Children who have been maltreated require care that routine surveillance practice do not fully meet, according to a Singapore study. Moreover, these kids are at risk of shirking their hospital appointments.
“It is imperative that families at risk of child maltreatment are identified early and their needs holistically evaluated, with care coordinated within the hospital–community support system,” said the researchers, who collected health and demographic data from the electronic medical records of children hospitalized in KK Women’s and Children’s Hospital between January 2018 and June 2019.
Children with development delay (DD), missed vaccination (MV), low outpatient attendance, high dependency unit (HDU) or intensive care unit (ICU) admission, and Child Protection Service (CPS) referral were deemed high-risk.
The research team then used chi-square or Fisher’s exact test for categorial variables and Mann‒Whitney U test for skewed quantitative variables.
Some 101 children were included in the analysis. Of these, 35.6 percent had pre-existing health conditions prior to hospitalization, 58.4 percent had new health conditions diagnosed during hospitalization requiring follow-up, and 26.7 percent had maltreatment-related injuries.
Among these children, the most common type of abuse was physical abuse, and the alleged perpetrator was their parents. One-fifth had DDs, and another one-fifth had MVs. Nearly one in five had missed all outpatient appointments. [Singapore Med J 2026;67:296-301]
“[W]e have made suggestions to enhance holistic care for these children, which include providing education, conducting structured evaluation, monitoring abuse, and providing support in the community,” said the researchers, adding that such interventions must be further studied.
Parental education
Most high-risk children lived in rented housing, and their mothers mostly had primary education or lower. This finding is consistent with a previous study, showing how lower parental education and lower family socioeconomic status are associated with child neglect. [Child Abuse Negl 2018;77:198-210]
Another Singapore study also found a connection between a larger household with extended or multigenerational families and child abuse. The authors suggested that the abuse could stem from either unsafe household overcrowding or low income. [Child Abus Negl 2018;79:465-475]
“We also considered that children from these households may have multiple caregivers from their extended family, as their parents have competing priorities,” the researchers said. “Having multiple caregivers may hinder the child from establishing a secure attachment with a primary caregiver.”
Along with maltreatment, the lack of secure attachment often contributed to structural and functional changes in the developing brain of children. [Nature Publishing Group 2016;41:177-196]
The current study also noted that the majority of those admitted to the HDU or ICU were <6 months old (66.7 percent vs 25 percent [6‒24 months] vs 8.3 percent [24‒47 months]; p=0.001). Furthermore, several children with DD were referred to CPS (63.2 percent; p=0.049) than to other agencies.
Notably, maltreated children were also at increased risk of medical conditions, with 53 percent having been newly diagnosed with various conditions during hospitalization that required follow-up.
“Singapore has a good healthcare system with one of the lowest infant mortality rates,” the researchers said. “Therefore, the developmental and health gaps observed in our study mostly reflect the impact of social disadvantages in this vulnerable population.”