Objective We aimed to evaluate the risk of infant maltreatment associated with commonly used criteria for home visiting programmes: young maternal age, maternal adversity (homelessness, substance abuse, intimate partner violence), newcomer status and mental health concerns in Ontario, Canada.
Design This retrospective cohort study included infants born in hospital in Ontario from 1 April 2005 to 31 March 2017 captured in linked health administrative and demographic databases. Infants were followed from newborn hospitalisation until 1 year of age for child maltreatment captured in healthcare or death records. The association between type and number of maternal risk factors, and maltreatment, was analysed using multivariable logistic regression modelling, controlling for infant characteristics and material deprivation. Further modelling explored the association of each year of maternal age with maltreatment.
Results Of 989 586 infants, 434 (0.04%) had recorded maltreatment. Maternal age <22 years conferred higher risk of infant maltreatment (adjusted OR (aOR) 5.5, 95% CI 4.5 to 6.8) compared with age ≥22 years. Maternal mental health diagnoses (aOR 2.0, 95% CI 1.6 to 2.5) were also associated with maltreatment, while refugee status appeared protective (aOR 0.6, 95% CI 0.4 to 1.0). The odds of maltreatment increased with higher numbers of maternal risk factors. Maternal age was associated with maltreatment until age 28 years.
Conclusion Infants born to young mothers are at greater risk of infant maltreatment, and this association remained until age 28 years. These findings are important for ensuring public health interventions are supporting populations experiencing structural vulnerabilities with the aim of preventing maltreatment.
- Child Abuse
- Child Welfare
- Child Health Services
- Mental health
- Child Protective Services
Data availability statement
All data relevant to the study are included in the article or uploaded as supplemental information.
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Contributors JNS conceptualised and designed the study, interpreted the results, drafted the initial manuscript and revised the manuscript. AG, KLH, AV and MS conceptualised and designed the study, interpreted the results and drafted the manuscript. AK was involved in the design of the study, had access to and analysed the data, interpreted the results and drafted the manuscript. KLH is guarantor.
Funding This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by: MOH, MLTC, Canadian Institute for Health Information (CIHI), and Immigration, Refugees Citizenship Canada (IRCC). Parts of this report are also based on Ontario Registrar General (ORG) information on deaths, the original source of which is ServiceOntario. KLH is supported by funding from the National Institute of Health Research (NIHR 17/99/19). This research was supported in part by the NIHR Great Ormond Street Hospital Biomedical Research Centre and the Health Data Research UK (grant no. LOND1), which is funded by the UK Medical Research Council and eight other funders. AG is funded by a Tier 1 Canada Research Chair in child health services and policy.
Disclaimer The analyses, conclusions, opinions and statements expressed here are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred. The views expressed are those of the authors and do not necessarily reflect those of ORG or Ministry of Government Services.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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