The strain on families from the COVID-19 pandemic raises serious concerns for child safety. “It’s a perfect storm,” says Christine Baker, program coordinator with Seattle Children’s Child Protection Advocacy/Outreach program. “The economic strain on families, health worries, the stress of being homebound with kids all day long, the housing insecurity for many, fear of becoming sick and losing loved ones. . . . Parents are stressed and isolated in many ways by this virus.” She notes that the depression of 2008 was followed by a three-fold increase in cases of abusive head trauma in Washington state (a diagnosis that applies only to children 2 years and younger).

The Zero Abuse Project noted last month, “Many child protection professionals believe child abuse is likely to increase during the COVID-19 pandemic because most abusers are parents or siblings who now have more complete access to the child victim. In turn, the victim may no longer have schoolteachers, faith leaders or other mandated reporters they can access for help or who may detect a sign of abuse. Children may also have reduced access to medical and mental health providers” (see Responding to Child Abuse During a Pandemic: 25 Tips for MDTs). Washington state’s child abuse hotline saw a 40% drop in calls in the week after Governor Inslee ordered all schools to close.

For advice about how PCPs can help keep kids safe at home during COVID-19, we turned to doctors from the Seattle Children’s Safe Child and Adolescent Network (SCAN).

Q: Are we seeing an increase in child abuse because of COVID-19?

A: We haven’t seen a spike in our region yet, but we do expect it; many of our abuse colleagues around the country already are reporting an increase.

Q: What can PCPs do to assess if a child is at risk of harm at home?

A: COVID-19 is affecting every family’s daily life. To assess if families need help, the first thing providers can do is open a conversation using a simple screening question at the start of every visit.

  • “COVID-19 means a lot of families are stressed and spending more time together at home. Do you and your family feel safe with each other? Do you have what you need to manage through this time?”

How the family answers this question can help guide your response and next steps. Remind them that it doesn’t have to be an emergency to seek help and that experiencing stress during this time is common.

It’s important to promote the early and active involvement of a social worker with families to connect them with resources that may decrease their baseline level of stress (e.g., childcare needs, food insecurity, unemployment). If your office doesn’t have a social worker or mental health professional you can refer to, consider having a list of resources ready to share, both verbally and in a handout form; Seattle Children’s has created a “Take 5” flyer PCPs can give to families.

Q: What should I be looking for during the visit?

A: Be alert for early warning signs of abusive head trauma. These include altered mental status, bulging fontanelle, increasing head circumference, vomiting and respiratory changes. Doctors miss this diagnosis up to one-third of the time, leading many infants to return sicker or reinjured.

Every infant visit is a good opportunity to remind parents that if they are getting frustrated they should set the baby down in a safe place and walk to another room.

In premobile infants, be especially alert for “sentinel injuries” such as frenulum tears (the webs between the lips and gums), subconjunctival hemorrhage (bleeding in the whites of the eyes) and bruising. All of these are red flags for risk of abuse. Regardless of the history provided by caregivers, there should be no bruises in a premobile infant. Even small bruises the size of a pencil eraser are cause for concern. For children who are mobile but under 4 years of age, bruises on the torso, ears and neck (TEN regions) are concerning for nonaccidental trauma.

Caretakers should learn to take their “emotional temperature.” When it is threatening to go from “warm” to “hot,” they should put the infant down in a safe place and take time to calm themselves away from the infant. Seek help from others to step in and relieve the tension.

Q: Where do I go for more information or a consult?

A: The Safe Child and Adolescent Network (SCAN) is available for medical consult if you have questions related to suspected abuse and neglect. You can reach the SCAN team by calling 206-987-2194 during business hours, or calling the Seattle Children’s operator at 206-987-2000 on evenings and weekends.

Resources:

For Caregivers Needing Immediate Support:

  • Parent Trust for Washington Children, The Family Help Line: 1-800-932-4673
  • Harborview Abuse and Trauma Center, Support and Tips to Manage Behavior: 206-744-1600
  • Disaster Distress Hotline: 1-800-985-5990
  • Crisis Text Line: Text HOME to 741741 for crisis counseling any day and time

Stress and Coping:

(English, Spanish, Chinese, Vietnamese and Korean available)

Mental Health Support:

Resources and Tips for Parents, Children and Others:

(English and Spanish available)