Using siblings' history of maltreatment to screen for abuse

It can be difficult for pediatricians to screen for child abuse, or understand the full impact of maltreatment when it occurs. A recent study reveals how maltreatment in 1 child affects others in the same household, detailing what types of abuse are most likely to be consistent among sibling pairs.

Studies like this can help highlight some of the increased risks—especially for children who share a household, writes Suzanne B. Haney, MD, MS, in a commentary published alongside the study. Haney, a pediatrician in Omaha, Nebraska, and medical director of the Project Harmony children’s advocacy group, says the study is the largest of its kind and shows significant increased risk of abuse shared by children who live in the same environment, particularly twins.

“Armed with the knowledge of the increased risk to siblings, medical providers and child welfare professionals should advocate for evaluations of these children at high risk,” Haney writes.

In the United States alone, reports of abuse are made on behalf of 3.5 million children each year, for a rate of about 9 out of 1000 children, according to the report.¹ Many studies have addressed child abuse, risk factors for abuse, and the long-term consequences for the abused child, but few studies have really investigated how common it is for siblings to share these experiences. The goal of this study was to identify how likely siblings of abused children are to be mistreated, as well, so that interventions could be better designed to anticipate and prevent further abuse.

Published in Pediatrics, the study investigated more than 500 sibling pairs who were exposed to suspected mistreatment as children.¹ In 8.5% of sibling pairs, reports of abuse were made for both children at once.¹ When reports applied to only one child first, the likelihood that a report would be made for a sibling increased 60-fold.¹ This association was highest when neglect was the primary form of abuse, followed by sexual abuse. In cases where a one child had reported sexual abuse, nearly 60% of sibling reported similar abuse—even decades later.¹

Some of the indicators of abuse noted in the study were maternal age younger than 20 years, maternal depression, race or indigenous status, parental relationships, and poverty.

In the cohort studied, the majority of first-born children were female, and a sibling—most often male—followed less than 2 years later. Notifications of abuse for first-borns usually appeared around age 5 years, with neglect being the most common form of abuse. That trend continued in second-born children, with similar numbers of reports filed, also around age 5 years. Physical, emotional, and sexual abuse were the most common forms of abuse after neglect in both groups, with sexual abuse being reported in some cases decades later.¹

The research team noticed that there were few cases where siblings encountered different types of abuse from one another, with the only link being physical abuse in one and sexual abuse in another in some cases.

Suggested assessments Haney details include head imaging for at-risk children with mental status changes, along with interviews and physical examinations. Some of the trends identified in the report, like being born to a young mother or having a sibling who has been abused, can help pediatricians and child advocates improve prevention efforts.

“As pediatricians, we are advocates for children, so our evaluation for suspected child abuse or neglect should include asking about the presence of siblings or other children in that environment,” Haney says. “Subsequently, we should follow-up to ensure that any siblings are appropriately evaluated for abuse themselves.”

References

1. Kisley S, Strathearn L, Najman JM. (2021.) Risk factors for maltreatment in siblings of abused children. Pediatrics. May 2021,147(5)e2020036004; doi:10.1542/peds.2020-036004.

2. Haney SB. Siblings are also at risk for abuse.Pediatrics. May 2021,147(5)e2021049930; doi:10.1542/peds.2021-049930.