Table 1.

Articles assessing CM during the COVID-19 pandemic

Author (Year)	Study Design	Sample Source and Sample Size	Sample Characteristics	Data Time Frame (MM/DD/YYYY)	Child Maltreatment Operational Definition	Findings	NIH NHLBI Study Quality Assessment
Barboza (2020)21	Negative binomial regression analysis of surveillance data	•Los Angeles, USA •Reports of CAN to the Los Angeles Police Department •Pre-COVID-19: n = 661 reports •COVID-19: n = 614 reports	•Pre-COVID-19: 50% Female; 65% Hispanic, 23% Black, 8% White, 1% Asian, 3% Other Race; •COVID-19: 49% Female; 60% Hispanic, 27% Black, 8% White, 1% Asian, 5% Other Race; •No age data reported	07/24/2019–01/20/2020 compared to 01/21/2020–07/19/2020	Physical abuse and neglect • Abuse: Penal Code 273d • Neglect: Penal Code 270	Compared to the time period immediately preceeding it, there was a 7.95% decrease in the number of child abuse and neglect reports during the COVID-19 pandemic.	Good
Bérubé (2020)33	Cross sectional analysis from a prospective longitudinal cohort	•Quebec, Canada •MAVIPAN cohort: parents of children aged 0–17 •n = 414 parents	85.7% Female; mean age = 40.2; no race data reported	04/29/2020–05/10/2020	Neglect • MNBS Parent-Report short version • Room for Parents Questionnaire • Cognitive and Affective Needs Scale • Basic Care Needs Scale	Compared to parents of children aged 0–12, parents of teenaged children were signifcantly less likely to be able to respond to their child's basic care needs (P<.001).	Fair
Chong (2020)34	Retrospective review	•Singapore •Medical records from KK Women's and Children's Hospital, a major pediatric hospital •n = 58,367 children	•Pre-DORSCON Orange (1): 53% Female; mean age = 8.0 y (SD = 4.7); •Post-DORSCON Orange (2): 48% Female; mean age = 7.0 y (SD = 4.3); •During Lockdown (3): 18% Female; mean age = 6.9 y (SD = 4.2); •Post Lockdown (4): 44% Female; mean age = 7.7 y (SD = 4.4); No race data reported	•(1): 01/01/2020–02/06/2020; •(2): 02/07/2020–04/06/2020; •(3): 04/07/2020–06/01/2020; •(4): 06/02/2020–08/08/2020	Physical abuse • SNOMED-CT and ICD codes for child abuse related diagnoses	The hospital saw a greater proportion of child abuse-related emergencies during lockdown (44 children, 0.5% of emergencies) and post-lockdown (79%, 0.6%) compared to pre-DORSCON orange (36%, 0.2%) (P<.001).	Good
Degiorgio (2020)35	Retrospective review	•Malta •Mater Dei health records and computer databases of all acute pediatric hospital admissions for children aged 0–15 •Pre-COVID: n = 729 admissions; •COVID Wave 1: n = 266 admissions	•Pre-COVID, 2019: 44% Female; •COVID Wave 1: 50% Female; No race data reported	•Pre-COVID, 2019: 03/01/2019–05/09/2019; •COVID Wave 1: 03/01/2020–05/09/2020	Physical abuse • EHR	Compared to the same period in 2019, there was a higher percentage of child abuse or social paediatric cases in 2020 (0.14% vs 3.5% of cases) (P<.001)	Good
Garstang (2020)36	Retrospective review	•Birmingham, England •CPME referrals for children aged 0–18 at Birmingham Community Healthcare Trust •EPR for the children referred •2018: n = 78 referrals •2019: n = 75 referrals •2020: n = 47 referrals	37% Female; median age = 69 mo; no race data reported	compared 03/2018–6/2018; 03/2019–6/2019; 03/2020–6/2020	Physical abuse and neglect • Conclusion from CPME • History from EHR	Compared to the same period in 2018 and 2019, there was a decrease in CPME referrals in 2020 (39% reduction; 95% CI: (14%, 57%)).	Good
Kovler (2020)30	Retrospective review	•Maryland, England •Cases taken from the trauma registry at a Level 1 pediatric trauma center for children under age 15 •2018: n = 60 patients •2019: n = 111 patients •2020: n = 86 patients	•2018: 0% Female; 33% Black, median age = 21 mo; •2019: 50% Female; 75% Black, median age = 10 mo; •2020: 62% Female; 75% Black; median age = 11.5 mo	compared 3/28/2018–04/27/2018; 3/28/2019–04/27/2019; 3/28/2020–04/27/2020	Physical abuse • Hospital evaluation • Injury pattern	Compared to the same period in 2018 and 2019, there was a significantly higher proportion of trauma patients treated for child-abuse related injuries in 2020 (P = .009)	Good
Martins-Filho (2020)37	Retrospective population-based study	•State of Sergipe, Brazil •Official child maltreatment registries •2019: n = 70 cases of child abuse •2020: n = 53 cases of child abuse	•2019: 78.6% Female; 25.7% aged 0%–11% and 74.3% aged 12%–17%; 24.3% White, 7.1% Black, 60.0% Brown, 8.6% missing race data; •2020: 71.7% Female; 30.2% aged 0%–11% and 69.8% aged 12%–17%; 15.1% White, 11.3% Black, 62.3% Brown, 11.3% missing race data	01/01/2019–06/30/2019 compared to 01/01/2019–06/30/2020	Physical abuse • Official child maltreatment database	Compared to 2019, child physical injury decreased by 24.3% in 2020. Decreasing rates occurred in January, February, March, and May.	Good
