An increase in child abuse, mostly in infants, is linked with the recent recession in new research that raises fresh concerns about the impact of the nation's economic woes.
The results are in a study of 422 abused children from mostly lower-income families, known to face greater risks for being abused, and the research involved just 74 counties in four states. But lead author Dr. Rachel Berger of Children's Hospital of Pittsburgh said the results confirm anecdotal reports from many pediatricians who've seen increasing numbers of shaken baby cases and other forms of brain-injuring abuse.
Berger decided to study this type of injury, known as abusive head trauma, after noticing an increase at her own hospital from late 2007 through June 2009. Her hospital averaged 30 cases per year during those recession years versus 17 yearly before 2007.
Though this abuse is still uncommon, the number of cases in the counties studied increased sharply, rising from about 9 cases per 100,000 children in pre-recession years, to almost 15 per 100,000 kids during the recession — a 65 percent increase.
By contrast, juvenile diabetes — a better-known condition — affects about 19 per 100,000 children younger than age 10.
Children studied were younger than 5, and most were infants. Most suffered brain damage and 69 died, though the death rate didn't rise during the recession.
Unemployment rates in the 74 counties rose during the five-year study. The proportion of children on Medicaid in those counties also increased, from 77 percent before the recession to 83 percent. However, insurance and family employment information were not reported for the abused children in the study.
Combine the stress of raising a young child with wage cuts or lost jobs and you get "a sort of toxic brew in terms of thinking about possible physical violence," said Mark Rank, a social welfare professor at Washington University in St. Louis. He said the study echoes sociological research linking violence with declines in economic well-being.
Along with U.S. Census data released last week indicating that a record 46 million Americans are poor, the study shows that "as poverty goes up and economic stagnation continues...there are really human costs involved," Rank said.
The study was released online Monday in Pediatrics.
The counties studied included Pittsburgh and western Pennsylvania; central and southern Ohio; and a handful of counties in northern Kentucky and in the Seattle area. The researchers examined medical records and national labor statistics for 2004 through November 2007 and compared them with data from the recession.
Of the 422 children diagnosed with abusive head trauma during the study, roughly 65 cases occurred each year before the recession, versus about 108 yearly during the recession.
Federal government data suggest that the recession did not affect child abuse rates. But the study authors said those numbers are based on reports from child protective services, not medical diagnoses, and did not address brain injuries specifically.
The research doesn't prove that the recession caused the abuse. Studying different regions and children from more middle-class families would help clarify if the recession really played a role, said Dr. Peter Sherman, director of the residency program in social pediatrics at Montefiore Medical Center in New York.
Sherman noted that most children studied were publicly insured even before the recession, suggesting that their families were already struggling financially.
Still, the recession affected many lower-income families, and Sherman said the study highlights "a very important issue."
Many of his patients are from poor families and abuse is not uncommon, he said.
He said pediatricians could help with prevention by asking families about difficulties paying for food or shelter and referring those in need to social service agencies. Sometimes just asking parents about stresses in their lives and acknowledging their struggles can help, he said.
Most parents who abuse young children aren't "ill-intentioned," he said. "Most of it is kind of just snapping...maybe being sleep-deprived and just losing it. It's something that can happen to anyone. Economics is just another stress" that can increase the risks, Sherman said.