Document Type

Article

Publication Date

2026

DOI

10.1016/j.acap.2026.103219

Publication Title

Academic Pediatrics

Volume

26

Issue

3

Pages

103219

Abstract

Objective

Prior research on confessions of physical abuse (PA) has explored mechanisms of injury. Little is known about conditions supporting a confession of abuse or how confessions may influence case outcomes.

Methods

This cross-sectional study of suspected PA in children age < 10 years at 10 centers participating in CAPNET, a multicenter child PA research network, included children with in-person Child Abuse Pediatrics (CAP) consultations between Feb 2021-Dec 2022 and excluded children without injury. Our focus was a confession of inflicted injury known to the CAP during clinical involvement. We compared child and clinical characteristics, out-of-home (OOH) placements, and arrests between cases with and without confessions. Multivariable models using generalized estimating equations (GEE) produced adjusted predicted probabilities (APP) clustering by CAPNET site.

Results

Confessions were known to CAPs in 115/4297 (2.7%) cases, with significant site variability. In a multivariable GEE model, confessions were more likely in cases with injuries with high-specificity for abuse (APP 6.0% vs 1.5%, p< 0.001), near-fatality (APP 5.5% vs 2.3%, p< 0.001), and older children (APP 4.8% vs 2.5%, p = 0.025). OOH placements and arrests were more common in cases with confessions. CAP awareness of confessions, OOH placements, and arrests did not follow racial or ethnic patterns seen in the US child welfare system. Lower socioeconomic status was associated with OOH placements and arrests but not CAP awareness of confessions.

Conclusions

Our findings highlight differences in case characteristics and outcomes where a confession is known to the CAP and raise questions about agency response based on child characteristics.

Rights

© 2026 The Authors

This is an open access article under the Creative Commons Attribution 4.0 International (CC BY 4.0) License.

Original Publication Citation

Russell, M., Laskey, A. L., Puls, H. T., Starling, S. P., Wood, J. N., Lindberg, D. M., Harper, N. S., McNamara, C. R., Bachim, A. N., Brink, F. W., Frasier, L. D., Anderst, J., Vaughn, P., & Campbell, K. A. (2026). Confessions in cases of child physical abuse - a CAPNET study. Academic Pediatrics, 26(3), Article 103219. https://doi.org/10.1016/j.acap.2026.103219

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