When it comes to child abuse, the first year of life is the most dangerous for children. Although SIDS, or sudden infant death syndrome, attracts far more attention, the rate of hospital admissions related to SIDS is actually lower than the rate of child abuse — 50 per 100,000 children under age 1 for SIDS, compared with 58.2 per 100,000 births, according to research published Monday in the journal Pediatrics.
“These kids are physically vulnerable because they’re small,” says Dr. John M. Leventhal, lead author of the study and a professor of pediatrics at Yale Medical School. “They are challenging for some parents to take care of because they cry, it’s hard to understand what they want and parents can get frustrated, exhausted and angry.”
It’s parents, in fact, who are most often to blame for children’s injuries. Previous research has found that parents — and occasionally babysitters — are the ones who lose control. Of parents, men — fathers, stepfathers and boyfriends — are the largest single group of perpetrators.
Researchers at Yale University found that abuse landed 4,569 children under 18 in the hospital in 2006; 300 of them died. The death rate — 6% — was substantially higher than for children who were admitted for other kinds of injuries or medical or surgical problems.
For the most part, children arrived with abusive head trauma, fractures, burns, abdominal injuries and bruises. Their hospitalizations cost the U.S. about $73.8 million and lasted almost twice as long compared to children who were hospitalized with other kinds of injuries.
Poor children are at greatest risk, suffering abuse at six times the rate of children not on Medicaid. The recession has only made the situation worse. Two small studies that have tracked the incidence of abusive head trauma before and during the recession have found it’s doubled. “When families are under stress, bad things happen to children,” says Leventhal.
There may be some cause for optimism: in cases tracked by state Child Protective Service agencies, physical abuse has declined by 55% between 1990 and 2010. Leventhal is in the early stages of comparing more than a decade of data, but so far he has not found a substantial decrease. Discrepancies could be due to a difference in methods of analysis. But regardless of whether things have gotten better or worse, a significant problem remains. Much of that problem may have to do with a lack of parental understanding of infant development.
It’s not coincidence that abusive head injuries peak in the first few months of life when babies typically cry the most. “Crying makes parents very frustrated and they can sometimes lose it,” says Leventhal.
But crying is completely normal for babies; that’s what they do. Prevention programs that explain why babies cry and how to cope — put the baby down in a safe place and just walk away to defuse your stress — have been rolled out in North Carolina, Pennsylvania and British Columbia. “We need a nationwide effort to enhance prevention,” says Leventhal.
When my children were born in North Carolina, for example, my pediatrician drew a graph that charted the peaks and valleys of a baby’s age-related crying. It didn’t make the noise any easier to bear, but it did help me understand that my children’s wailing was developmentally normal and expected.
Relying on home visitors is another innovative approach. Leventhal would like to see trained public health personnel stop by the homes of new parents as often as weekly during the first year of life. They could serve as support for fledgling moms and dads, answering questions and offering advice and support. In many European countries, new mothers receive home support visits for the first few months after they give birth.
Home visits would be expensive, for sure, but would they outweigh the cost of child abuse in the U.S.? Last week, the Centers for Disease Control and Prevention reported child maltreatment costs us $124 billion — and that, of course, is but one measure of the toll.