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Referrals to Child Protective Services for pediatric emergency department patients after falls.

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Title: Referrals to Child Protective Services for pediatric emergency department patients after falls.
Authors: Shapiro, Joseph P.1 (AUTHOR) joseph.shapiro@childrensnational.org, Pino, Elizabeth C.2 (AUTHOR) Elizabeth.pino@bmc.org, Dholakia, Ayesha3 (AUTHOR) Ayesha.Dholakia@childrens.harvard.edu, Goodridge, Annie4 (AUTHOR) goodrida@bu.edu, Nelson, Kerrie P.5 (AUTHOR) Kerrie@bu.edu, Hoch, Ariel6 (AUTHOR) Ariel.hoch@bmc.org, Kendi, Sadiqa1 (AUTHOR) skendi@childrensnational.org, Boyle, Tehnaz P.7 (AUTHOR) tehnaz.boyle@bmc.org, Kistin, Caroline J.8 (AUTHOR) caroline_kistin@brown.edu
Source: Child Abuse & Neglect. May2026, Vol. 175, pN.PAG-N.PAG. 1p.
Subject Terms: *Child abuse, Child protection services, Pediatric emergency services, Emergency medical services, Crash injuries, Children's injuries, Health equity, Home accidents
Geographic Terms: United States
Abstract: Falls are the leading cause of non-fatal childhood injury in the United States. When falls are thought to result from inadequate supervision, clinicians may refer families to Child Protective Services (CPS). However, the frequency of CPS referrals for unintentional falls and factors influencing referral decisions are unknown. To investigate characteristics of children presenting to the pediatric emergency department (PED) for unintentional falls and the relationship between patient race and referrals to CPS for supervisory neglect. Children under 5 years old evaluated at an urban academic PED for an unintentional fall between October 2015 and December 2020. We conducted a cross-sectional analysis using electronic health record diagnosis codes to identify patients. Patient demographics, fall characteristics, injuries, ED arrival method, and CPS referrals were abstracted by manual chart review. Logistic regression models evaluated associations between patient demographics and visit characteristics with CPS referral. Among 933 eligible encounters, 22 patients (2.4%) were referred to CPS. In univariate analysis, fall height > 1 m (OR = 8.77, 95% CI 3.61–21.29, p = 0.0001), fracture diagnosis (OR = 5.15, 95% CI 2.15–12.33, p = 0.003), head injury diagnosis (OR = 4.34, 95% CI 1.75–10.76, p = 0.02), and ambulance arrival (OR = 3.57, 95% CI 1.50–8.50, p = 0.05) were associated with higher odds of CPS referral. Race was not significantly associated with referral. CPS referrals after unintentional falls are associated with injury severity and fall height rather than race. Future research should examine whether these factors reflect inadequate supervision or simply injury severity. [ABSTRACT FROM AUTHOR]
Copyright of Child Abuse & Neglect is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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DbLabel: Education Research Complete
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PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
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  Data: Referrals to Child Protective Services for pediatric emergency department patients after falls.
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  Data: <searchLink fieldCode="AR" term="%22Shapiro%2C+Joseph+P%2E%22">Shapiro, Joseph P.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> joseph.shapiro@childrensnational.org</i><br /><searchLink fieldCode="AR" term="%22Pino%2C+Elizabeth+C%2E%22">Pino, Elizabeth C.</searchLink><relatesTo>2</relatesTo> (AUTHOR)<i> Elizabeth.pino@bmc.org</i><br /><searchLink fieldCode="AR" term="%22Dholakia%2C+Ayesha%22">Dholakia, Ayesha</searchLink><relatesTo>3</relatesTo> (AUTHOR)<i> Ayesha.Dholakia@childrens.harvard.edu</i><br /><searchLink fieldCode="AR" term="%22Goodridge%2C+Annie%22">Goodridge, Annie</searchLink><relatesTo>4</relatesTo> (AUTHOR)<i> goodrida@bu.edu</i><br /><searchLink fieldCode="AR" term="%22Nelson%2C+Kerrie+P%2E%22">Nelson, Kerrie P.</searchLink><relatesTo>5</relatesTo> (AUTHOR)<i> Kerrie@bu.edu</i><br /><searchLink fieldCode="AR" term="%22Hoch%2C+Ariel%22">Hoch, Ariel</searchLink><relatesTo>6</relatesTo> (AUTHOR)<i> Ariel.hoch@bmc.org</i><br /><searchLink fieldCode="AR" term="%22Kendi%2C+Sadiqa%22">Kendi, Sadiqa</searchLink><relatesTo>1</relatesTo> (AUTHOR)<i> skendi@childrensnational.org</i><br /><searchLink fieldCode="AR" term="%22Boyle%2C+Tehnaz+P%2E%22">Boyle, Tehnaz P.</searchLink><relatesTo>7</relatesTo> (AUTHOR)<i> tehnaz.boyle@bmc.org</i><br /><searchLink fieldCode="AR" term="%22Kistin%2C+Caroline+J%2E%22">Kistin, Caroline J.</searchLink><relatesTo>8</relatesTo> (AUTHOR)<i> caroline_kistin@brown.edu</i>
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  Data: <searchLink fieldCode="JN" term="%22Child+Abuse+%26+Neglect%22">Child Abuse & Neglect</searchLink>. May2026, Vol. 175, pN.PAG-N.PAG. 1p.
