult medical and psychosocial issue. Pediatric nonaccidental burns (PNABs) are unfortunately relatively common. In our study, we aim to present the key findings on PNABs with the intention of raising awareness, improving early, and recognizing accurately by identifying red flags, developing triage tools, and establishing prevention strategies for this sensitive issue. METHODS: A computerized literature search was conducted on PubMed, Google Scholar, and Cochrane for articles published until November 2020. The online screening process was performed by 3 independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS: A total of 12 studies were included for analysis. Scald burns via forced immersion accounted for the majority of reported PNABs affecting both feet and hands. Complications included wound infection, sepsis, requiring systemic antibiotics, or intensive care. Abused children's parents had a history of mental illness, unemployment, substance abuse, incarceration, and/or low annual income. CONCLUSIONS: Scalds via forced immersion remain the most common mechanism of PNABs. All health care professionals must remain vigilant, be able to recognize subtle signs of abuse, triage patients appropriately, report to police and/or social services, and ensure no further harm is made to the child or children. Repeated abuse with burns can lead to death. Prevention and education are the cornerstones for addressing this social phenomenon.

Parenting and parenting resources among Chinese parents with children under three years of age: rural and urban differences.

BACKGROUND: Parenting is essential for children's development and preventing child abuse and neglect. Providing parenting services within the primary health care settings demonstrated effectiveness in improving parenting quality. However, little is known about the status of parenting and parenting resources in rural areas and whether they differ between rural and urban areas in Mainland China. OBJECTIVE: This study aimed to examine the rural-urban differences in parenting and availability of, utilization of, and need for parenting resources among Chinese parents with children under three years of age. PARTICIPANTS AND SETTING: A total of 425 parents of children under three years of age participated in an online survey between March and May 2020. METHODS: The Parenting and Family Adjustment Scale and Child Adjustment and Parenting Efficacy Scale were used to assess parenting, family adjustment, and parenting efficacy. The availability of, utilization of, and need for parenting resources were measured using self-developed questions based on literature. Chi-square tests, t tests, and Wilcoxon rank-sum test were used to examine the differences in responses between parents in rural and urban areas. RESULTS: Compared with their urban counterparts, rural parents reported a higher level of negative parenting and more limited parenting resources. Both rural and urban parents reported low availability and utilization of parenting resources as well as a great need for parenting support services. CONCLUSIONS: Rural parents faced more parenting challenges and limited parenting resources compared with urban parents. Both rural and urban parents with children under three years of age reported great needs for parenting resources. These findings highlight the potential of delivering accessible, sustainable, and cost-effective parenting programs via the primary health care system for public welfare in both urban and rural areas, with more attention paid to rural parents to help them improve their parenting.

Effects of the Attachment Video-feedback Intervention (AVI) on parents and children at risk of maltreatment during the COVID-19 pandemic.

BACKGROUND: The global health crisis caused by the COVID-19 pandemic has led to an increase in situations of risk of child abuse and neglect. OBJECTIVE: The objective of this study was to examine whether the Attachment Video-feedback Intervention (AVI) program can improve protective factors (decrease parental stress and household chaos, increase parent-child emotional availability and parental reflective functioning) that may diminish child maltreatment in a group of families at risk for child abuse and neglect during the COVID-19 pandemic. PARTICIPANTS AND SETTING: The sample consisted of 41 children aged between 0 and 5 years (Mage = 35.36 months, SD = 14.65; 85.4 % boys) and their parents (Mage = 35.44, SD = 6.04; 75.6 % mothers). METHODS: The study design incorporated two randomized groups (Intervention group: AVI; Control group: treatment as usual) with pre- and post-test evaluations. RESULTS: In comparison to the control group, parents and children exposed to the AVI showed increases in emotional availability. Parents in the AVI group also presented increases in certainty regarding their child's mental states and reported lower levels of household chaos compared to those of the control group. CONCLUSIONS: The AVI program is a valuable intervention for increasing protective factors in families at risk of child abuse and neglect in times of crisis.

Child Abuse Consultation Rates Before vs During the COVID-19 Pandemic in Japan.

