First-time maltreatment in children ages 2–10 with and without specific birth defects: A population–based study

Children with disabilities are at an increased risk for maltreatment. However, little is known about the risk of maltreatment in children with specific types of birth defects. This study was conducted to determine whether the risk and predictors of maltreatment in children 2 to 10 years of age differ between those without and with specific birth defects: Down syndrome, cleft lip with/without cleft palate, and spina bifida. State administrative and United States Census data were linked to identify study groups, variables of interest, and outcome measures. Kaplan-Meier and multivariate Cox proportional hazard analyses were used to identify study groups and variables associated with an increased risk for maltreatment. The prevalence of substantiated maltreatment was consistently highest among children with cleft lip with/without cleft palate. After adjusting for birth-level factors, children with Down syndrome and cleft lip with/without cleft palate were 34% and 26% more likely to have been maltreated than those without birth defects, respectively. In all three birth defect groups, the risk of medical neglect was higher (relative risks ranged from 3 to 11) than in the unaffected group. The factors associated with increased risk for maltreatment were similar across all groups. Of note, parity, maternal education, and maternal Medicaid use at birth were all associated with greater than 2-fold increased risk for maltreatment. Our findings suggest that the families of children with birth defects may need support services throughout early childhood to help families cope with the needs of their children and reduce the risk of maltreatment.