Child Physical Abuse During the COVID-19 Pandemic Across Levels of Community Advantage.
Document Type
Article
Publication Date
5-2026
Identifier
DOI: 10.1016/j.acap.2026.103300
Abstract
OBJECTIVE: To determine whether community advantage moderated rates of hospital encounters for child physical abuse during the COVID-19 pandemic.
METHODS: This was a population-based retrospective study of 12 states during 2019 to 2021. The Child Opportunity Index 3.0 (COI) measured ZIP code-level community advantage. Average monthly rates of hospital encounters (ie, ED visits and hospitalizations) for physical abuse per 100,000 children aged < 5 years were calculated for each pandemic period overall and stratified by COI quintile and type of injury. Pandemic periods were defined a priori as pre-pandemic (Jan 2019 to Feb 2020), early-pandemic (Apr 2020 to Aug 2020), and mid-pandemic (Sept 2020 to Dec 2021). Poisson regression models compared rates between pandemic periods.
RESULTS: Compared to pre-pandemic, the overall rate of hospital encounters for physical abuse was 14.0% lower during the early-pandemic period (P< .0001) and statistically unchanged during the mid-pandemic period. Compared to pre-pandemic, rates of physical abuse during the early-pandemic period were 20.3% lower in ZIP codes with very low COI (P = .001) and 17.8% lower in ZIP codes with low COI (P = .01), without significant changes among other COI quintiles. Compared to pre-pandemic, rates of isolated skin injuries were 19.3% lower in the early-pandemic period (P< .0001) and 7.5% lower in the mid-pandemic period (P = .02), without significant changes in abusive traumatic brain injury or abusive fractures.
CONCLUSIONS: Lower-severity abusive injuries were less often diagnosed early in the pandemic, specifically among children from disadvantaged communities. These results hint at a complex interplay of potential prevention via social policy and factors relating to detection.
Journal Title
Acad Pediatr
Volume
26
Issue
4
First Page
103300
Last Page
103300
MeSH Keywords
Humans; COVID-19; Child Abuse; Child, Preschool; Retrospective Studies; Infant; Male; Female; United States; Hospitalization; Pandemics
PubMed ID
41876043
Keywords
COVID-19 pandemic; child abuse; child opportunity; community; neighborhood
Recommended Citation
Puls HT, Lindberg DM, Noelke C, Austin AE, Chaiyachati BH, Hall M. Child Physical Abuse During the COVID-19 Pandemic Across Levels of Community Advantage. Acad Pediatr. 2026;26(4):103300. doi:10.1016/j.acap.2026.103300
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