As hospitals see more severe child abuse injuries during coronavirus, ‘the worst is yet to come’

YORK, Penn. — Pennsylvania hospitals are treating more children with severe child abuse injuries, indicating the state’s most vulnerable kids are not safe at home during the coronavirus outbreak. 

Several advocates and pediatricians who specialize in child abuse say they are seeing an increase in the number of abused children who need to be hospitalized. 

And in perhaps the most grim outlook, a Penn State pediatrician says “the worst is yet to come.”

“We’re worried we’re at the beginning of an onslaught of cases,” said Dr. Lori Frasier, chief of the child abuse pediatrics division at Penn State Children’s Hospital.

A rise in the east

The uptick correlates with the first stay-at-home orders put in place by Gov. Tom Wolf in mid-March. 

That’s when Dr. Norrell Atkinson, section chief of the child protection program at St. Christopher’s Hospital for Children in Philadelphia, started noticing a change. She’s a child abuse pediatrician at the 180-bed hospital, which is affiliated with the medical schools at Drexel and Temple universities. 

The hospital is a Level 1 trauma and burn center that tends to treat more severely injured kids anyway, but there has been a noticeable change lately. 

“Numbers are down overall, but we’re tending to see kids that are more severely injured,” she said. “We are seeing more kids coming into the ER with more severe injuries that require hospitalization.”

The hospital has teams dedicated to child physical abuse and child sexual abuse, and “both teams are seeing an increase in severity,” Atkinson said. 

Both teams are continually educating each other on how to recognize concerning symptoms of abuse.

“We know we’re one of the few sets of eyes on children these days,” she said. “We’re being mindful at every encounter we have with a child to make sure the child is safe.”

The coronavirus outbreak in Pennsylvania has sidelined most mandated reporters of abuse, such as teachers, coaches and clergy members, because of closures and stay-at-home orders. Doctors are sometimes the only lifeline the abused child has outside of the home. 

There’s been a 50 percent decrease in calls to ChildLine, a state hotline that accepts reports of suspected abuse 24 hours per day. In April 2019, there were 21,232 reports made to ChildLine. Last month, 10,674 reports were made, according to the Pennsylvania Department of Human Services. 

“While we wish that a data trend of fewer child abuse reports could be reasonably interpreted to indicate fewer instances of child abuse, we know this is unlikely to be the case,” said Ali Fogarty, spokeswoman for the state Department of Human Services. 

Temporary school closures result in a lack of interaction between children, their teachers and other mandated reporters in school settings, she said.

School officials are reliable reporters of child abuse. For example, of the 39,040 reports made by mandated reporters to ChildLine in 2018, more than a third were reported by school employees, Fogarty said. 

The hotline reports have dissipated, but the abuse has not. Atkinson said the same stressors are there, and now they are worse. 

St. Christopher’s is in North Philadelphia, one of the poorest neighborhoods in the country, she said. Children there frequently suffer through poverty, food insecurity and the opioid epidemic.

“There are lots of stressors already,” Atkinson said. “The pandemic has put additional stress on every single family. That can certainly create a stressed-out parent, which can lead to abuse.”

Victims of the virus

The overwhelming majority of child abuse victims are never written about or revealed to the public. 

Hospitals don’t share much because of patient privacy laws and legal cases that result from the abuse.

The York Daily Record/Sunday News and most other news outlets don’t identify victims of abuse. 

But sometimes victims are identified after they die, and some cases are written about once they become police reports. 

In just a few of the Pennsylvania child abuse cases reported during the coronavirus pandemic in April: 

Kyrah Andrews died at 6 weeks old on April 2, a few weeks after sustaining  injuries consistent with abusive head trauma, according to police in Allegheny County. Police charged her father, 33-year-old Robert Andrews of Stowe, who was already awaiting trial on aggravated assault and endangering the welfare of children for a 2018 incident. Those criminal charges claim that another child in his care experienced second-degree burns to the face, neck and chest. Kyrah was injured in mid-March when Andrews was taking care of her while her mother was being treated in St. Clair Hospital for an infection, according to police. 

Mikel Fetterman, a 3-year-old boy from Westmoreland County, died on April 24 after spending weeks in pediatric intensive care at UPMC Children’s Hospital of Pittsburgh for injuries related to physical and sexual abuse. Police say Mikel’s mother’s boyfriend, 31-year-old Keith Lilly Jr. of New Kensington, attacked the child, leaving him with a fractured skull and brain bleed, injuries to the eyes and mouth, fractures and significant bruising. 

