Do chronic conditions increase young children's risk of being maltreated?
Section snippets
Maltreatment risk for children with chronic conditions
Children with special needs are at an increased risk of maltreatment (Sullivan & Knutson, 2000). Several studies have sought to better understand caregiving dynamics that trigger or increase the risk of maltreatment for these children, with many finding that the added stress, either emotional, psychological, or economical, can increase caregiving strain (Cummings, 1976, Dyson, 1997, Friedrich, 1979, Glidden, 1993, Hauser-Cram et al., 2001; Kazak & Clark, 1986; King, Rosenbaum, & King, 1996;
Background
Several studies have addressed the prevalence of maltreatment among children with special needs. The National Center for Child Abuse and Neglect (NCCAN, 1993) found that, among a sample of U.S. children in the 35 states’ child protective services, children with mental or physical disabilities had maltreatment rates that were 1.7 times greater than children without disabilities. The disabilities were not delineated by type in this study. Rather, children were defined as having a disability if
Sample
The sample was children under age 6; approximately one-half of all reports of maltreatment occur among this age group. Our longitudinal study drew on administrative data for 101,189 Illinois children born between January 1990 and March 1996 and enrolled continuously through age 3 in Medicaid. Between the ages of 3 and 6, children may exit the Medicaid program and our Cox proportional hazard models control for this variation in time in the Medicaid program. For the 101,189 Medicaid
Analysis
To assess whether a relationship exists between maltreatment and any of these three categories of chronic condition, we used a Cox proportional hazards model. This model allowed us to estimate the relative risk (RR) of the selected health conditions on the likelihood of child maltreatment for the sample of children. In general, a hazard rate can be defined as the instantaneous probability that a transition from one state to the next will occur at that point in time given that no such transition
Descriptive statistics
As Table 1 shows, during the first 6 years of life, 11.7% of the children were maltreated, 7.1% before the age of 3, including 2.0% who were substance-exposed infants. Of the children, 4.9% experienced abuse or neglect between ages 3 and 6. Approximately one-fourth of the sample (24.1%) had identified chronic physical health conditions, with asthma the most frequently diagnosed condition (ICD-9-CM Codes of 49390, 49300). Four percent (4.2%) had developmental delay or mental retardation, with
Discussion
This study shows that chronic behavioral/mental health conditions place low-income, young children at greater risk of maltreatment than their peers without such conditions. Youth under age 6 with these conditions are nearly twice as likely to be abused or neglected as those without such conditions. Having a chronic physical health condition also places the child at marginally greater risk of abuse or neglect, but the risk is less than for behavioral/mental health conditions.
Conclusions
Young, low-income children receiving public health insurance with an identified behavior/mental health are at an increased risk of child maltreatment. Chronic physical health conditions also place children at a slightly elevated risk of maltreatment. Pediatricians, child welfare professionals, and others who interact regularly with children should be alert to the heightened risk of maltreatment among these groups of children. Although this study established an increased risk of maltreatment
References (33)
- et al.
Reported maltreatment in children with multiple disabilities
Child Abuse & Neglect
(1990) - et al.
The handicapped child and child abuse
Child Abuse & Neglect
(1985) Family reactions and coping strategies in response to the physically ill or handicapped child: A review
Social Science and Medicine
(1983)- et al.
Maltreatment and disabilities: A population-based epidemiological study
Child Abuse & Neglect
(2000) Guidelines for health supervision II
(1988)Screening infants and young children for developmental disabilities
Pediatrics
(1994)The impact of the child's deficiency on the father: A study of fathers of mentally retarded and of chronically ill children
American Journal of Orthopsychiatry
(1976)Fathers and mothers of school-age children with developmental disabilities: Parental stress, family functioning, and social support
American Journal on Mental Retardation
(1997)Predictors of the coping behavior of mothers of handicapped children
Journal of Consulting and Clinical Psychology
(1979)- et al.
Profiling the health service needs of populations: Description and uses of the National Association of Children's Hospitals and Related Institutions classification of congenital and chronic health conditions
Pediatric Annals
(1997)
What we do not know about families with children who have developmental disabilities: Questionnaire on resources and stress as a case study
American Journal on Mental Retardation
Children with special needs
The role of the pediatrician in the delivery of mental health services to children
Pediatrics
Mental health problems among children seen in pediatric practice: Prevalence and management
Pediatrics
Children with disabilities: A longitudinal study of child development and parent well-being
Monograph Society for Research on Child Development
Neglect of chronically ill children
American Journal of Diseases of Children
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The characteristics of children referred to a child protection team in Japan and factors associated with decision-making: A retrospective study using a medical database
2022, Child Abuse and NeglectCitation Excerpt :It is interesting that in our sample, developmental disability and psychological disorder were significantly associated with substantiation while developmental delay, historically known as mental retardation, did not. A previous study suggested that behavioral or mental health conditions placed children at greater risk of maltreatment while developmental delay/mental retardation did not (Jaudes & Mackey-Bilaver, 2008), and this type of knowledge may potentially affect the decision-making by CPTs. Our research was in line with previous studies in that parental factors had the strongest association with substantiation (Benbenishty et al., 2014; Vinitha et al., 2020).
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