This cross-sectional study examines the association between the first 2 years of the COVID-19 pandemic and child abuse consultations in 47 Japanese prefectures.

[Child maltreatment and Covid-19: A crisis within a crisis]. / Maltraitance envers les enfants et Covid-19 - Une crise dans la crise.

The fight against the SARS-CoV-2 pandemic was carried out through strong restrictive measures, including general population lockdown, which allowed the convergence of risk factors for child abuse. During this period, the French national hotline for children in danger recorded a 56% increase in calls. Calls followed by an alert to departmental child protection services increased by 30%. Through an algorithm created by our team, we showed a 50% increase in the relative frequency of hospitalizations for physical abuse in children aged 0-5 years during the lockdown. This has fueled thinking about subsequent health measures to protect the youngest children. Our goal is now to use this algorithm for epidemiological purposes as a barometer of abuse or in daily practice to help the diagnosis of physical abuse in young children.

Title: Maltraitance envers les enfants et Covid-19 - Une crise dans la crise. Abstract: En France, au début de l'année 2020, environ 690 000 vies ont pu être épargnées grâce au confinement général de la population et aux mesures restrictives de lutte contre la Covid-19. Conséquence inattendue, ces mesures ont eu un impact sur une autre frange vulnérable de la population : celle des jeunes enfants, pour lesquels il a été démontré une augmentation des maltraitances subies à cette période. À partir de données de la littérature et de l'apport de nos travaux de recherche dans le domaine, nous proposons une documentation de cette crise des violences intra-familiales, intriquée dans la crise sanitaire de la Covid-19.

Prevention of violence against children in the home: an overview of reviews protocol.

BACKGROUND: Violence against children (VAC) in the home, or by household members, is a widespread problem with devastating and costly consequences for individuals and societies. In the past two decades, much research has been dedicated to the prevention of VAC in the home, in particular, in low- and- middle-income countries, but there are few systematic examinations of the growing body of literature. We present a protocol for an overview of reviews to synthesize the evidence from recent reviews on the effectiveness and characteristics of both universal and selective interventions to prevent VAC in the home or by household members. METHODS: We will conduct an overview of reviews of quantitative studies of universal and selective interventions to prevent VAC in the home published after 2000. Our outcomes will be VAC in the home (e.g., physical, sexual, or psychological violence or neglect) and drivers or direct risk factors for VAC (e.g., beliefs or attitudes towards VAC, parenting stress). We will search for reviews in multiple databases using controlled vocabularies and keywords. We will use the AMSTAR 2 to assess the quality of reviews and will extract information on outcomes, main results, and geographic distribution of primary studies, among other data. We will conduct a narrative synthesis of the findings. DISCUSSION: The proposed overview will provide timely evidence on effective strategies to prevent VAC in the home and will identify the key strengths and limitations of the current body of evidence on this topic. In doing so, we will inform future research, policy, and practice aimed at building effective strategies to prevent VAC globally. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022304784.

Empowering Elementary and Middle School Youth to Speak Up and Be Safe: Advancing Prevention of Child Maltreatment with a Universal School-Based Curriculum.

Child maltreatment is a global public health problem, and school-based universal prevention programs such as the Speak Up Be Safe (SUBS) curriculum can be an effective solution to help address child violence. This randomized control study employed a pre-, post-, and six-month follow-up design for students in kindergarten to grade 8, approximately ages 5-13 (n = 2797). Surveys measured the efficacy of the curriculum in increasing students' knowledge of safety rules and self-protection strategies. The analyses explored the differences at follow-up between the conditions for each index/scale for each grade using an analysis of covariance, which controlled for the pre-survey scores. The SUBS group had significantly higher scores at follow-up than the students in the control group. This study showed that the students learned new knowledge and skills to act upon and identify child abuse and neglect in keeping themselves and others safe. Policy- and decision makers now know that as a child maltreatment prevention program, SUBS can be implemented universally in schools at a low cost, delivering an essential evidence-based safety curriculum that protects students from child maltreatment.

