Child maltreatment among children with specific birth defects: A population-based study, Texas 2002-2011

Bethanie Van Horne, The University of Texas School of Public Health


This population-based study examined first-time substantiated maltreatment occurring during the first 10 years of life in children with and without specific birth defects (Down syndrome, cleft lip with or without cleft palate, and spina bifida) in Texas from 2002-2011. Four sources of data were linked to identify study groups, variables of interest, and outcome measures, including data from: Texas Department of State Health Services (DSHS) Vital Statistics Unit, DSHS Birth Defects Epidemiology and Surveillance Branch Birth Defects Registry, Texas Department of Family and Protective Services, and the U.S. Census Bureau's American Communities Survey. In total, 3,027,935 children were included in these analyses (96.7% of live births in Texas, 2002-2009), including 3,020,278 unaffected children, 3,743 with Down syndrome, 2,943 with cleft lip with or without cleft palate (CL±P) and 971 with spina bifida. Separate analyses were completed based on the age of the child at the first substantiated maltreatment report (reports before the child's 2nd birthday and reports occurring between ages 2-10). Poisson regression and Cox proportional hazards regression were used to estimate the crude and adjusted risk of maltreatment as well as to identify and compare risk factors associated with maltreatment. Results from this study suggest that the risk of maltreatment varies by specific birth defect, age of the child, and type of maltreatment. After adjusting for birth-level factors, children with Down syndrome were at increased risk of maltreatment after age 2. Children with CL±P were at an increased risk for maltreatment throughout the first 10 years of life, whereas children with spina bifida were significantly more likely to be maltreated in the first 2 years of life. Across the entire study period, all three birth defect groups were significantly more likely to have a substantiated report of medical neglect as compared to children without birth defects. After adjusting for all other factors, covariates examined at the child-, family-, and neighborhood-levels were found to be significantly associated with maltreatment. However, family level factors (parity, maternal education, and maternal Medicaid use at birth) were the most strongly associated with RR>2. Existing support services available to families with children with birth defects may need to be enhanced to include child maltreatment prevention strategies and need to be available for families throughout childhood.

Subject Area

Social research|Public health|Public policy

Recommended Citation

Van Horne, Bethanie, "Child maltreatment among children with specific birth defects: A population-based study, Texas 2002-2011" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3641720.