Risk of Injury Among Children and Youths Whose Mothers Experienced Violent Injury

Importance: Maternal exposure to violent injury is a sentinel event with implications for child health and safety. Quantifying the risk of injury in children whose mothers have experienced violent injury is essential for trauma-informed pediatric care. Objective: To review and synthesize evidence on the risk of physical and sexual injury among children whose mothers have experienced violent injury. Data Sources: MEDLINE, Embase, Cochrane, and Web of Science were searched from inception to August 7, 2024. Study Selection: Observational cohort, cross-sectional, and case-control studies and secondary analyses of randomized clinical trials that reported comparative risk estimates or prevalence of child injury following maternal violent injury were included. Children were required to be younger than 25 years at both exposure and outcome assessment. Data Extraction and Synthesis: Two reviewers independently screened studies and extracted data, with disagreements resolved by a third reviewer. Risk of bias was assessed using Joanna Briggs Institute tools. Random-effects meta-analyses pooled prevalence ratios, odds ratios, and prevalence estimates. Comparative meta-analyses focused on physical injury outcomes. Sexual injury outcomes were synthesized descriptively because of sparse and heterogeneous comparative data. Prespecified subgroup analyses examined corporal punishment vs other physical injuries. Main Outcomes and Measures: The primary outcome was the risk of physical injury in children exposed to maternal violent injury compared with unexposed children. Sexual injury was a secondary outcome. Results: Of 6218 unique records identified, 48 (7 666 786 unique participants) met inclusion criteria. Children exposed to maternal violent injury had a higher risk of physical injury compared with unexposed children (pooled prevalence ratio, 1.65 [95% CI, 1.36-2.01]; pooled odds ratio, 2.53 [95% CI, 1.60-4.00]), with substantial heterogeneity. Among exposed children, the pooled prevalence of physical injury was 42.4% (95% CI, 30.6%-54.6%). Sexual injury prevalence among exposed children was 17.0% (95% CI, 12.3%-22.3%); comparative estimates were insufficient for pooling. Subgroup and sensitivity analyses yielded similar findings across injury types. Conclusions and Relevance: In this systematic review and meta-analysis of children exposed to maternal violent injury, these children were at substantially increased risk for physical injury and experienced a high burden of sexual injury, underscoring the need for trauma-informed integrated family supports following maternal assault.