Background Early adverse childhood experiences (EACES) such as child maltreatment between the ages of 0 to 3, has significant impact on a child’s cognitive development and behaviour. Negative experiences and even the absence of positive experiences e.g. in extreme deprivation, can cause disruptions to brain architecture, with long-lasting effects. EACES also increase the risk of physical health, mental health and relational difficulties in adulthood with poor academic and employment outcomes. Understanding the risk factors associated with health and developmental conditions in maltreated children provide more effective interventions to improve their outcomes.
Objectives The purpose of the study was two-fold. One, to explore the demographics, social, developmental and physical health conditions of young children admitted to a tertiary children’s hospital for suspected child maltreatment Two, to examine the occurrence of child maltreatment with developmental delays and missed vaccinations.
Methods 99 children aged 0 to 3, admitted between the period of January 2018 and June 2019 were included in this quasi-observational study. Medical data was electronically extracted on variables surrounding their health, development, and demographics.
Results Children in this study had a mean age of 1.3 years; and 59% were males. The most common reported abuse type was physical (74%), followed by neglect (14%) and sexual abuse (10%) 2% had more than one of three abuse types. 35% of children had pre-existing developmental conditions and significant medical conditions e.g. asthma or atopy. During the hospitalisation, 58% of children were assessed to have child maltreatment-related injuries, missed vaccinations and developmental conditions requiring health care follow-up. Specifically, 19% (n=19) of children had existing or present developmental delays, where six were detected through routine developmental screening during hospitalization. Children with developmental delays were more likely to have missed vaccinations than those without delays [Odds ratio (OR) 3.6, 95% confidence interval (CI) 1.04–12.62]. The correlation with developmental delays was independent of maternal education or household income. Children staying in rented housing were more likely to have missed vaccinations than those staying in purchased housing [OR 9.5, 95% CI 1.09–82.72]. When it came to parental factors, the majority of children’s parents had only primary school education; and had a mean household income of S$823 – well below the national average. 20% stayed in purchased housing, 27% in rented housing, and 5% were lodging with relatives or friends. Majority of children (72%) were referred to statutory child protection agencies as part of safeguarding procedures, indicating significant concerns over the child’s injury and social circumstances.
Conclusions A sizeable proportion of maltreated children were identified with developmental delays – twice that seen in the general population. A significant proportion also presented with health concerns that utilize health care resources and follow-ups. Those with social deprivation were more likely to have neglected basic health needs e.g. vaccination. Thus, managing child maltreatment should include enhanced developmental screening using standardized tools to improve early detection and robust health surveillance, ensuring the timely identification of needs and access to appropriate services for better health equity.
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