Risk factors for infant maltreatment: a population-based study

Abstract

Context:

Of the approximately 900,000 children who were determined to be victims of abuse or neglect by US child protective services in 2002, the birth-to-3 age group had the highest rate of victimization (1.6%) and children younger than 1 accounted for the largest percentage of victims (9.6%).

Objective:

To identify perinatal and sociodemographic risk factors associated with maltreatment of infants up to 1 year of age.

Design and Setting:

Observational cohort study.

Participants:

189,055 children born in 1996 in Florida.

Main Outcome Measure:

Infant maltreatment, defined as a verified report of abuse, neglect, or threatened harm that occurred between day 3 of life and 1 year.

Results:

1,602 children (.85%) of the 1996 birth cohort had verified instances of maltreatment by age 1. Of 15 perinatal and sociodemographic variables studied, 11 were found to be significantly related to infant maltreatment. Five factors had adjusted relative risks (RR) of two or greater: Mother smoked during pregnancy (RR 2.8); more than two siblings (RR 2.7); Medicaid beneficiary (RR 2.1); unmarried marital status (RR 2.0); low birth weight infant (RR 2.0). Infants who had four of these five risk factors had a maltreatment rate seven times higher than the population average.

Conclusions:

Data on nearly all risk factors found to be significantly associated with infant maltreatment are available on the birth certificate. Such information can be incorporated into a population-based risk-assessment tool that could identify subpopulations at highest risk for infant maltreatment. Because resources are limited, these groups should be given priority for enrollment in child abuse prevention programs.

Résumé

French- and Spanish-language abstracts not available at time of publication.

Resumen

French- and Spanish-language abstracts not available at time of publication.

Introduction

Since the early 1960s, public concern about child abuse and neglect has grown dramatically. The federal government enacted the Child Abuse Prevention and Treatment Act and established a National Center on Child Abuse and Neglect in 1974. In 1990, the US Advisory Board on Child Abuse and Neglect called it a national epidemic (US Advisory Board on Child Abuse and Neglect, 1990). The total number of maltreated children reported to authorities has nearly doubled since 1986, with an estimated 896,000 abused or neglected children in the United States in 2002 (Schwartz-Kenney, McCauley, & Epstein, 2000; Sedlak & Broadhurst, 1996; Wolfe, 1999, US Department of Health and Human Services, 2004). Prevent Child Abuse America (2001) estimates the costs associated with child abuse in the US at $94 billion per year.

In the last 10 years, investigators and clinicians have begun to focus on primary prevention of child abuse (Bethea, 1999, MacMillan, 2000). Efforts have centered on identifying the youngest children who are at high risk for maltreatment, so that suitable interventions can be undertaken at the earliest time to reduce prevalence (Kotch et al., 1995, Kotch et al., 1997; Kotch, Browne, Dufort, Winsor, & Catellier, 1999; McGuigan & Pratt, 2001; Zelenko, Lock, Kraemer, & Steiner, 2000). Of the nearly 900,000 children who were determined to be victims of abuse or neglect by US child protective services in 2002, the birth-to-3 age group had the highest rate of victimization (1.6%) and children younger than 1 accounted for the largest percentage of victims (9.6%) (US Department of Health and Human Services, 2004).

A number of factors have been found to be associated with an increased risk of child abuse. These include: maternal poverty, young maternal age, low maternal educational achievement, and infant prematurity (Famularo, Fenton, & Kinscherff, 1992; Hay & Jones, 1994; Sidebotham, Golding, & The ALSPAC Study Team, 2001; Stier, Leventhal, Berg, Johnson, & Mezger, 1993). Children experiencing maltreatment are more likely to exhibit delays in achieving developmental milestones; aggression, violence and criminal activity; risky health behaviors such as substance abuse; abuse of family members; school failure; and suicidal tendencies (Grilo, Sanislow, Fehon, Martino, & McGlashan, 2001).

In fiscal year 2001–2002, the Florida Abuse Hotline Information System received 207,322 calls reporting that children under the age of 18 had been abused or neglected. Upon investigation, it was determined that 48,532 of these initial reports (36.8%) had a finding of “verified” or “some indication” (Florida Department of Children and Families, 2002).

The purpose of the present study was to identify perinatal and sociodemographic risk factors in mothers and infants that were associated with maltreatment during the first year of life. There is a paucity of research on predictors of infant maltreatment. We could locate only one recent study investigating the relationship between maternal characteristics and infant maltreatment (Bugental & Happaney, 2004). The dependent variable of that study was not a verified case finding of maltreatment but “harsh parenting and safety neglect” as measured by responses on a questionnaire (p. 237). The chief independent variable of interest was maternal depression. The single-center sample was small (N = 71) and homogenous (98% Hispanic). Our study of risk factors for infant maltreatment was population-based. Using a large, statewide child abuse registry, we were able to analyze a wide spectrum of sociodemographic, health, and behavioral risk factors for an entire birth cohort. We believe that the methodology we employed with Florida data, linking birth vital statistics, Medicaid eligibility files, and Child Protective Services records, represents a model that agencies and researchers in other states can use to initiate early identification of maternal-infant dyads most at risk for maltreatment.