Tazmir Ransom was fatally beaten days after his 7th birthday and died on April 15, according to police. Police arrested the boy’s mother, 26-year-old Natasha Franks of Philadelphia, and charged her with attempted murder, aggravated assault and related offenses.

A 1-month-old girl in Delaware County suffered broken bones and multiple bruises resulting from abuse in mid-April, according to police.  Her father, 29-year-old Brandon Murphy of Garnet Valley, has been criminally charged with multiple counts of abusing his two children. Police say he abused a 16-month-old child in October. The 16-month-old child had been removed from the home and placed in foster care. 

Kyrah Andrews died at 6 weeks old on April 2, a few weeks after sustaining  injuries consistent with abusive head trauma, according to police in Allegheny County. Police charged her father, 33-year-old Robert Andrews of Stowe, who was already awaiting trial on aggravated assault and endangering the welfare of children for a 2018 incident. Those criminal charges claim that another child in his care experienced second-degree burns to the face, neck and chest. Kyrah was injured in mid-March when Andrews was taking care of her while her mother was being treated in St. Clair Hospital for an infection, according to police. 

Mikel Fetterman, a 3-year-old boy from Westmoreland County, died on April 24 after spending weeks in pediatric intensive care at UPMC Children’s Hospital of Pittsburgh for injuries related to physical and sexual abuse. Police say Mikel’s mother’s boyfriend, 31-year-old Keith Lilly Jr. of New Kensington, attacked the child, leaving him with a fractured skull and brain bleed, injuries to the eyes and mouth, fractures and significant bruising. 

Tazmir Ransom was fatally beaten days after his 7th birthday and died on April 15, according to police. Police arrested the boy’s mother, 26-year-old Natasha Franks of Philadelphia, and charged her with attempted murder, aggravated assault and related offenses.

A 1-month-old girl in Delaware County suffered broken bones and multiple bruises resulting from abuse in mid-April, according to police.  Her father, 29-year-old Brandon Murphy of Garnet Valley, has been criminally charged with multiple counts of abusing his two children. Police say he abused a 16-month-old child in October. The 16-month-old child had been removed from the home and placed in foster care. 

Half of the 40 children’s advocacy centers in Pennsylvania are seeing fewer child sex abuse cases and more severe physical abuse cases, said Chris Kirchner, interim executive director of the Pennsylvania Chapter of Children’s Advocacy Centers and Multidisciplinary Teams. 

“Directors across the state say they are doing more physical abuse cases than ever before and that they are more serious,” Kirchner said. “We’re all frantically worried about what’s going on in homes.”

One of the areas of concern for advocates is that school nurses are telling them 11- to 16-year-old kids are taking care of younger children during the pandemic while parents continue to work. Schools and day care centers have been closed for about two months. That, combined with stay-at-home orders, has given working parents few options for child care.

A 14-year-old might not intentionally abuse a child, but they might not know how to properly take care of one. They might not know that you don’t shake a baby because it could cause a brain injury, advocates say. 

“In the state of affairs in which we find ourselves, there’s not just one red flag. There are many,” said Cathleen Palm, the founder of The Center for Children’s Justice. 

Children at risk 

Though there has been an uptick in severe physical abuse injuries, child sexual abuse is also being reported. 

“The number of perpetrators is not increasing, but the number of acts is,” said Victor Vieth, director of education and research at Zero Abuse Project. “A child who was being abused once or twice a week is being abused more now because the child is not in school and the abuser is not going to work.”

Zero Abuse Project trains about 30,000 people a year on how to detect abuse, and Vieth on Monday will offer a virtual training to child advocates in Pennsylvania. 

His findings that children are being abused more frequently are in line with what is being reported to RAINN, the Rape, Abuse and Incest National Network. 

For the first time in its 25-year history, RAINN said half of the victims receiving help from its National Sexual Assault Hotline are minors. 

“Unfortunately for many, and especially for children experiencing sexual abuse, ‘stay at home’ doesn’t mean ‘safe at home,’” said RAINN President Scott Berkowitz. “Sadly, it is likely that the risk of children being sexually abused will increase as shelter-in-place orders continue — one more tragic consequence of the public health crisis the country currently faces.”

That is also being observed locally in southcentral Pennsylvania. 

“Our WellSpan Sexual Assault Forensic Examiner (SAFE) program has reported an uptick in the severity of both child abuse and domestic abuse cases,” said Matt Heckel, spokesman for WellSpan Health. 

The COVID-19 outbreak is creating an unprecedented crisis in child abuse, without a safety net of life outside the home, Palm said.  

“If you are 24/7 locked in same home as someone who has sexually assaulted you, it is extremely traumatizing,” she said.

