While Caucasian children make up the largest portion of children diagnosed with NAT, Black children are disproportionately represented. There are significant disparities in the management, reporting, and outcomes of injured children related to race/ethnicity. Furthermore, victims of NAT from neighborhoods with a lower median income (indicators of lower socioeconomic status) or with government-based healthcare were more likely to die from their injuries, regardless of injury severity. While individual risk factors for child maltreatment change depending on the cross section of patients examined, decreased parental age, decreased gestational age or weight, parents with pre-existing social concerns, less access to perinatal care or resources, parental smoking or substance abuse, households with a history of domestic violence, and poverty have all been implicated for increasing the risk for NAT. These numbers almost certainly underrepresent the total number of infants affected by maltreatment because of known issues with underreporting. Infants are also three times more likely to die compared to older children as a result of NAT. While the overall incidence of abuse in children is 6 per 100,000 children, infants have a nearly tenfold higher incidence at 58 per 100,000 children. Furthermore, we provide an update on current, evidence-based strategies for NAT prevention.Īmong the spectrum of pediatric age groups, infants are more disproportionately affected by NAT. The goal of this manuscript is to provide a summary of recent literature related to the epidemiology, evaluation, and diagnosis of NAT specific for the infant age group. This starts with the most vulnerable and the most disproportionately affected pediatric age group-infants. Įvery clinician whose practice includes taking care of children has a responsibility to recognize the warning signs of child maltreatment and initiate the diagnosis and treatment of suspected child abuse. There is also evidence that some victims of abuse may go on to become abusers themselves, perpetuating the cycle of maltreatment. In addition to the direct harm of physical injury, traumatic events in childhood have been shown to lead to long-term issues with attachment as well as alteration of the biologic responses to stress and early brain development. NAT results in longer and costlier hospital stays, and the lifetime societal costs for a single year of child abuse cases number in the billions. However, mortality is only one small aspect of the consequences of child maltreatment. In fact, non-accidental trauma (NAT) is an independent predictor of mortality in infants and older children compared with other mechanisms of traumatic injury. This burden is carried disproportionately by infants (children < 1 year of age) accounting for nearly half of all abuse-related deaths in the USA. There were over 650,000 substantiated reports of child maltreatment to the various child protective service (CPS) agencies across the USA in 2019, and around 1,800 deaths attributable to abuse or neglect.
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