Children younger than 2 years were more likely to be maltreated if they had spina bifida or cleft lip/palate than if they had Down syndrome, according to a population-based study of 3 million children born in Texas from 2002-’09.
Birth defects occur in one in 33 U.S. births, and children with disabilities face an increased risk for maltreatment and out-of-home placement. It is not known how the risk might vary by type of birth defect.
The study was conducted to assess whether the risks and predictors of maltreatment vary by three types of birth defects: Down syndrome (intellectual impairment), cleft lip with or without cleft palate (facial malformation and speech impairment) and spina bifida (physical disability). Children with these disabilities were compared to an unaffected group.
The risk of any type of maltreatment was significantly higher for children with spina bifida and cleft lip/palate, an increase of 58% and 40%, respectively, even after adjusting for child-, family-, and neighborhood-level factors. Children with Down syndrome, however, were not at increased risk of maltreatment before age 2.
The study also found that children with birth defects are at risk for different types of maltreatment than other children. The risk of medical neglect was three to six times higher in the three birth defects groups compared with the unaffected group, which may be related to the medical complexity of the children’s conditions.
Maltreated children tended to be males and those born prematurely. Parents were the most frequent perpetrators, especially those living in poverty.
The risk of maltreatment was elevated for children whose mothers were young, white non-Hispanic, unmarried and who did not indicated paternity information on birth certificates. They were more likely to have a high school education or less, to have given birth previously and to have had the birth covered by Medicaid.
Future studies could inform policies and services aimed at improving outcomes of at-risk families by targeting populations with the highest risk for maltreatment, the authors noted.
Children with developmental delays, including those with the birth defects examined in this study, qualify for early childhood intervention services (Part C) under the Individuals With Disabilities Education Act, but many qualifying children do not receive these services, the study points out.
Pediatricians can help children at risk for maltreatment by referring families to support groups or social workers, and by advocating for programs such as home visitation, said Bethanie Van Horne, Dr.P.H., lead author of the study and assistant director of state initiatives, University of Texas Health Science Center at Houston. Families in impoverished neighborhoods often need extra help finding resources.
“I think this kind of information (from the study) shows there are kids at great risk for abuse,” Dr. Van Horne said. “Those interventions where a nurse would come in and work with the family for two years could be very beneficial if they actually qualified for those services.”