Amid the dismal health landscape of the pandemic, researchers have uncovered good news about family well-being. Physician Robert Sege, professor of medicine and pediatrics at Tufts University School of Medicine and director of the Center for Community-Engaged Medicine at Tufts Medical Center, and his TMC colleague Allison Stephens found that three different statistical indicators of child abuse – ER visits, abusive head injury admissions, and reports to child welfare offices – dropped sharply in the spring of 2020, precisely as the world moved into lockdown. It surprised some experts, who feared child abuse was on the rise as families — under the duress of closed schools, work disruptions and a myriad of other pandemic stressors — tried to find their way . Sege, whose research focuses on child abuse prevention, addressed the paradox in a recent interview.
Clumps now: You and Allison Stephens recently wrote in JAMA Pediatrics on the “missing epidemic of child abuse,” arguing that the latest data flies in the face of conventional wisdom that child abuse and neglect is increasing during the pandemic. How do you explain this paradox of falling rates despite increased risk?
Robert Sege: I think this is good news in many ways. We know that many people had more free time due to work interruptions or working remotely. They were less in a hurry; their children were less in a hurry. During this period, state, local, federal and neighboring governments have intervened. So while unemployment soared, there was eviction protection, stimulus checks, direct supports for food and utility services, and increased unemployment insurance.
What people don’t know about child abuse is that most children who are abused are abused by their parents or guardians, not by strangers. The second thing is that most parents really love their children. When child abuse happens, it’s not because parents don’t love their children; it is because they have reached the end of their rope. This is because they are already struggling financially or under relationship stress, or have mental health issues or drug issues. So children do childish things; babies cry a lot and toddlers behave oppositely and teenagers try to grow up. When parents’ own problems and stresses have already pushed them over the edge, they cannot handle those normal issues and difficulties of raising children.
We believe that during the pandemic, families received enough support to never reach that level.
How do you bridge the bonds between families who receive help with daily needs and less child abuse at home?
We’ve known for a long time that family supports—food allowances, public service assistance, all of those things—reduce child abuse. And in particular, paid parental leave, which we just won in Massachusetts in 2021, decreases undue head injuries in infants. All of these things indicate that these external social factors are crucial: if you give enough to families so that they are not pushed to the limit, they do not abuse their children. It’s really important.
Wouldn’t you expect there to be fewer people noticing and reporting abuse while schools are closed?
First, emergency department visits for child abuse and neglect have dropped precipitously. Second, a Yale group found that hospital admissions for undue head trauma, a serious consequence of child abuse, also dropped dramatically. So those are two medical indicators.
The third is the number of reports of physical abuse of children. It happens when someone calls the state welfare office – in Massachusetts it would be the Department of Children and Families – because they are concerned that a child is being abused. These ratios have decreased by up to 70%. Some experts said at the time that reports had decreased because children were not going to school or preschool, so perhaps there was child abuse going on undetected from the usual way. So we looked at that. Before the pandemic, in 2019, educators made about 20% of all abuse reports, so the loss of educator reports alone cannot explain the 70% drop.
You’ve also surveyed parents about their pandemic experiences, working with the American Academy of Pediatrics and the CDC to survey 9,000 US parents in 2020 and 2021. What surprised you?
They tell us that they feel closer to their children in general and closer to their children even when helping them with their remote learning. And what’s interesting is that even people who say they are extremely stressed by the pandemic say they are closer to their children.
We know that the human brain is capable of what is called post-traumatic growth. If people suffer from psychological trauma and recover, one of the hallmarks of recovery is feeling closer to the people you had the traumatic experience with. So we think that while parents and children are going through an incredibly difficult time of stress together, a lot of them are bonding.
The key lesson here is that even though we professionals feared that violence would increase, we found that families were resilient and concrete supports for families protected children.