Maternal Assault Linked to Higher Child Injury Risk in Ontario

Key Takeaways

• In Ontario, children whose mothers had assault-related injuries severe enough to result in emergency care, hospitalization, or death had higher 5-year assault-related injury risk than matched unexposed children, 3.7% versus 1.3%.
• These children also had higher assault-related injury rates over person-time follow-up than matched unexposed children.
• Higher adjusted rates were also reported across severity thresholds, including child assault leading to an ED visit, the composite of ED visit, hospitalization, or death, and hospitalization or death alone.
• The authors concluded that healthcare-based interventions after a mother’s assault should include attention to her children as well.

Violence against women can affect children through disrupted caregiving, psychological trauma, or exposure to the same perpetrator. When maternal assault is serious enough to bring a woman to medical attention, an important clinical question is whether that event marks higher later risk of serious assault-related injury in her child. That question is especially relevant when contact with the healthcare system may be one of the few visible signs of ongoing danger. Investigators examined that association in Ontario, Canada.

Investigators conducted a matched cohort study in Ontario, Canada using province-wide linked health administrative data. Eligible children were born in Ontario, were aged 0 to 18 years between 2005 and 2023, and had public health insurance. Exposure was a mother’s assault-related injury resulting in an emergency department (ED) visit, hospitalization, or death, and exposed children were matched 1:4 with unexposed children by sex, maternal age, and child age at index. The primary outcome was a child’s ED visit, hospitalization, or death from assault within five years. The cohort included 79,496 exposed children and 315,775 unexposed children; 48.5% were female and median age at index was 7 years (IQR 3-11). Modified Poisson regression was used to estimate adjusted rate ratios (aRRs) while controlling for child sociodemographics, child health conditions, and maternal factors.

In Physical Injuries in Children Following a Mother’s Assault or Homicide, exposed children were more likely to be assaulted within five years, 3.7% or 9.6 per 1,000 person-years versus 1.3% or 3.0 per 1,000 person-years in unexposed children. After adjustment, child assault resulting in ED visits occurred at a higher rate in exposed children, with aRR 2.34 (95% CI 2.20-2.48). The composite outcome of ED visit, hospitalization, or death showed the same adjusted rate, aRR 2.34 (95% CI 2.21-2.48), and hospitalization or death alone was also higher at aRR 2.40 (95% CI 1.94-2.97).

Because the analysis was observational, it supports an association between maternal assault-related injury and later child assault-related injury rather than a causal effect. The maternal exposure captured assaults severe enough to result in emergency care, hospitalization, or death, and the child outcomes were limited to assault events that came to medical attention or resulted in death. This was an Ontario population-based analysis of publicly insured children in Canada, and further subgroup or implementation detail was not provided in the abstract.

Maternal assault-related injury was associated with markedly higher 5-year rates of serious assault-related injury in children in this Ontario cohort. The authors concluded that healthcare-based interventions after a mother’s assault should include attention to her children as well.

Clinician Questions

How was maternal assault exposure defined in the Ontario child injury cohort?

Maternal exposure was defined as a mother’s assault-related injury resulting in an ED visit, hospitalization, or death. The study captured assaults severe enough to come to medical attention or result in death, rather than all possible violence exposure.

Which child outcomes counted as serious assault-related injury after maternal assault?

The primary outcome was a child’s ED visit, hospitalization, or death from assault within five years. Adjusted analyses also reported ED visits alone and hospitalization or death as separate severity thresholds.

What do these findings apply to, and what do they not establish?

These results come from an observational matched cohort of publicly insured children in Ontario, Canada, so they report an association rather than causation. They apply to maternal assaults and child assault injuries that resulted in emergency care, hospitalization, or death, not to all possible violence exposure or all child maltreatment events.