Collateral Damage of COVID-19: Home Injuries, Suicides in Kids?

There may be a connection between the unprecedented events of COVID-19 and an increase in certain injuries in children, investigators reported.

COVID-19 was declared a pandemic by the World Health Organization (WHO) in March 2020, which set off a far-reaching chain of events including travel bans, stay-at-home orders, and a new reliance on telemedicine.

Observational studies suggested the events of that year were associated with more children:

• Going to U.S. emergency departments (ED) after swallowing magnets, electronics, and small batteries
• Presenting to Midwest trauma centers with a burn injury
• Dying from firearm suicides in the Chicago area

"During the COVID-19 pandemic, families experienced unprecedented increased social and financial pressure, and children were out of school for extended periods of time," said Christina Georgeades, MD, of Children's Wisconsin and Medical College of Wisconsin in Milwaukee. "The onset of the COVID pandemic introduced an extraordinary set of events with unclear consequences."

Georgeades and other researchers reported their findings as abstracts at the American Academy of Pediatrics (AAP) virtual meeting.

Foreign Body Ingestion

The COVID-19 era saw no change in the frequency of total foreign body ingestions, but dangerous items were being swallowed more, according to national surveillance data.

Incidence of suspected foreign body ingestions in children up to age 17 years was not significantly different from 2017-2019 (pre-COVID-19; n=59,933) to 2020 (COVID-19 period; n=54,926; P=0.06). However, there were substantial increases in:

• Children requiring escalation of care due to ingestions
• Magnet ingestions
• Electronics ingestions
• Button battery ingestions

These objects are among the most dangerous objects ingested; small rare-earth magnets can cause perforation, whereas button batteries can cause death through charge-dependent hydrolysis, reported Elyse Geibel, MD, of Naval Medical Center San Diego.

"The injury patterns described in this analysis, particularly with respect to electronics and magnets, provides an opportunity for targeted advocacy and education of patients, parents, educators, and other caregivers. This should guide future pandemic public health campaigns to increase home safety and prevent future [foreign body ingestions]," she said.

Geibel's group conducted the retrospective study using National Electronic Injury Surveillance System data spanning 2017-2020. They were unable to capture information on ingestions from primary care visits, she acknowledged.

Burn Injuries

Pediatric burn injuries grew more common in the spring and summer of 2020, perhaps a result of accidents from home fireworks displays.

Across eight Level 1 pediatric trauma centers, the number of children presenting with burn injuries went up 32.5% during during implementation of stay-at-home orders (522 in March-September 2020 vs 394 in March-September 2019, P=0.03), with the biggest spike occurring in July and among school-aged children, according to Georgeades.

"The disproportionate increase in burn injuries in July may reflect the cancellation of professional firework shows across the nation and an increase in amateur pyrotechnicians experimenting with their own fireworks," she said, citing one estimate that consumer fireworks sales increased by 200%-300% during the summer of 2020.

For this study, Georgeades and colleagues relied on records from the Midwest Pediatric Surgery Consortium.

"Ultimately, more studies are needed to target children and families most in need of additional support during these times of stress," she stated.

Pediatric Firearm Deaths

Finally, a small study suggested a rise in firearm suicides while firearm homicides stayed stable among Chicago children during the pandemic.

Pediatric firearm suicides reached a peak in the year 2020 (n=11) compared with the previous 4 years (range 2-7). Eight of these suicides were in teenagers ages 15-17, and three in children ages 10-14 years, marking more firearm suicides in this younger age group in 2020 than all four previous years combined, according to Ashley Wolf, MD, MS, of Rush University Children's Hospital in Chicago.

The CDC had previously reported a 39% increase in ED visits for suspected suicide attempts among youth ages 12-17 years in 2020 compared with 2019.

On the other hand, the number of pediatric firearm homicides in 2020 (n=67) stayed in line with previous years (range 47-82). The majority of firearm homicides was in Black children ages 15-17 years, but there was an uptick in firearm homicides in children ages 1-14 years (n=14 vs previous range 3-10).

In Chicago, Black male adolescents were disproportionately affected by firearm suicide and firearm homicide. There were no bumps in either type of death coinciding with the city's stay-at-home order in spring 2020.

Wolf and colleagues performed a retrospective review of the Cook County Medical Examiner's records from 2016-2020.