Children are also at risk of predators outside the home, according to experts. 

The U.S. Department of Justice is warning that, due to the coronavirus outbreak, kids are spending more time unsupervised online, and it’s making them vulnerable to child sexual exploitation. 

[All suspected online enticement or sexual exploitation of a child should be immediately reported by calling 911, contacting the FBI at tips.fbi.gov, or filing a report with the National Center for Missing & Exploited Children at 1-800-843-5678 or report.cybertip.org, according to the Department of Justice.]

Reports to the National Center for Missing and Exploited Children more than doubled during the first month of stay-at-home orders across the country, climbing from nearly 984,000 reports in March 2019 to more than 2 million reports in March this year. 

“Sex offenders are taking advantage of the pandemic,” Vieth said.

Parents are more stressed and aren’t paying as much attention to what their children are accessing online, he said.

“There’s a correlation between cyber tip line reports and neglect,” Vieth said. “There’s an increased pool of kids who want to get away and online more and fewer people looking out for them. It’s a perfect storm for accessing children online.”

Lessons of the past

Frasier, chief of child abuse pediatrics at Penn State Children’s Hospital, is worried about what’s to come because of what’s happened in the past ⁠— especially during the recession in 2008.

“One of our big concerns is that in 2008 during economic stress, we were all seeing a lot of shaken baby syndrome,” she said. “We know about half of infants shaken have developmental problems that last their entire life. Very few end up perfectly normal.”

Child abuse “skyrocketed” during the recession, according to a study led by Dr. Rachel Berger, a child abuse specialist at UPMC Children’s Hospital of Pittsburgh.

The study included more than 500 patients with abusive head trauma who ranged in age from 9 days old to 6 years old. The patients were treated at children’s hospitals in Pittsburgh, Cincinnati, Columbus and Seattle.

Of the children studied, more than 300 had injuries severe enough that they required hospitalization in pediatric intensive care units, and about 100 died.

Berger launched the study in 2008 because more patients at UPMC Children’s Hospital of Pittsburgh were dying from abusive head trauma than from non-inflicted brain injury.

“To think that more children died from abusive head trauma than from any other type of brain injury that year is really remarkable and highly concerning,” she said in May 2010.

Berger, who is still working as a pediatric child abuse specialist at UPMC Children’s Hospital of Pittsburgh, was not available for an interview last week. 

“Our results show that there has been a rise in abusive head trauma, that it coincided with the economic recession, and that it’s not a phenomenon isolated to our region but happening on a much more widespread level,” Berger said in May 2010. “This suggests we may need to dramatically increase our child abuse prevention efforts now and in future times of economic hardship.”

Frasier said she talks a lot about prevention.

“Put down the baby if the baby is crying, safe and clean,” she said. “Just close the door. Babies cry because sometimes they are frustrated, even if their needs are met. Some babies just cry. If a baby is sick, don’t hesitate to call the doctor.”

Injuries and child abuse consequences of 2008 were more than head traumas, and they will be more than that this year, advocates say. 

“When a child is hurt by someone who loves them, that is a traumatic experience,” Frasier said. “It can cause significant emotional and developmental problems.”

It’s also damaging for children to be in an environment with a lot of frustration or partners who are fighting. Children exposed to chronic violence or bad moods struggle in adulthood, she said.

Economic indicators, such as a U.S. unemployment rate hovering around 15 percent, suggest the current downturn will be more like the Great Depression than the 2008 recession. 

Advocates worry that, like those economic indicators, child abuse could be worse this year than in 2008. 

“We’re not really going to know the extent of the damage for a decade or so, but we do see indicators,” Vieth said. 

But there’s another big difference between 2008 and 2020:

“There were built-in safety valves in 2008,” Palm said. “Children could turn to teachers and grandparents. Parents could reach out when they needed an hour break. We don’t have those now.” 

Advocates seeking solutions

In a rush to close counties and prevent the spread of the coronavirus, the state abdicated its responsibility to vulnerable children, Palm said. 

