Maternal, prenatal and postnatal risk factors for early child physical abuse: a French nationwide cohort study

Background Identifying risk factors for early child physical abuse (CPA) is crucial for understanding its mechanisms and defining effective preventive interventions. We aimed to identify maternal, prenatal and postnatal factors associated with early CPA. Methods This cohort study was based on comprehensive data from the Mother-Child EPI-MERES nationwide register and included all infants born alive in France between 2010 and 2019. Factors associated with early CPA (before age 1) were identified with a multilevel Cox regression model with random intercepts at the regional level. Findings Among the 6,897,384 included infants, 2994 (40/100,000) had a diagnosis of early CPA, at a median age of 4 months. Independent factors most strongly associated with early CPA were maternal low financial resources (adjusted hazard ratio [aHR] 1.91; 95% confidence interval [95% CI] 1.67–2.18), maternal age <20 years versus 35–40 years (aHR 7.06; 95% CI 6.00–8.31), maternal alcohol use disorder (aHR 1.85; 95% CI 1.48–2.31), opioid use disorder (aHR 1.90; 95% CI 1.41–2.56), intimate partner violence (aHR 3.33; 95% CI 2.76–4.01), diagnosis of a chronic mental disorder (aHR 1.50; 95% CI 1.14–1.97) or somatic disorder (aHR 1.55; 95% CI 1.32–1.83), hospitalisation for a mental disorder (aHR 1.88; 95% CI 1.49–2.36), very preterm birth (aHR 2.15; 95% CI 1.68–2.75), and diagnosis of a chronic severe neurocognitive disorder in the infant (aHR 14.37; 95% CI 11.85–17.44). Interpretation Independent risk factors of early CPA identified at the national level in France may help in understanding CPA mechanisms and developing effective prevention programs including risk-stratification tools to optimise the allocation of parenting interventions to parents who could most benefit from them. Funding Ile-de-France regional council, L'Oréal-UNESCO For Women In Science France Young Talent Award, French National Observatory for Child Protection [ONPE], French Association of Ambulatory Paediatrics [AFPA], HUGO university hospitals network, Mustela Foundation and Sauver la Vie prizes.