US shelter in place policies and child abuse Google search volume during the COVID-19 pandemic.

The COVID-19 pandemic has led to unemployment, school closures, movement restrictions, and social isolation, all of which are child abuse risk factors. Our objective was to estimate the effect of COVID-19 shelter in place (SIP) policies on child abuse as captured by Google searches. We applied a differences-in-differences design to estimate the effect of SIP on child abuse search volume. We linked state-level SIP policies to outcome data from the Google Health Trends Application Programming Interface. The outcome was searches for child abuse-related phrases as a scaled proportion of total searches for each state-week between December 31, 2017 and June 14, 2020. Between 914 and 1512 phrases were included for each abuse subdomain (physical, sexual, and emotional). Eight states and DC were excluded because of suppressed outcome data. Of the remaining states, 38 introduced a SIP policy between March 19, 2020 and April 7, 2020 and 4 states did not. The introduction of SIP generally led to no change, except for a slight reduction in child abuse search volume in weeks 8-10 post-SIP introduction, net of changes experienced by states that did not introduce SIP at the same time. We did not find strong evidence for an effect of SIP on child abuse searches. However, an increase in total search volume during the pandemic that may be differential between states with and without SIP policies could have biased these findings. Future work should examine the effect of SIP at the individual and population level using other data sources.

Documenting Opportunity for Systematic Identification and Mitigation of Risk for Child Maltreatment.

This is a communication of preliminary data as a matter of priority in relation to Clinical Trials protocol ID 2018110118; NCT04438161. This protocol represents, to our knowledge, a first-ever attempt to convert an epidemiologic discovery on risk for child maltreatment (CM) into a readily deployable modification of obstetrical practice designed to offset risk for CM and its psychiatric sequelae. Before¹ and during the coronavirus disease 2019 (COVID-19 pandemic),^2,3 CM has incurred a burden of epidemic proportions to U.S. children, with confirmed incidents occurring on the order of 12% of the population. Wu et al.⁴ and Putnam-Hornstein and Needell⁵ previously established that profiles of risk ascertained exclusively from birth records identified specific groups of newborns at highly elevated risk for official-report CM. For example, infants with the joint characteristics of low birth weight, more than 2 siblings, and maternal characteristics of being unmarried, on Medicaid, and smoking during pregnancy (ascertained separately) were found to have a 7-fold risk for maltreatment compared with the population average.⁴ Putnam-Hornstein and Needell showed that newborns with 3 or more risk factors ascertained from birth records (including any of the above, delayed prenatal care, less than high school maternal education, and maternal age less than 24 years) comprised 15% of an epidemiologic birth cohort but accounted for more than half of all the children in the cohort who experienced substantiated official-report maltreatment by the age of 5 years. This study explored whether prospective implementation of birth records screening in an urban obstetrical service recapitulated the association with CM observed in an epidemiologic context and whether families in higher echelons of risk (ascertained in this manner through birth records) could be prospectively engaged in supportive interventions of demonstrated effect in reducing the occurrence of CM. This work follows on promising efforts elsewhere to use birth records information to prioritize support services for young families,⁶ though such innovations have yet to be systematically incorporated into obstetrical or newborn medical services of U.S. health systems.

Child protective services during COVID-19 and doubly marginalized children: International perspectives.

BACKGROUND: Alongside deficits in children's wellbeing, the COVID-19 pandemic has created an elevated risk for child maltreatment and challenges for child protective services worldwide. Therefore, some children might be doubly marginalized, as prior inequalities become exacerbated and new risk factors arise. OBJECTIVE: To provide initial insight into international researchers' identification of children who might have been overlooked or excluded from services during the pandemic. PARTICIPANTS AND SETTING: This study was part of an international collaboration involving researchers from Brazil, Canada, Colombia, Israel, South Africa, Uganda, the UK and the USA. Researchers from each country provided a written narrative in response to the three research questions in focus, which integrated the available data from their countries. METHOD: Three main questions were explored: 1) Who are the children that were doubly marginalized? 2) What possible mechanisms may be at the root? and 3) In what ways were children doubly marginalized? The international scholars provided information regarding the three questions. A thematic analysis was employed using the intersectional theoretical framework to highlight the impact of children's various identities. RESULTS: The analysis yielded three domains: (1) five categories of doubly marginalized children at increased risk of maltreatment, (2) mechanisms of neglect consisting of unplanned, discriminatory and inadequate actions, and (3) children were doubly marginalized through exclusion in policy and practice and the challenges faced by belonging to vulnerable groups. CONCLUSION: The COVID-19 pandemic can be used as a case study to illustrate the protection of children from maltreatment during worldwide crises. Findings generated the understanding that child protective systems worldwide must adhere to an intersectionality framework to protect all children and promote quality child protection services.

