Most healthcare workers use vigilance when treating children with injuries that could signal a potential case of child abuse, but bias can influence perception. According to a study published in JAMA Network Open, Black children hospitalized for traumatic injuries are more likely to be suspected of having experienced possible child abuse than White children. When examining data for 634,309 pediatric patients, researchers demonstrated 75% greater odds of suspicion for child abuse for Black patients and 11% greater odds of suspicion for child abuse for Hispanic patients compared with White patients. Additionally, the authors note that Black patients admitted after traumatic injury tend to have a longer length of stay (26.5% longer) compared with White patients admitted. Researchers used controls for socioeconomic factors and hospital characteristics in the analysis. According to an accompanying editorial commentary, the lower threshold for suspecting child abuse in Black children and the higher threshold for White children may be attributed to bias, but using clinical decision support tools and seeking clinical consultation from pediatricians may be positive steps that clinicians can take when abuse—also known as “nonaccidental trauma”—is suspected.
What to do: Establishing protocols may help reduce the over-evaluation of some children and under-evaluation of others. All 50 states mandate that specific individuals report suspected child abuse, such as teachers, medical providers, mental health workers, dentists, and some clergy. Check your specific state statutes to determine which agencies should be notified about suspected child abuse. Read more from the JUCM archive: Duty to Report