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Child abuse pediatrics (CAP) subspecialists evaluate, diagnose, and treat children when abuse or neglect is suspected. Despite the high rates of child maltreatment across the United States, CAP remains the smallest pediatric subspecialty. The CAP workforce faces numerous challenges, including few fellows entering the field, decreased financial compensation compared with other fields of medicine, and threats to workforce retention, including secondary trauma and harmful exposure in the media. A microsimulation model that estimates the future of the US CAP workforce over the next 20 years shows that, although the number of child abuse pediatricians in the field is expected to increase, the growth is smaller than that of every other pediatric subspecialty. In addition to the low overall CAP workforce in the United States, other workforce issues include the need to increase CAP subspecialists who are underrepresented in medicine and unequal geographic distribution across the country. To meet the medical needs of suspected victims of maltreatment, especially in CAP-underserved areas, many children are evaluated by providers who are not board-certified in CAP, such as general pediatricians, family medicine physicians, emergency medicine physicians, and advanced practice providers, whose CAP experience and training may vary. Current child abuse pediatricians should continue introducing the field to medical students and residents, especially those who identify as underrepresented in medicine or are from CAP-underserved areas, and offer mentorship, continuing education, and oversight to non-CAP physicians meeting this population's medical needs. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Suspicion for child abuse is influenced by implicit biases. Evaluation by a Child Abuse Pediatrician (CAP) may reduce avoidable child protective services (CPS) referrals. Our objective was to investigate the association of patient demographic, social and clinical characteristics with CPS referral before consultation by a CAP (preconsultation referral). METHODS: Children < 5 years-old undergoing in-person CAP consultation for suspected physical abuse from February 2021 through April 2022 were identified in CAPNET, a multicenter child abuse research network. Marginal standardization implemented with logistic regression analysis examined hospital-level variation and identified demographic, social, and clinical factors associated with preconsultation referral adjusting for CAP's final assessment of abuse likelihood. RESULTS: Among the 61% (1005/1657) of cases with preconsultation referral, the CAP consultant had low concern for abuse in 38% (384/1005). Preconsultation referrals ranged from 25% to 78% of cases across 10 hospitals (P < .001). In multivariable analyses, preconsultation referral was associated with public insurance, caregiver history of CPS involvement, history of intimate partner violence, higher CAP level of concern for abuse, hospital transfer, and near-fatality (all P < .05). The difference in preconsultation referral prevalence for children with public versus private insurance was significant for children with low CAP concern for abuse (52% vs 38%) but not those with higher concern for abuse (73% vs 73%), (P = .023 for interaction of insurance and abuse likelihood category). There were no differences in preconsultation referral based on race or ethnicity. CONCLUSIONS: Biases based on socioeconomic status and social factors may impact decisions to refer to CPS before CAP consultation. [ABSTRACT FROM AUTHOR]

Aim: The COVID‐19 pandemic drastically altered human behaviour and socialisation and may have created an environment that could lead to increased incidence of domestic abuse and non‐accidental trauma, or child physical abuse (CPA). Initial reports about the effect of the COVID‐19 pandemic on the rates of CPA have been mixed. The purpose of this study is to describe the effects of COVID‐19 on rates of CPA in a large metropolitan paediatric hospital and level I paediatric trauma centre. Methods: We identified and compared all CPA admissions under 18 years from May 2019 to February 2020 and considered that to be the pre‐COVID time frame. The ensuing 12‐month period of March 2020 to February 2021 was considered to be the intra‐COVID time frame. Results: There were 49 (0.32%) unique CPA patients pre‐COVID and 83 (0.85%) unique CPA patients intra‐COVID (P < 0.001) with lower total admissions for any reason during the intra‐COVID time frame. Monthly CPA cases were increased (P < 0.03) during the intra‐COVID time period (mean 6.9, 95% confidence interval: 5.8–12.7) compared to the pre‐COVID time period (mean 4.9, 95% confidence interval: 3.3–8.2). Conclusion: During the COVID‐19 pandemic, there were decreased overall hospital admissions in the period of mandated shutdowns and isolation. However, we saw an increased rate of CPA admissions compared to the time period prior to the pandemic. Knowledge of such data, trends and circumstances will help keep health‐care providers alert and vigilant in identifying children at risk for maltreatment, and may impact child abuse protocols and guidelines. [ABSTRACT FROM AUTHOR]

This study's purpose is to evaluate whether bone speed of sound (SOS) data, a parameter of quantitative ultrasound, collected from an infant autopsy sample are comparable to data collected from healthy, living infants. We hypothesize that SOS values obtained from deceased term‐born infants will fall within the normal range for healthy, living infants. The study sample consists of 351 deceased infants between the ages of 30 weeks gestation at birth to 1 year postnatal at the time of death receiving autopsies at the Harris County Institute of Forensic Sciences or Texas Children's Hospital in Houston, TX. Various multivariate and univariate statistics were used to examine the relationship between SOS and age, prematurity, and chronic illness. The results of an ANOVA comparing the study sample data to published data from healthy, living infants indicate the SOS data are comparable. Additionally, a MANOVA indicated significant differences in SOS related to prematurity (p = 0.001) and age (p < 0.001). Mean SOS was significantly greater among term‐born infants (M = 3065.66, SD =165.05) than premature infants (M = 2969.71, SD =192.72). Age had a significant polynomial (cubic) relationship with SOS for both the premature and term groups (p < 0.001). Results suggest that bone from an infant autopsy sample is an appropriate surrogate to examine the relationship between SOS and determinants of bone strength. Therefore, future research will use this study sample to investigate the relationship between SOS and determinants of bone strength in infants. [ABSTRACT FROM AUTHOR]