Early recognition of child abuse through screening indicators at the emergency department: experience of a tertiary urban pediatric hospital.

BACKGROUND: Emergency Departments play a pivotal role in detecting cases of child abuse. Despite the efforts made in the past decades on the need for a screening method for the early detection of abuse victims, a unique instrument shared by the international scientific community has not been made. These instruments should be able to help recognizing whether it is necessary to further investigate the child's condition. The aim of the study is to illustrate the screening indicators in use since 2010 in the Emergency Department of the Bambino Gesù Children's Hospital to early recognise the victims of abuse and the modifying process of the screening tool undertaken over the years. METHODS: We retrospectively analyzed the process that led to the editing of the indicators of child abuse in use nowadays at the Bambino Gesù Children's Hospital. We codified three clinical pathways to apply in case of suspected abuse. Furthermore, we investigated the medical records of screening-positive accesses in the Paediatric Emergency Department of the Bambino Gesù Children's Hospital from January 2008 to October 2020. RESULTS: An estimation of positive screening, regarding the type of abuse suspected, and the number of accessed in ED was made, resulting in a cohort of 956 patients. In 2010 we created a list of 14 items grouped in three clusters: anamnestic declarations or incongruences, carelessness/neglect and evident lesions at physical examination. Positivity to one of the items allows the actuation of the investigating protocol named as clinical pathway.In 2013, after three years of experience, the criteria were edited to increase specificity. The application of screening led to a median number of 82 suspected cases/year from 2013 to 2020. CONCLUSION: A screening tool is essential and productive for the early recognition of victims of abuse. An in-deep analysis of suspected cases through a standardized method, such as the clinical pathway, allowed reaching the diagnosis in a more accurate and precise manner.

The impact of the COVID-19 pandemic on child protective services caseworkers and administrators.

BACKGROUND: The COVID-19 pandemic has impacted children and young people experiencing child abuse and neglect. Child Protective Services (CPS) has played an important role in supporting children and families during the COVID-19 pandemic. Few studies to-date have evaluated the impact of the pandemic on CPS caseworkers and administrators in the United States. OBJECTIVES: We conducted interviews to explore CPS caseworkers' and administrators' experiences working and serving families during the pandemic. METHODS: Participants were U.S.-based CPS caseworkers and administrators. We conducted semi-structured virtual interviews with participants and used an inductive thematic analysis approach. RESULTS: We conducted 37 interviews. Participants discussed how the COVID-19 pandemic has changed the way they conduct investigations and provide services to families in the CPS system. Several services were adapted to occur virtually, providing challenges and unique opportunities. Participants also described the personal barriers they faced during the pandemic, including working remotely, experiencing burnout, and challenges obtaining personal protective equipment. Finally, participants shared creative solutions they engaged in to support children and families during the COVID-19 pandemic, including expanding collaborations with other community-based organizations. DISCUSSION: This study suggests the important role that CPS has played during the pandemic and challenges individual CPS workers felt, in terms of both experiencing burnout and difficulty obtaining personalized protective equipment. Inclusion of the CPS system in emergency preparedness planning for future pandemics or natural disasters will ensure continuation of these vital services.

Child protection plans in the COVID-19 pandemic in Germany: Maintained, adjusted, or suspended?

