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In discussion with colleagues from across Scotland, no significant increase in numbers of infants of Abusive Head Trauma have been referred to medical child protection services was noted during 2020.
My original eLetter was submitted on 08 Jul 2020:
I share concerns about the impact of Covid, and note that we have seen an increase in NAI referrals over recent months (but not AHT). Given that the number of cases in this institution was so low in previous years, I wonder if there has been a change in referral patterns with GOSH admitting more general PICU cases than usual. Has there been an impact from other PICUs in London that were caring for adults during the peak?
Sidpra et al1 reported seeing 10 patients with suspected abusive head trauma between 23 March and 23 April 2020, when previously their unit only saw 0.67 cases per month. They concluded that this indicated a pandemic. In support, they cited (providing an incorrect journal name) a published review suggesting an increased risk of family violence2, but in fact the review cited referred to decreasing reports of child abuse and neglect during the Covid-19 pandemic.
Sidra et al made no mention of the likely explanation for their observations, namely a change in referral patterns. A number of children’s wards in hospitals in London and elsewhere in the UK have been taken over by adult Covid-19 patients, coupled with the closure of some paediatric urgent care centres and emergency departments, resulting in the diversion of ill children to other centres.
If, as is suggested, the apparent 1493% increase in inflicted head injury cases is indeed the result of adverse psychosocial factors resulting from efforts to reduce Covid-19 transmission, then one would expect paediatric services worldwide to be deluged with other types of inflicted injury, which as yet has not been reported.
Without other supporting data, and only using information from a single unit, we are not convinced that there is a sound case for the authors' conclusion that these 10 cases represent a ‘pandemic’. The word pandemic means a disease that is prevalent over a whole country or the whole...
Without other supporting data, and only using information from a single unit, we are not convinced that there is a sound case for the authors' conclusion that these 10 cases represent a ‘pandemic’. The word pandemic means a disease that is prevalent over a whole country or the whole world. We urge caution in the use of language in these difficult times, when there is already an increased level of public concern about medical problems and medical facilities.
1. Sidpra J, Abomeli D, Hameed B, et al. Arch Dis Child Epub ahead of print: [02 July 2020]. doi:10.1136/archdischild-2020-319872
2. Campbell AM. An increasing risk of family violence during the Covid-19 pandemic: strengthening community collaborations to save lives. Forens Sci Internat Reports Epub ahead of print [12 April 2020] doi.org/10.1016/j.fsir.2020.100089