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Submitted Nov. 1, 2021.

Every child is unique and irreplaceable. When a child dies, the promise that was that child’s life is now lost and society is less because of it.

Recently, we were reviewing pediatric data on COVID-19 dashboards and were appreciative that society remains vigilant about COVID-19’s impact on children. This data informs, influences behaviors, and promotes strategies to mitigate the adverse effects of the pandemic on children. 

Still, we are perplexed that another catastrophic crisis — child abuse — has failed to generate comparable urgency, timely dashboards, or mobilization of required resources to safeguard children.

Prior to COVID-19, the number of child abuse cases in Pennsylvania and nationally were already alarming. A November 2019 night exemplified how rampant the crisis had become.

On that night, most of the children in Geisinger Janet Weis Children’s Hospital’s Intensive Care Unit were victims of life-threatening child abuse. Our staff were treating several infants who had suffered devastating brain injuries, who required assistance to breathe and neurosurgical interventions. Another toddler was severely injured with multiple broken bones—some new and some weeks old. Two older children had previously survived abusive head trauma, but the debilitating effects of that abuse necessitated ongoing critical care services.

Today, the news remains grim. Daily, children’s hospitals across Pennsylvania provide critical care to children directly victimized by violence or severe neglect or affected by opioid ingestions. Society has grown numb to the almost daily reports of another child dying from unfathomable and preventable circumstances.

Collectively, we have failed to recognize that child abuse is itself a pandemic.  The World Health Organization firmly recognizes child maltreatment as an uncontrolled global problem resulting in serious life-long consequences.

Let’s place the magnitude of the abuse pandemic in context comparing child abuse fatalities with fatalities from influenza and COVID-19.

In the 2019-2020 influenza season, across the nation, 188 children died. In Pennsylvania, approximately 2-6 children die annually from influenza.

We reiterate the death of every child is tragic regardless the cause.

Sounding the alarm about lethal child abuse is not intended to minimize the toll that the COVID-19 pandemic has on children. Beyond the virus’ physical threat, children are grieving the loss of loved ones and social isolation and feelings of helplessness have fueled an associated behavioral health crisis. 

542 children are estimated to have died from COVID-19 in the United States according to data compiled by The American Academy of Pediatrics and the Children’s Hospital Association. This approximates 400 deaths annually. In Pennsylvania, at least 17 children have died from COVID-19 or approximately 12 annually.  

Now consider lethal child abuse. Pennsylvania recently reported that 73 child deaths were substantiated as child abuse in 2020. 

The harsh reality is children in Pennsylvania are four times more likely to die from abusive injuries than COVID-19 and influenza combined. 

Unlike influenza or COVID-19, when a child is a victim of child abuse, they may not receive a medical evaluation by a health care professional specially trained to accurately diagnose child abuse. Accurately diagnosing child abuse is consequential for children, families and those alleged to have abused a child. We cannot afford for it to be over or under diagnosed.  

Interrupting cycles of abuse depend on high-quality interdisciplinary investigations. These investigations are often tackled by overwhelmed and under-supported front-line child welfare professionals. These professionals deserve more relevant training, better resources and the ability to team with partners able to identify and address complex issues. 

Nearly a decade ago, Pennsylvania lawmakers enacted significant child protection legal reforms. It is disappointed and exasperating that many frontline child protection professionals believe children are not better protected today than 10 years ago. The changes were well-intended, but were never operationalized to the point of effectiveness.

In November 2019 and again in May 2020, we were part of a call-to-action on behalf of abused children. It is now October 2021 and we still urge policymakers to:

  • Ensure that front-line workers are appropriately compensated and supported to do the life and death work we ask of them.
  • Improve and strengthen the tools utilized to screen, triage and divert reports made to ChildLine.
  • Seriously address the combined effects of COVID-19, the opioid epidemic and child abuse, including the dramatic uptick in child opioid ingestions.  
  • Stipulate that children’s advocacy centers and expert medical evaluations are a core, not an optional component of child abuse investigations. Seek to ensure regionalized access to specially trained child abuse pediatricians. 
  • Empower Pennsylvania’s Child Advocate to lead independent child fatality and near fatality reviews.  
  • Create a tiered approach to the child abuse registry and safeguard children testifying in proceedings about whether a perpetrator will remain on the registry.

COVID-19 was met with urgency, strength of conviction, and unwavering resolve to tackle its lethality. The time has come for equal urgency and resolve to ensure that every child’s life is protected so that the promise of that precious life is fulfilled.

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The opinions, beliefs, and viewpoints expressed in this letter to the editor do not necessarily reflect the opinions, beliefs, and viewpoints of NorthcentralPa.com. 


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