Infants with history of reported maltreatment at greater risk of death from medical causes, study shows

A new USC study published in the journal Pediatrics finds a heightened risk of death from medical causes for infants with histories of reported maltreatment, suggesting a need for ongoing care coordination between the child protection system and pediatric health providers.

“Newborns in families involved with the child protection system reflect a highly vulnerable group and it is not surprising that their rates of death are elevated relative to infants never reported,” said study author Janet Schneiderman, a research associate professor emerita and former chair of the Department of Nursing at the USC Suzanne Dworak-Peck School of Social Work.

“Families with children who are reported to the child protection system often have risk factors that make providing adequate care for their children or meeting their children’s health care needs more difficult, especially during infancy.”

Researchers used a dataset for analysis comprised of birth and death records for all children born in California between 2010 and 2016 obtained from the California Department of Public Health, and administrative child protection system and foster care placement records made available through a data-sharing agreement between USC, the California Department of Social Services and the Children’s Data Network.

After adjusting for baseline risk factors, the researchers found that the risk of death from medical causes among infants reported for maltreatment was two to three times greater than observed for infants never reported. Among infants reported for maltreatment, the study found that periods of foster care placement reduced the risk of infant death due to medical causes by roughly half.

“Foster care placement was found to be protective against infant death from medical causes, highlighting the preventable nature of many of these deaths and raising questions of missed opportunities to ensure health and other preventive services for infants who remain at home,” Schneiderman said.

“Only one quarter of infants reported for maltreatment spent any time in foster care, and infant death is a rare event. The emergence of statistically significant differences in risk of preventable death is provocative and suggests that more intensive case management and health care supports are needed for infants remaining at home following allegations of abuse or neglect,” said co-author Emily Putnam-Hornstein, a distinguished scholar at USC, the John A. Tate Distinguished Professor for Children in Need at the University of North Carolina School of Social Work and co-director of the Children’s Data Network.

In addition to Schneiderman and Putnam-Hornstein, the study was authored by John Prindle, research assistant professor for the Children’s Data Network at the USC Suzanne Dworak-Peck School of Social Work.

The study was supported by The Conrad N. Hilton Foundation and the Heising-Simons Foundation, and data infrastructure support from First 5 LA  for the Children’s Data Network.

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