Reports of child abuse and neglect were down 34% overall this spring but cases of child maltreatment during the pandemic have remained steady at Hasbro Children’s Hospital in Providence. Here’s what two pediatricians there are seeing.

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WEISMAN: This is how Dr. Amy Goldberg felt back in the middle of March.

GOLDBERG: In the beginning of the pandemic we were very, very scared. I still am quite frankly. I was really, really nervous every time I would hear a code blue in the hospital in the first month of the pandemic. I literally would hold my breath and think OK, is that the pediatric trauma room where there’s a baby who I’m going to get called about in an hour?

WEISMAN: Dr. Goldberg is a pediatrician and attending physician at Hasbro Children’s Hospital in Providence. She is board certified in the subspeciality of child abuse pediatrics. Like may other child abuse experts, she braced for a grim scenario when COVID-19 pandemic lockdowns began.

GOLDBERG: Because I thought all these babies are at home now with parents who have increased frustration, what’s that going to do? And that maybe has been seen in other places but I would not say that’s what we’re seeing right now.

WEISMAN: Back in the spring, hospital emergency rooms in some large U.S. metropolitan areas reported treating more children with head trauma, broken bones and other serious injuries resulting from child abuse and neglect. Not so in Rhode Island. That’s despite a significant decline in reports of child maltreatment to Child Protective Services at the Rhode Island Department of Children, Youth and Families or DCYF. Dr. Goldberg’s initial fears that the pandemic would result in more child abuse have not materialized. In fact, the number of cases has remained relatively steady at Hasbro Children’s Hospital.

GOLDBERG: We’re Rhode Island so we’re small so it’s a really difficult comparison comparing two cases to one or four cases to two cases. I mean sure, it’s double but that’s not statistically valid comparison. What I can tell you is that our numbers are steady if not a little bit higher. That doesn’t mean that I’m making the diagnosis of child maltreatment. It means that I’m seeing the same number of kids, definitely fewer kids who are being called in with injuries that were called in by a school but I’m seeing more vulnerable kids. So the numbers are steady but they’re different types of cases.

WEISMAN: Anyone who suspects a case of child abuse or neglect is required to report it to DCYF by calling the 24/7 hotline 1-800-RI-CHILD.

Numbers provided by DCYF show a 34% decline overall in reports for the months of March through June compared to the same four months in 2019. Stay-at-home orders and school closures because of the COVID-19 pandemic meant kids were seeing fewer people outside their own homes. People like teachers, law enforcement personnel, mental health clinicians, social service workers and health care providers who are often the ones who report suspected child maltreatment.

A 34% decrease sounds like it could be a big problem, but it’s important to note research has documented that the overwhelming majority of child abuse reports are ultimately unsubstantiated. One 2017 study found investigators substantiated between 10% and 14% of reports.
Another factor:

RUEST: I think it’s important that we not conflate poverty and the effects of poverty with child maltreatment.

WEISMAN: That’s Dr. Stephanie Ruest, a pediatrician and emergency room staff physician at Hasbro Children’s Hospital.

RUEST: So it is not intentional child maltreatment. It is I have to decide between keeping the electricity on and feeding my children so parents are making difficult choices. Unfortunately, there’s not really a great system other than these hotlines to call for people to be able to bring up these concerns.

WEISMAN: Since the pandemic began, Hasbro Children’s Hospital has seen a rise in what Dr. Ruest calls cases of supervisional neglect.

RUEST: In one day, I had three kids with really bad burns, which was really unusual and all of them ultimately were accidental mechanisms but parents admittedly in those cases were I was on a conference call or I was in my kids Zoom class meeting and the other one pulled down the hot tea off the counter. Things like that. So that’s definitely a trend that we’re seeing. Those cases are not necessarily called in to the hotline. Those are cases sometimes we’ll run by Dr. Goldberg and her team but ultimately a report is not filed because of the circumstances that they happen.

WEISMAN: Dr. Ruest calls in Dr. Goldberg when she suspects child abuse or neglect.

