1. In this retrospective cohort study of 3900 children 3 years of age and younger, children with public health insurance were more likely to be reported to child protective services for maltreatment than those with private health insurance.

2. Children born to Native American mothers had the highest rates of hospitalization for maltreatment-related injuries and CPS reports.

Evidence Rating Level: 2 (Good)

Study Rundown: Concern for child maltreatment is often reported to child protective services (CPS), with most reports initiated by professionals. Despite this, many children hospitalized for maltreatment-related injuries do not receive a CPS report. This discrepancy in reporting may be in part due to implicit racial bias. The objective of this study was to examine the role that race, ethnicity, and poverty play in CPS reports of children less than 3 years of age. Population-based linked datasets were used to obtain birth, hospitalization, and CPS records for children 3 years and younger who were hospitalized for maltreatment-related injuries in Washington State. Public and private insurance information was collected, with public insurance used as a proxy for poverty. In total, 3907 children were hospitalized between 1999-2013. Children born to Native American and Black mothers had the highest rates of maltreatment-related hospitalizations. Children with Native American mothers additionally had the highest rates of CPS reports (40%), whereas children with Asian/Pacific Islander mothers had lower rates of CPS reports than all other race/ethnicities. Children with public health insurance were reported to CPS more frequently in all maternal race and ethnicity categories, as compared to those with private insurance. This study suggests race, ethnicity, and poverty are important factors in the reporting of child maltreatment, although the underlying reasons behind these discrepancies (e.g. implicit bias) require further study.

Click to read the study in PEDIATRICS

Click to read an accompanying editorial in PEDIATRICS

Relevant Reading: Risk factors in child maltreatment: A meta-analytic review of the literature

In-Depth [retrospective cohort]: Participants included all children born in Washington State between 1999-2013 who were hospitalized due to child maltreatment-related injuries prior to 3 years of age. CPS reports were included if they were submitted by a professional related to the hospitalization (i.e., medical, mental health, social service professional, CPS worker, or law enforcement) and if the report occurred in the time frame of 4 days prior to hospitalization through to the discharge date. In total, 3907 children were hospitalized for child maltreatment-related injuries. Based on race/ethnicity, children with Native American mothers, followed by Black mothers, had the highest rates of hospitalizations (7 per 1000 births and 4.5 per 1000 births, respectively). Children with Native American mothers additionally were reported to CPS most frequently (40%), whereas children born to Asian/Pacific Islander mothers were reported the least (p=0.002). Individuals with public health insurance were more likely to be reported to CPS (RR: 1.29).

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