Has the Covid-19 epidemic had an impact on cases of child abuse? This is suggested by a study carried out by researchers from the AP-HP Necker-Enfants Malades Hospital, the University of Paris Cité and Inserm, published this Tuesday in the journal Open JAMA Network.
These research teams analyzed the evolution of the incidence and severity of shaken baby syndrome (SBS) in babies in the Ile-de-France region during the first two years of the Covid-19 pandemic (the period 2020-2021). ) compared to the pre-pandemic period (the 2017-2019 period). A decision motivated because “anesthesiologists and neurosurgeons gave the alert last summer because they noticed an explosion of cases,” explains Martin Chalumeau, a pediatrician at the Necker-Enfants Malades hospital and co-author of the study.
Their results released Tuesday confirmed doctors’ fears. The incidence of shaken baby syndrome has doubled and its mortality has increased ninefold in the Paris region during the Covid-19 pandemic. “There were more abused babies, but above all the cases were more serious,” summarizes Flora Blangis, co-author of the Inserm epidemiology thesis study on child physical abuse. This increase in abuse, however, did not occur directly during the first two lockdowns of 2020, but after. “There was no increase in 2020, but there was a significant increase in 2021”, specifies the researcher.
Motor and intellectual consequences, sometimes lifelong
These results are even more concerning because SBS is the most serious form of child abuse and neglect. “The consequences are immediate,” says Professor Martin Chalumeau, who adds that “a certain number of children die due to massive brain damage that will lead to necrosis or compression of the brain.” As a reminder, SBS is the most common cause of traumatic death in infants in high-income countries.
“If babies survive these injuries, which is the case for most, there will be serious consequences because they are very young children,” specifies the pediatrician. « Ça peut être des conséquences en termes de cécité, des visual deficits, des auditory conséquences, des motor, sensitive, cognitive, behavioral consequences… Ce sont aussi des enfants qui vont avoir des difficultés d’apprentissage majeures », enumère-t -The. These are all consequences that can lead to lifelong disability.
500 : This is the number of babies diagnosed with shaken baby syndrome, according to a government campaign launched last February
In all, 99 babies with SBS were included in the study published Tuesday in JAMA Network Open. For all these babies, the signs of severity of the violence inflicted were very frequent: 87% had ruptured bridging veins (which connect the brain to the inner wall of the skull), 75% retinal hemorrhages, 32% fractures, 26% had status epilepticus, and 13% died.
As can be seen in the graph below, the consequences of SBS were more severe in 2020 and 2021 than during the 2017-2019 period. Babies who fell victim during the pandemic showed more signs of epilepsy, skin lesions, or ruptured bridge veins. During the 2017-2019 period, only 4% of babies followed died, compared to 12% in 2020 and 28% in 2021.
The peak incidence is between two and four months. And the abusive adult is rarely shaken just once: shaken babies have been shaken an average of ten times, according to data published in 2017 by the High Health Authority (HAS).
The containment in question?
For the research teams, the fact that this massive increase in SBS in Ile-de-France did not occur during the first year of the pandemic when containment and mitigation measures were at their maximum, but during its second year, could be explained. by different factors
“The hypothesis that we put forward in our study, which seems the most obvious, is that confinement would have led to an accumulation of psychosocial discomfort in families that would have led to more child abuse,” Flora Blangis emphasizes.
In the opinion of Martin Chalumeau, “perhaps there are also specificities of the Paris region” that come into play: “The size of the accommodation, the fact that there has been a lot of teleworking, few green spaces to walk around could have led to a saturation of the capacities of the parents”, he considers. The pediatrician points out, however, that this hypothesis does not explain the cases of shaken babies in nannies, for example.
Beyond the reasons, the authors call for greater awareness of the medical profession in the face of the increase in this form of violence and ask for preventive actions. National studies should also be initiated to understand the scope of the phenomenon beyond Ile-de-France.