Referrals to a hospital-based child abuse committee: a comparison of the 1960s and 1990s

Objective: Although reports of child maltreatment have increased yearly sin ce national data were first collected in 1976, little information is availa ble about changes in the characteristics of children reported. Therefore, t o examine changes over time in recognition and reporting in a medical setti ng, we compared referrals to a hospital-based child abuse committee in the late 1960s and early 1990s. Design: Retrospective, cross-sectional review of medical records and logs o f the hospital's child abuse committee. Settings: Ambulatory, emergency, and inpatient services at Yale-New Haven H ospital. Patients: Medical records were reviewed for 101 of the 165 children referre d to the child abuse committee in 1968-1969 (early group) and 107 of the 84 3 children referred in 1990-1991 (late group). Cases of sexual abuse were e xcluded. Results: Referrals for nonsexual abuse cases increased from 80 children per year in the early group to 181.5 per year in the late group; the late grou p was characterized by a larger number of newborn referrals (1% vs. 52%, p < .001). When non-newborns were compared, the two groups were similar with respect to gender and race, but the late group had fewer patients with priv ate insurance (31% vs. 12%, p < .05). The late group also had more female-h eaded households (32% vs. 67%, p < .05) and more parents with a history of substance abuse (4% vs. 49%, p < .001). Excluding newborns, who were all cl assified as "at-risk," the types of problems were classified as abuse (41% early vs. 29% late), neglect (41% vs. 35%), and "at-risk" (16% vs. 35%). Al though the types of injuries were similar: superficial injuries (20% vs. 16 %), burns (9% vs. 8%), and fractures (6% vs. 4%), fewer maltreated children suffered physical injuries in the late group (71% vs. 49%, p < .05). Conclusions: A substantial change has occurred in referrals to the hospital 's child abuse committee for abuse or neglect. Most referrals have become s ocially high-risk newborns and children or children with minimal injuries. This shift is likely due to broader definitions of maltreatment and earlier recognition of troubled families. <(c)> 2001 Elsevier Science Ltd. All rig hts reserved.