Effect of covid-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK

Objectives

To determine any change in referral patterns and outcomes in children (0-18) referred for child protection medical examination (CPME) during the covid-19 pandemic compared to previous years.

Design

Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown.

Setting

Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288,000 children.

Participants

Children aged under 18 years attending CPME during an 18 week period from late February to late June during the years 2018, 2019, and 2020.

Main Outcome Measures

Numbers of referrals, source of disclosure and outcomes from CPME

Results

There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95%CI 12.4-59.0) reduction in referrals from 2018 to 2020, and a 37.3% (95%CI 8.6-57.4) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12(26%) compared to 36 (47%) and 38 (52%) in 2018 and 2019 respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns.

Conclusions

School closure due to covid-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully re-open as children disclose the abuse they have experienced at home.

Article summary: Strengths and Limitations of the Study

• This is a highly robust study: we obtained CPME reports for 97% of CPME referrals during the study period.

• We ensured consistency of data extraction by double reviewing every report, with further consensus discussions for the few cases that raised uncertainties.

• The team extracting the data comprised highly experienced paediatricians with expertise in child abuse.

• One weakness is that we only considered minor injuries from outpatient CPME, excluding those admitted to hospital, so our findings do not include those with more serious NAI, however they would be taken to hospital for treatment due to the severity of their injuries.