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

• Published in: BMJ open Vol. 10; no. 9; p. e042867
• Main Authors: Garstang, Joanna, Debelle, Geoff, Anand, Indu, Armstrong, Jane, Botcher, Emily, Chaplin, Helen, Hallett, Nutmeg, Morgans, Clare, Price, Malcolm, Tan, Ern Ern Henna, Tudor, Emily, Taylor, Julie
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 29-09-2020; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Alternative approaches; Betacoronavirus; Child; Child abuse & neglect; Child Abuse - prevention & control; Child Abuse - psychology; Child Abuse - statistics & numerical data; Child Protective Services - methods; Child Protective Services - statistics & numerical data; Child welfare; Child Welfare - statistics & numerical data; Child Welfare - trends; Children; Children & youth; Childrens health; Communicable Disease Control - methods; Communicable Disease Control - statistics & numerical data; Coronavirus Infections - epidemiology; Coronavirus Infections - prevention & control; Coronavirus Infections - psychology; Coronaviruses; COVID-19; Data collection; Female; Health services; Hospitals; Humans; Injuries; Male; Medicine; Observational studies; Paediatrics; Pandemics; Pandemics - prevention & control; Pneumonia, Viral - epidemiology; Pneumonia, Viral - prevention & control; Pneumonia, Viral - psychology; Population; Protection; Referrals; SARS-CoV-2; School Health Services - statistics & numerical data; Schools; Sex crimes; Shelter in place; Social Isolation; Social services; Social Work - methods; Social Work - statistics & numerical data; United Kingdom - epidemiology; United Kingdom; United Kingdom > UK; England; child protection; non-accidental injury; community child health
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2020-042867

ObjectivesTo 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 with previous years.DesignRetrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown.SettingBirmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children.ParticipantsChildren aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018–2020.Main outcome measuresNumbers of referrals, source of disclosure and outcomes from CPME.ResultsThere were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 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.ConclusionsSchool 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 reopen as children disclose the abuse they have experienced at home.