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  Data: *<searchLink fieldCode="DE" term="%22Child+abuse%22">Child abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Child+protection+services%22">Child protection services</searchLink><br /><searchLink fieldCode="DE" term="%22Pediatric+emergency+services%22">Pediatric emergency services</searchLink><br /><searchLink fieldCode="DE" term="%22Emergency+medical+services%22">Emergency medical services</searchLink><br /><searchLink fieldCode="DE" term="%22Crash+injuries%22">Crash injuries</searchLink><br /><searchLink fieldCode="DE" term="%22Children's+injuries%22">Children's injuries</searchLink><br /><searchLink fieldCode="DE" term="%22Health+equity%22">Health equity</searchLink><br /><searchLink fieldCode="DE" term="%22Home+accidents%22">Home accidents</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22United+States%22">United States</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Falls are the leading cause of non-fatal childhood injury in the United States. When falls are thought to result from inadequate supervision, clinicians may refer families to Child Protective Services (CPS). However, the frequency of CPS referrals for unintentional falls and factors influencing referral decisions are unknown. To investigate characteristics of children presenting to the pediatric emergency department (PED) for unintentional falls and the relationship between patient race and referrals to CPS for supervisory neglect. Children under 5 years old evaluated at an urban academic PED for an unintentional fall between October 2015 and December 2020. We conducted a cross-sectional analysis using electronic health record diagnosis codes to identify patients. Patient demographics, fall characteristics, injuries, ED arrival method, and CPS referrals were abstracted by manual chart review. Logistic regression models evaluated associations between patient demographics and visit characteristics with CPS referral. Among 933 eligible encounters, 22 patients (2.4%) were referred to CPS. In univariate analysis, fall height > 1 m (OR = 8.77, 95% CI 3.61–21.29, p = 0.0001), fracture diagnosis (OR = 5.15, 95% CI 2.15–12.33, p = 0.003), head injury diagnosis (OR = 4.34, 95% CI 1.75–10.76, p = 0.02), and ambulance arrival (OR = 3.57, 95% CI 1.50–8.50, p = 0.05) were associated with higher odds of CPS referral. Race was not significantly associated with referral. CPS referrals after unintentional falls are associated with injury severity and fall height rather than race. Future research should examine whether these factors reflect inadequate supervision or simply injury severity. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Group: Ab
  Data: <i>Copyright of Child Abuse & Neglect is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1016/j.chiabu.2026.107988
    Languages:
      – Code: eng
        Text: English
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        PageCount: 1
        StartPage: N.PAG
    Subjects:
      – SubjectFull: Child abuse
        Type: general
      – SubjectFull: Child protection services
        Type: general
      – SubjectFull: Pediatric emergency services
        Type: general
      – SubjectFull: Emergency medical services
        Type: general
      – SubjectFull: Crash injuries
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      – SubjectFull: Children's injuries
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      – SubjectFull: Health equity
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      – SubjectFull: Home accidents
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      – SubjectFull: United States
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      – TitleFull: Referrals to Child Protective Services for pediatric emergency department patients after falls.
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            – D: 01
              M: 05
              Text: May2026
              Type: published
              Y: 2026
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