Child Maltreatment and Pediatric Health Outcomes: A Longitudinal Study of Low-income Children

Background and Purpose: Given the number of children affected by maltreatment, the impact of childhood disease on development, and the high cost of providing medical care, a better understanding of the relationship between maltreatment and pediatric health is needed. Asthma is the most common chronic disease of childhood in the United States and diseases such as asthma, pneumonia, pleurisy, and bronchitis topped the list of reasons children visit the emergency room. Other bacterial and viral infections like pharyngitis are also common in childhood. In addition to immediate costs of treatment, some childhood health problems have been associated with long-term health and socioeconomic consequences. Among low income children, are maltreated children at higher risk for asthma, cardiorespiratory disease or other non-sexually transmitted infection, controlling for other stressors in the home and community?

Methods: This study follows 6,282 children for between 12 and 18 years. Administrative service records with exact dates allow for prospective analyses. The present study uses an ecological framework and draws on the literature relating allostatic load to health outcomes as a potential mechanism for the effect of maltreatment on child and adolescent health outcomes. Other potential risks and stressors are controlled statistically, including known infant or congenital conditions that might explain later health outcomes independent of stressors. Bivariate, Cox and negative binomial regression statistics are used to explore risk of negative health outcomes for maltreated and nonmaltreated children controlling for individual, family and community stressors.

Results: Children with maltreatment reports had 74% higher (asthma) to double (cardiorespiratory and infection) the risk of hospital care. Recurrent reports of maltreatment were associated with heightened risk of any disease category as well as total count of hospital care episodes. The change in expected count of hospital care for any of the three disease categories was about 3% per additional report of maltreatment while controlling for maltreatment type (any neglect vs. abuse), age at first maltreatment report, substantiation of the first report, demographic characteristics, and infant/congenital health risk.

Conclusions and Implications: Our study suggests that the negative health impact of maltreatment can be detected during childhood. This has implications for pediatric screening for maltreatment and for increased attention to the health care needs of children reported for maltreatment. Findings also suggest the benefit of preventing infant and congenital health problems.