Elsevier

Child Abuse & Neglect

Volume 32, Issue 7, July 2008, Pages 671-681
Child Abuse & Neglect

Do chronic conditions increase young children's risk of being maltreated?

https://doi.org/10.1016/j.chiabu.2007.08.007Get rights and content

Abstract

Objective

To examine whether and to what extent specific chronic health conditions place young children at risk of maltreatment.

Methods

The study used a sample of Illinois children (born between January 1990 and March 1996) who were through age 3 continuously enrolled in Medicaid, a public health insurance program for low-income families. The study used “paid claims” data and ICD-9-CM health codes to identify children with one or more of three chronic conditions: chronic physical illness, developmental delay/mental retardation (dd/mr), and behavior/mental health conditions (b/mh). The analysis used Cox proportional hazard models to estimate the risk of substantiated child maltreatment that each of these health conditions confer on children under age 6.

Results

Among children under age 6, 24.1% had chronic physical health conditions, 6.1% had b/mh conditions, and 4.2% had dd/mr. Among the children, 11.7% were maltreated (abused or neglected). Children with b/mh conditions were 1.95 times more likely than children without such conditions to be victims of child abuse or neglect. Children with chronic physical health conditions were 1.1 time more likely to be maltreated (p  .001). In contrast, children with dd/mr were not at an increased risk of maltreatment. Further, if the child had a prior history of abuse or neglect before age 3 and was also diagnosed with a behavioral health condition, that child was 10 times more likely to be maltreated again (relative risk of 9.2, p  .0001).

Conclusions

Behavioral/mental health conditions placed low-income children under age 6 at the highest risk of abuse or neglect. Developmental delay/mental retardation, however, did not appear to increase the risk of maltreatment, while chronic physical health conditions increased the risk slightly among this group of children. Therefore, identified behavior/mental health in young, low-income children should be considered a risk factor for potential abuse to pediatricians and other health professionals. Child protection agencies should be trained to identify behavioral/mental health conditions of children.

Practice implications

Chronic behavioral/mental health conditions place young children at heightened risk of abuse or neglect. Early detection of mental or psychosocial health conditions is mandated by the Individuals with Disabilities Education Act (IDEA), a federal law that governs how state and public agencies provide services to children with disabilities. Given the higher risk of abuse and neglect among children with behavioral/mental health conditions, clinicians should give added scrutiny to these children. Child protection agencies should also be trained to identify behavioral/mental health conditions, and more states should record disability status in their abuse records.

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

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