In 2019, child protective services (CPS) agencies in the United States received an estimated 4.4 million reports of child maltreatment. The majority of those reports (68.6%) were from professionals, or mandated reporters, including 11.0% from medical personnel. Yet, several surveys, interviews, and observational studies of physicians have found that they do not always report suspicions of child maltreatment to CPS.

Race and ethnicity are social factors that have been determined as the basis of why physicians do not always report suspicious cases of maltreatment. In previous studies of abusive head trauma and fracture hospitalizations, white children were less likely to be reported to CPS than non-White children. Similarly, another study showed that Black children and children with public health insurance were more likely to undergo skeletal surveys. But the results showed that the diagnosis of abuse was highest for White children among those who received a skeletal survey. These studies were in line with the data regarding CPS involvement in maltreatment cases. These data have identified poverty to be the significant explanatory variable for racial disproportionality

As a result, a study published in Pediatrics examined the role of race/ethnicity and poverty in the reporting to CPS of children younger than age 3 years hospitalized for child maltreatment-related injuries and being assigned a specific maltreatment diagnostic code.

For the study, the data was collected using population-based linked administrative data that included the birth date, hospitalization, and CPS records. Based on the collected data, children were identified for maltreatment-related hospitalizations using standardized diagnostic codes. Regression models were used to compute crude and adjusted race/ethnicity estimates regarding the likelihood of being reported to CPS and assigned a specific maltreatment diagnostic code during maltreatment-related hospitalization.

The findings of the study showed that out of 3907 children hospitalized because of child maltreatment, children with public health insurance were more likely to be reported in comparison to those having private insurance. Similarly, children with Asian/Pacific Islander mothers were less likely to be reported to CPS than those with White mothers. However, no differences were found for children with Black, Hispanic, and Native American mothers compared with those with White mothers for CPS reporting. But the study also showed that children with Native American mothers and public health insurance were more likely to have a specific maltreatment diagnostic code.

It can be concluded that race/ ethnicity and poverty were factors for CPS reports during a child maltreatment-related hospitalization. Hence, it is necessary to implement programs and policies that can mitigate implicit bias to prevent inequities for children while receiving protective intervention.

Source: Pediatrics. 2022 Aug 1;150(2):e2021053346. doi: 10.1542/peds.2021-053346.