Open Access

ARTICLE

Risk Factors for Abuse in Children with Congenital Heart Disease Presenting at a Pediatric Tertiary Care Hospital

by Kristi K. Westphaln^1,2,*, Karen Kay Imagawa^2,3, Lorena Espinosa Smith^1,4, Julia Srivastava⁵, Nancy A. Pike^1,5

1 School of Nursing, University of California, Los Angeles, California, USA
2 Department of Pediatrics, Children’s Hospital Los Angeles, Audrey Hepburn CARES Center, Los Angeles, California, USA
3 Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
4 Department of Pediatrics, Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California, USA
5 Department of Pediatrics Heart Institute, Children’s Hospital Los Angeles, Los Angeles, California, USA

* Corresponding Author: Kristi K. Westphaln. Email:

Congenital Heart Disease 2023, 18(6), 657-670. https://doi.org/10.32604/chd.2023.044179

Received 23 July 2023; Accepted 30 October 2023; Issue published 19 January 2024

Abstract

Background: Congenital heart disease (CHD) is a chronic medical condition often diagnosed at birth and requires surgical intervention, multiple hospitalizations, and lifelong care. This can put significant stress on the family, leading to altered maternal mental health, bonding and attachment issues, and the potential for child abuse. The purpose of this study is to explore the characteristics of a sample of young children with CHD who experienced hospitalization with concurrent concern for child abuse in a free-standing pediatric tertiary care hospital. Methods: Electronic medical records were reviewed for children aged 0–5 years old who were hospitalized with concern for child abuse between 2016 and 2020. Variables were extracted related to the history of presentation, and sociodemographics including SDOH, admission, and discharge condition/follow-up. Descriptive statistics were used to characterize the sample and correlations to identify an association with abuse type. Results: Out of 251 hospitalizations involving concern for child abuse, 49 (19.5%) had a diagnosis of CHD. The majority of cases were neglect (51%), <1 year of age (80%), male (57%), Hispanic ethnicity (45%), and publicly insured (90%). CHD severity was moderate to severe (71%) with multiple co-occurring medical conditions (genetic syndrome, failure to thrive (FTT), prematurity, history of a feeding tube, developmental delay, and intrauterine drug exposure). Correlations associated with physical abuse were age, maternal mental health, head injury, and history of Child Protective Services (CPS) involvement. Neglect correlated with age, FTT, head injury, history of a feeding tube, previous CPS involvement, and substance use. Correlates specifically related to prenatal substance use included age, maternal mental health status, history of domestic violence, CPS involvement, feeding tube, FTT, lack of housing, employment status, and public insurance. Conclusions: Our study highlights the risk for abuse in children with CHD, regardless of defect severity. The most common abuse type was neglect (mostly prenatal substance use) which was associated with few child characteristics, but many parent/caregiver and neighborhood factors. This underscores the need for individual and/or family-based screening and approaches to provide psychological support and needed resources to assist parents of children with CHD to prevent abuse. Interventions should focus on families of low socioeconomic status with limited support and/or resources.

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