Platt (2020)38	Cross-sectional descriptive analysis	•State of Santa Catarina, Brazil •Notifications of violence against children age 0–19 in the Information System for Notifiable Diseases •n = 1851 notifications of interpersonal or self-inflicted violence	--	compared 01/01/2020–03/15/2020; 03/16/2020–05/31/2020	Physical abuse, psychological abuse, sexual abuse, neglect • Municipality notifications	Compared to the period before the lockdown, there was a decrease of 55.3% in notifications during the isolation period (1192 vs 659 notifications).	Good
Rapoport (2020)31	Retrospective analysis using SARIMA modeling	•New York City, USA •CAN allegations to NYC's Administration for Children’s Services •Count of NYC CPS investigations warranting child welfare preventative services •stratified CAN allegations data from January 2015 to May 2020 •observed and predicted values generated for March 2019 to February 2020	–	•Created models based on 01/2015–02/2020 •Observed actual values from 03/2020–05/2020	Physical abuse and neglect •Allegations to NYC's Administration for Children's Services	Fewer allegations than forecasted from March to May. • March: (Expected-Observed = 1848, 95%CI: (1272, 2423), %Change = −28.8%) • April: (Expected-Observed = 2976, 95%CI: (2382, 3570), %Change = −51.5%) • May: (Expected-Observed = 2959, 95%CI: (2347, 3571), %Change = −46.0%)	Good
Sidpra (2020)39	Retrospective Review	•London, UK •Cases of suspected abusive head trauma at Great Ormond Street Hospital For Children •2017: n = 0 cases; •2018: n = 1 case; •2019: n = 1 case; •2020: n = 10 cases	40% Female; mean age = 192 d (range = 17–401 d); no race data reported	compared 03/23/2020–04/23/2020 with incidence in the previous 3 y (no dates provided)	Physical abuse • Suspected AHT cases at hospital	Compared to the same period in the previous 3 years, there was a 1493% increase in cases of AHT between March 23 and April 23, 2020.	Good
Tierolf (2020)40	mixed methods study: quantitative analysis is longitudinal, qualitative analysis is a sub-study	•The Netherlands •Quant: Families that had been reported to CPS for suspected partner violence or child abuse in the Netherlands. Recruited both before and during the pandemic; •n = 159 families recruited before COVID and n = 87 families recruited during lockdown; •Qual: these same families and professionals that work with vulnerable families recruited through "contacts with researchers from previous studies" •n = 30 parents, n = 9 children, and n = 13 professionals	Parents • Before COVID-19: 66% Female; 0% aged 18%–24%, 22% aged 25%–34%, 42% aged 35%–44%, 30% aged 45%–55%, and 6% aged 55+; • During Lockdown (after 03/16/2020): 63% Female, 2% aged 18%–24%, 15% aged 25%–34%, 43% aged 35%–44%, 34% aged 45%–55%, and 6% aged 55+; No race data reported, no child demographics reported	∼1.5 y prior to 03/16/2020; 03/16/2020 -- ongoing parent study	Physical abuse, psychological abuse, neglect • Self-report of parents and teenagers on the CTSPC	No significant difference in number of child abuse and neglect inclidents reported by parents or teenagers before the COVID-19 crisis and after 03/16/2020.	Fair
Whelan (2020)32	Retrospective analysis using ARIMA modeling	•Oklahoma, USA •Publicly available court filings from the Oklahoma State Court Network •Feb 2020: n = 87 crimes; •March 2020: n = 100 crimes; •April 2020: n = 83 crimes; •May 2020: n = 80 crimes; •June 2020: n = 42 crimes	--	•Created models based on period starting on 01/01/2010 •Observed actual values from 02/01/2020–06/30/2020	Physical abuse, sexual abuse, neglect • Criminal charges	25.7% fewer allegations than forecasted from February to June. • February: Difference = −21.1, 95% CI: (−47.9, 5.7), %Change = −19.5% • March: Difference = 0.3, 95% CI: (−27.1, 27.6), %Change = 0.3% • April: Difference = −23.6, 95% CI: (−51.6, 4.3), %Change = −22.2% • May: Difference = −29.2, 95% CI: (−57.7, 0.6), %Change = −26.7% • June: Difference = −63.2, 95% CI: (−92.3, 34.1), %Change = −60.1%	Good

Abbreviations: AHT, abusive head trauma; ARIMA, auto regressive integrated moving average; CAN, child abuse and neglect; CI, confidence interval; COVID -19, coronavirus disease 2019; CPS, Child Protective Services; DORSCON, Disease Outbreak Response System Condition; EHR, electronic health record; ICD, International Classification of Diseases; MAVIPAN, "Ma vie et la pandemic au Québec"; MNBS, Multidimensional Neglectful Behavior Scale; NHLBI, National Heart, Lung, and Blood Institute; NIH, National Institutes of Health; SNOMED-CT, Systematized Nomenclature of Medicine -- Clinical Terms; SARIMA, seasonal auto regressive integrated moving average.