A Preliminary Analysis of the Relationship between Hazards in the Home and the Potential for Abuse with Families At-Risk

IntroductionChild maltreatment (CM) encompasses physical, emotional, and sexual abuse, as well as neglect (1). Physical abuse, the intentional injury to a child either directly by an individual, or the failure to protect the child from harm, accounted for about 18 percent of CM cases in 2013 (1). Neglect, the habitual failure to provide a child with basic needs either physically, medically, educationally, or emotionally, accounted for 79.5 percent of cases in 2013 (1).Children whose ages are birth through 1-year-old experience the highest rate of CM, 23.1 victims per 1,000 children in 2013 (1). Victimization rates for white children were the highest (44 percent), followed by Hispanic children (22.4 percent), and African American children (21.2 percent) (1).Risk factors found in parents with a higher incidence of CM have been well established: younger mothers and mothers' lower education level, low socioeconomic status, low income, employment status, drug or alcohol abuse, history of domestic violence, and family structure (2,3). Children in families in which there is only one caretaker were 77 percent more likely to be physically abused and 87 percent more likely to be neglected than families with two parents (3). However, families in which there are two caretakers in an unstable relationship or that have a higher number of dependent children were found to have higher rates of maltreatment (3). Identifying these factors that relate to CM allows researchers to identify potential for abuse and create more successful prevention programs by targeting known risk factors (2).The adverse consequences of CM impact virtually all aspects of life, including physical and emotional health as well as social and economic wellbeing, and continue well after the maltreatment ends (4). CM is known to be a risk factor for a number of poor physical health consequences in adulthood including: lung disease, heart disease, hernias, ulcers, kidney and liver disease, as well as neurological disorders (5). Increased levels of anxiety and depression in the mother were found to be significantly higher among those who reported having been victims of childhood abuse. The emotional consequences of CM result in lower levels of social support, self-esteem, and closeness with spouses or children as an adult (4). Adults who were abused as children were more likely to demonstrate the risk factors for CM when they became parents, such as low income and higher levels of stress, an indication of the cyclical nature of this phenomenon (6).Childhood injuries can often be a function of CM, especially child neglect. Unkempt living conditions, hazards in the home, and improper child supervision can all be considered child neglect and may lead to unintentional injury (7). In the U.S., unintentional injuries account for 32.5 percent of deaths in children between birth and four-years-of-age, making it the leading cause of death for that age group (8). Each year 9.2 million children are admitted to emergency room departments with nonfatal unintentional injuries (8). With an estimated cost of $300 billion annually, the majority of these injuries occur in or around the child's home. For this age group, the most common fatal injuries were suffocation and drowning, 78 percent of which occurred in the home, and males were found to have two times the death rate by injury than females. Rates of nonfatal injuries including being struck by or against an object, animal or insect bites, falls, suffocation, fire, burns, and drowning were highest in children up to four-years of age (8).The demographics of children at risk for unintentional injury mirror those of children who have a higher potential of experiencing CM. Children in low socioeconomic conditions as it relates to family structure, drug abuse, and poorer housing conditions have an increased risk for both CM and injury. Lower SES, is associated with more hazards in the home resulting from fewer child safety devices, such as baby gates, than children from a higher SES, and are more likely to experience unintentional injury than families from higher SEC (9). …