GOLDBERG: By the time I’m consulted and Steph and I have done a lot of work together so she’s like a really really good filter. So if it gets through her to me, the likelihood that it’s going to be child abuse is actually pretty high.

WEISMAN: So how often then do physicians decide that the case they are seeing is a result of child abuse? Here’s Dr. Goldberg again.

GOLDBERG: We make the diagnosis of child abuse in approximately just about half of the cases that we see.

WEISMAN: Dr. Goldberg is particularly concerned about adolescents living in group homes during the pandemic. Strict quarantine measures imposed if they take an unauthorized leave from the premises might place them at high risk.

GOLDBERG: I say to my kids if you think you’re bored in this house with all of your things, you can’t even imagine what it’s like for a 15-, 16-, 17-year old kid who’s in a congregate care setting, who not only, I mean they’re supposed to be having visits with loved ones, they’re supposed to be having access to another group of people other than the three kids they’ve been assigned to live with plus adults who have been assigned to take care of them And God forbid they leave their group home setting, they just bought themselves a COVID test and a quarantine test for 14 days. So quarantine like not a quarantine you and I are talking about, quarantine like sitting in their room. So that kid is at unbelievably high risk to leave and that is what is happening. Definitively where I’m seeing an increased number of cases is adolescents who are leaving a group home setting and doing quite frankly things that adolescents do pretty developmentally normally, which is experiment. I’m not condoning certain behaviors, but they’re doing things that all kids do which is hang out with their friends. That kid now is on the street and a child  who doesn’t have a stable caregiver who is now engaging in pretty high risk behaviors, that’s another form of child maltreatment. It’s not clear who the perpetrator is that we’ve seen.

WEISMAN: Dr. Ruest remains concerned about the impact of kids not being in the classroom or postponing well-child visits to their doctor.

RUEST: The kids that we’re all worried about are the kids who have bruises or marks that are not life threatening but certainly inflicted injuries that are often noted by teachers or their pediatricians and those kids who are picked up earlier before they have a life-threatening injury, kids who would be called in or have services established. We just don’t know who we’re missing      in terms of those inflicted injuries that are not forced to come to medical attention. And I don’t think there’s any way of truly knowing that number because those kids aren’t being picked up and whether or not that number has changed, I don’t know that we’ll ever know.

WEISMAN: Both of these Hasbro physicians say pediatricians should broaden their approach to treating children beyond just a single visit. Asking questions of children and their parents could help determine what other resources may be needed in the home, especially with a pandemic that shows no signs of letting up.

RUEST: I think taking that extra moment to really do a thorough exam. If a kid comes in for a chin laceration do I just look at the rest of their skin to make sure I’m not missing another injury. Whenever possible, having kids alone if they’re age appropriate just to run through, hey are you feeling safe at home, is there anything that you need or anything that you’re worried about? Kids who come in with mental health complaints, making sure that you’re really asking about safety, about abuse, neglect, what the dynamic is at home, what their access is to food, things like that. I think as kids start re-entering pre-schools and the school environment having people remember that again they should be looking out for these things but also know that under these stressed out times, these kids may just need some extra resources and referrals to social services that are not punitive but really can help families in terms of food, access and things like that. So I think that’s where we can as we’re opening back up, as we’re getting more exposure to kids or when we do have access to them to really take advantage of those moments of face to face time and making sure that we’re not missing an opportunity to identify kids who are at risk or who are experiencing child maltreatment.

WEISMAN: Thanks to Dr. Amy Goldberg and Dr. Stephanie Ruest from Hasbro Children’s Hospital in Providence for their perspective on the impact of the pandemic on rates of child abuse in Rhode Island.

Dr. Goldberg and Dr. Ruest are both members of the Rhode Island Medical Society.

The DCYF 24/7 statewide toll-free hotline to report abuse and neglect is 1-800-RI-CHILD (1-800-742-4453). All calls are recorded. You may call anonymously.

Thank you for listening. I am Janine Weisman.