She and other Pennsylvania advocates want Wolf and lawmakers to take immediate actions to prevent child abuse and save lives: 

Direct Pennsylvania’s Office of Advocacy and Reform to swiftly collaborate with interdisciplinary and community-based stakeholders to develop and deploy child abuse and neglect prevention strategies.   Enhance reliance on evidence-based lethality screening tools when police respond to a report of domestic violence Effectively screen and supervise individuals released from a correctional facility,  particularly on an expedited timetable due to COVID-19 mitigation strategies Safeguard children, recognizing the combined effect of COVID-19 and the opioid epidemic, such as implementing and monitoring plans of safe care for infants born affected by substance exposure, readily available medication lock boxes, providing therapeutic support when a child is present at an overdose Empower Pennsylvania’s child advocate, created by executive order, to lead independent and time-sensitive reviews. The reviews should be focused on serious, near-fatal, and fatal incidents when child abuse is suspected or when abuse may not be suspected, but the child was receiving services from a publicly funded child-serving system or residing in a state-licensed facility. Improve and strengthen the tools utilized to screen, triage and divert reports made to ChildLine. Reports to and expectations of Pennsylvania’s child welfare agencies are so broad as to be ensnaring families for what many see as consequences of poverty versus abuse. By contrast, reports that include a red flag (or many) are falling through the cracks.    Leverage child-centered children’s advocacy centers and expert medical evaluations as a core, not optional, component of child abuse investigations.  End the arbitrary timetable for the destruction of child welfare records.   Create a tiered approach to the child abuse registry. Now is the time for Pennsylvania to move beyond a one-size-fits-all approach by which a perpetrator is placed on Pennsylvania’s child abuse registry. Some named perpetrators should be included on the registry indefinitely and others for less time, such as 5 or 10 years.

The most important recommendation, Palm said, would be that any report of a child injury needs to be evaluated by a doctor, not a child service worker.

Wolf’s office did not respond to questions about the governor’s plan to reduce gaps in child protection during the COVID-19 crisis. 

“The Department of Human Services remains steadfast in our commitment to protect and provide services to children and families across Pennsylvania,” Fogerty said. “Above all, we are focused on ensuring that children are still being kept safe and allegations of abuse or neglect are being reported and investigated.”

Anyone handling cases of child abuse should be considered essential workers, Vieth said. 

“They, too, are dealing with life or death situations,” he said. “The state cannot be cutting back in any way.”

Child abuse investigations have continued throughout the public health crisis, Fogerty said, and all ChildLine reports are screened and directed to the appropriate authority for investigation and follow-up.

The Department of Human Services is also working closely with the Department of Education to help teachers learn how to spot signs of potential abuse or neglect through distance learning.

DHS is trying to teach the public how to spot potential abuse and how to report it through social media, media outreach, an ongoing paid media campaign, and through Secretary of Health Dr. Rachel Levine’s daily briefing, Fogerty said.

Atkinson, the chief of child protection at St. Christopher’s, supports that effort. 

“The concept is everyone is a mandated reporter,” she said. “If you see something concerning, it becomes your job to report it.”

[DHS encourages any member of the public who suspects that a child is being abused or neglected to contact ChildLine at 1-800-932-0313.]

Child protection advocates are also working to prevent abuse before it begins. 

Through the Play Safe, Stay Safe initiative, the Butler County Alliance for Children is collecting new, unopened board games, card games and outdoor games that will be distributed to families throughout the county. 

The games are being used to build family ties and reduce the kind of family stress that could lead to abuse, said Denna Hays, executive director at the Butler County Alliance for Children. 

She and her team are trying to go to each Butler County school at least once to hand out games and resources to families, Hays said. The resources include flyers about parenting during the pandemic, as well as community resources. 

“I think there are some resources that mid- to high-income families may not know about, like 211,” she said.

The 211 helpline operated by the United Way is a free, confidential referral service that connects callers with health, housing and human services information. 

Hays is especially concerned about mid- to high-income families because “those parents aren’t used to being at home, and you have more parents who have to homeschool. The higher level of stress can lead to emotional, physical and sexual abuse.”

[DHS encourages parents and families who are struggling to cope during this time of crisis to reach out for help. Anyone struggling with mental health or who is in need of referrals to helpful programs can call Pennsylvania’s new Support & Referral Helpline, which is operated 24/7 by skilled caseworkers. The number to call is 1-855-284-2494. For TTY, dial 724-631-5600.] 

Hays said reaching out for help or having someone call ChildLine doesn’t mean children will be taken away from their parents or guardians.

“The Pennsylvania child welfare system is designed to be family focused,” she said. “There’s a very false narrative that a call is made and a child welfare worker shows up and the child is removed. Children are only removed when it’s the last resort.”

And the sooner preventative steps are taken, the less likely that would happen.

Hays encourages people to reach out now to families that might be struggling. She recommends helping a busy parent with their grocery list, and taking dinner or cookies to the home. 

“Do what you can to brighten someone’s day,” she said. “There are little things you can do today to make someone’s life easier and prevent child abuse and neglect.”

Candy Woodall is a reporter for the USA Today Network. She can be reached at 717-480-1783 or on Twitter at @candynotcandace.