March 01, 2012

New Study Tracks Serious Physical Abuse among Hospitalized Children

Claire Chiamulera

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

The number of children hospitalized with serious injuries due to physical abuse is highest among children age one year and younger, a new study finds. That rate climbs even higher among infants covered by Medicaid.

Other trends found by the study included:

  • Abused children with serious injuries stay in the hospital longer than nonabused children.
  • A fair number of seriously abused children die as a result of their injuries, particularly infants.
  • The longer hospital stays and critical care required to treat serious injuries drive up hospital costs.

The Study

Researchers from the Yale University School of Medicine and the Johns Hopkins School of Medicine focused on children who are hospitalized with serious injuries due to physical abuse. While data exists on the national occurrence of child maltreatment, it has not identified serious cases of physical abuse, such as children hospitalized with head injuries, fractures, or burns caused by abuse, according to the researchers.

Using data from the 2006 Kids’ Inpatient Database (KID), a national dataset of hospitalized children, the researchers estimated the incidence of hospitalizations due to physical abuse among children under 18 years of age. They looked at demographic characteristics, mean costs, and length of stay among three groups of hospitalized children: abusive injuries, nonabusive injuries, and “other” reasons for hospitalizations.

The 2006 KID is a weighted sample of discharged patients from all nonrehabilitation hospitals prepared by the Healthcare Cost and Utilization Project. The sample includes 3,739 hospitals in 38 states, representing 88.8% of the population in 2006. Hospital discharge information includes demographics, payment, hospital type, diagnoses, external cause of injury based on the International Classification of Diseases, and disposition (e.g., discharge, death).

Children with serious abusive injuries, defined as children who entered the hospital with an injury that was coded as abuse or assault, were grouped into the following injury types: fractures, traumatic brain injuries, abdominal injuries, burns, skin injuries/open wounds, and “other.” The researchers did not include children who entered the hospital with injuries that were suspicious for abuse but who were later diagnosed with nonabusive injuries.


The number of children hospitalized with serious injuries caused by physical abuse in 2006 was 4,569 – a rate of 1.5% per year. Three-hundred of these children died because of their abuse. The mean length of hospital stay for the children in the abuse group was 7.4 days compared to 3.9 days for children with nonabusive injuries.

Children under age one experienced the highest incidence of serious abuse (58.2 per 100,000). The researchers noted this rate was almost twice the rate for abusive head trauma (30 per 100,000). They urged interventions aimed at preventing infant abuse similar to those that have broadened awareness of shaken baby syndrome and head trauma.

A significant number of children in the serious abuse group received Medicaid (71.6%). The incidence of serious abuse injuries was highest among infants on Medicaid in their first year of life: 133 per 100,000. This represented a rate nearly six times higher than children not on Medicaid. Only 36.6% of children with nonabusive injuries and 48.5% of children hospitalized for other causes received Medicaid. This finding emphasizes the link between poverty and child abuse and the need for prevention.

The national cost of the hospitalizations due to serious abusive injuries was $73.8 million in 2006. The researchers explained that this rate is similar to a rate cited in a 2005 study, but differs significantly from a widely cited figure of $6.6 billion by Prevent Child Abuse .

Of the children who were hospitalized for serious abusive injuries, 58.8% were males and 41.2% were females. Nearly half of the children were white (45.3%), while 25.5% were African American, 19.6% Hispanic, and 9.5% were grouped as “other” race/ethnicity.


The researchers noted the following limitations of the study and their potential impact on the findings:

Only hospitalized children were studied. Never-hospitalized children, and children who died before entering the hospital, were not counted, likely resulting in an underestimate of the problem.

Hospitalizations during a specific year were counted, not children, so children who were hospitalized twice in a year could have been counted twice, although the researchers took steps to avoid this outcome.

The researchers relied on physicians’ diagnoses of abuse and assigning child abuse codes. This approach depends on the accuracy of the diagnosis and the proper assignment of injury codes.

Tips for Advocates

Having data on abused children who are hospitalized with serious injuries can help gauge the extent of the problem and related costs. If tracked over time, it can also play a role in assessing whether prevention efforts are reducing serious abuse-related injuries.

The high incidence of serious injuries among infants suggests a need to intervene with pregnant and newly parenting mothers and fathers. A number of resources and supports exist to help vulnerable, at-risk families and give them the tools they need to promote the health and well-being of their infants and toddlers.

Advocates working with families with very young children who have entered the child welfare system due to abuse should know how to support these children and advocate for healthy outcomes. A range of supports are available to help promote their physical and mental health, and help them achieve permanency. (See Healthy Beginnings, Healthy Futures)

Poverty is a clear risk factor for serious abusive injuries leading to hospitalization. Targeting prevention efforts in poor communities through services that serve these families is key: community health clinics, community centers, early child care programs, homeless and domestic violence shelters, churches and faith organizations, food pantries, among others. Helping families meet their needs and address daily stresses can help prevent issues from escalating to abuse. Integrating efforts to promote healthy parenting can also make a difference.