BACKGROUND: COVID-19 infection prevention measures have enhanced risks of abuse and neglect for children and youth. Simultaneously, they have affected the practice of child protection, especially impacting the social infrastructure on which child protection work tends to rely, as well as the ability of practitioners to meet with family members face-to-face and in their homes. OBJECTIVES: This article focuses on the ways in which infection prevention measures have shaped child protection plans in Germany, i.e. family support and counselling, which is accompanied by monitoring and scrutiny. METHODS: The article is based on a qualitative study, in which 40 semi-structured interviews were held with first-line management representatives of German Youth Welfare Agencies between July and October 2020. RESULTS: The study's results show that protection plans have either been maintained, modified or (temporarily) suspended. Several influencing factors were identified. First, the extent to which the social infrastructure relevant for child protection could be maintained, or emerging gaps be filled in a timely fashion by child and youth welfare organisations. Second, the degree of effectiveness of the working relationship between practitioners and parents under the new conditions, including practitioners' ability to resort to flexible, digital or hybrid communication methods with families proved important. Moreover, everyday practical help from Youth Welfare Agencies and family service providers could often change the parental perception of these professionals for the better, thereby strengthening the relationship between practitioners and parents. LIMITATIONS: A key limitation of the study comprises the fact that the study findings are limited to the earlier phase of the pandemic.

Impact of COVID-19 lockdown: Domestic and child abuse in Bridgend.

INTRODUCTION: Financial stress, social stress and lack of support at home can precipitate domestic and child abuse (World Health Organization, 2020). These factors have been exacerbated by the COVID-19 pandemic (NSPCC, 2020b) (NSPCC, 2020a). We hypothesise an increase in Bridgend's domestic and child abuse during lockdown. METHOD: Data was collected retrospectively from 23rd March to 30th September 2020 and compared to the same time period in 2019. Wales-wide data on domestic abuse was shared by the Welsh Government's Live Fear free helpline. Local data was shared by domestic abuse charity CALAN, the Emergency Department (ED) and Paediatric Department of Princess of Wales Hospital (POWH). RESULTS: During lockdown, Live Fear Free reported increasing average monthly contact across Wales in 2020 (511 April; 631 December). Locally, CALAN reported a 190% increase in self-referrals and a 198% increase in third party referrals, but there was a 36% decrease in referrals from Police for domestic abuse. The Paediatric Department observed a 67% decrease in child protection medical examinations (CPMEs) undertaken (52 vs. 17). 23 examinations in 2019 were referred from schools compared to 1 in 2020. There was a greater proportion of self-referrals for CPMEs in 2020. ED child protection referrals increased from 189 (2019) to 204 (2020). CONCLUSION: There was an increase in self-referrals to local support services for domestic and child abuse concerns and an increase in referrals from families/friends for child protection concerns. This was not the case with police, ED and schools/nurseries referrals. This suggests reduced engagement with public sector organisations during lockdown which services should consider.

A global priority: addressing violence against children.

OBJECTIVE: To determine the reasons for the lack of priority given to addressing violence against children, and to identify the challenges that proponents must address to improve prioritization of this issue. METHODS: We reviewed relevant literature to identify experts to interview. We carried out a thematic analysis of the literature and interview transcripts. We iteratively developed data coding on the many characteristics of violence against children, on the framing of the issue by proponents, and on the problem of governance - that is, how proponents organize themselves for collective action. FINDINGS: The analysis of our data sources reveals many obstacles for global prioritization of addressing violence against children, including the forms of violence considered, inadequate data to describe prevalence and a lack of evidence of the effectiveness of proposed solutions. There exists fundamental disagreement among proponents on the recently introduced frame of violence against children, including differences in the types of violence that should be prioritized and in the proposed solutions (e.g. prevention or remediation). On governance, competition between networks focused on specific forms of violence is hampering efforts to create strong governing institutions. CONCLUSION: Despite the complex challenges identified, proponents have made some progress in global prioritization of addressing violence against children. To improve this prioritization further, proponents must resolve framing tensions and strengthen governance mechanisms to promote shared goals, while ensuring that networks focused on particular forms of violence are able to maintain their distinct identities.