title: Referrals to a hospital-based child abuse committee: a comparison of the 1960s and 1990s.
abstract: OBJECTIVE
  Although reports of child maltreatment have increased yearly since national data were first collected in 1976, little information is available about changes in the characteristics of children reported. Therefore, to examine changes over time in recognition and reporting in a medical setting, we compared referrals to a hospital-based child abuse committee in the late 1960s and early 1990s.
  
  
  METHODS
  Retrospective, cross-sectional review of medical records and logs of the hospital's child abuse committee.
  
  
  METHODS
  Ambulatory, emergency, and inpatient services at Yale-New Haven Hospital.
  
  
  METHODS
  Medical records were reviewed for 101 of the 165 children referred to the child abuse committee in 1968-1969 (early group) and 107 of the 843 children referred in 1990-1991 (late group). Cases of sexual abuse were excluded.
  
  
  RESULTS
  Referrals for nonsexual abuse cases increased from 80 children per year in the early group to 181.5 per year in the late group; the late group was characterized by a larger number of newborn referrals (1% vs. 52%, p < .001). When non-newborns were compared, the two groups were similar with respect to gender and race, but the late group had fewer patients with private insurance (31% vs. 12%, p < .05). The late group also had more female-headed households (32% vs. 67%, p < .05) and more parents with a history of substance abuse (4% vs. 49%, p < .001). Excluding newborns, who were all classified as "at-risk," the types of problems were classified as abuse (41% early vs. 29% late), neglect (41% vs. 35%), and "at-risk" (16% vs. 35%). Although the types of injuries were similar: superficial injuries (20% vs. 16%), burns (9% vs. 8%), and fractures (6% vs. 4%), fewer maltreated children suffered physical injuries in the late group (71% vs. 49%, p < .05).
  
  
  CONCLUSIONS
  A substantial change has occurred in referrals to the hospital's child abuse committee for abuse or neglect. Most referrals have become socially high-risk newborns and children or children with minimal injuries. This shift is likely due to broader definitions of maltreatment and earlier recognition of troubled families.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520-8064, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Thomas
authors.forename: J M
authors.initials: JM
authors.lastname: Leventhal
authors.forename: E
authors.initials: E
authors.lastname: Friedlaender
mesh_terms: D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003237:Connecticut / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019221:Mandatory Reporting; D010044:Outpatient Clinics, Hospital; D010290:Parents / Q000523:psychology; D011367:Professional Staff Committees / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000145:classification / Q000453:epidemiology