A top pediatric trauma surgeon and Central Florida child-welfare advocates are sounding an alarm over a sharp rise in severe child abuse cases since the start of the coronavirus pandemic — a trend they fear could continue until classrooms reopen in August and the economy improves.

“These are not just a belt mark or a cigarette burn. These are major, life-threatening injuries,” said Dr. Donald Plumley, medical director for pediatric trauma at Orlando Health’s Arnold Palmer Hospital for Children. “We maybe would see one case a month or so before this, and now we’ve had seven in about a three-week period. … And it’s not just us.”

The spike in severe cases comes as overall reports to child abuse hotlines have plummeted — the result, authorities said, of children no longer being seen by teachers, coaches, grandparents, neighbors and even primary-care doctors who might report suspected abuse. It is only the most egregious cases — typically, very young children with traumatic head injuries, multiple broken bones or serious burns — that are coming to light.

“This is mirroring a trend around the state,” said Marie Martinez, operations manager of Orlando Health’s Howard Phillips Center for Children & Families, which helps young victims of abuse and neglect. “When we speak on conference calls with other child-protection teams, everyone is reporting the same thing. … So we know that abuse is occurring because of the pressure-cooker environment that we are all in.”

At the Howard Phillip’s Center, for instance, there were eight cases in March 2019 in which children from Orange and Osceola counties were abused so badly that they had to be hospitalized. This March, the number climbed to 19.

For the month of April, cases rose from nine in 2019 to 13 this year.

Though the numbers may seem small overall, advocates say they represent the tip of an iceberg.

“The reality in child abuse is that teachers are the most common reporters,” said Glen Casel, CEO of Embrace Families, the nonprofit agency contracted by the state Department of Children and Families to manage foster care, adoptions, and abuse and neglect prevention programs in Central Florida.

“I was hoping that, if at all possible, we would have kids return to the classroom for at least a couple of weeks before the summer break — just for the sake of identifying children who are being abused,” he said. “The teachers could catch those cases that had escalated without having to wait such a long time. Now it looks like it will be back to school in August before we have a sense of what has happened.”

Not only are schools closed, but so are child-care centers, youth sports programs, YMCAs, camps and Boys and Girls Clubs — all places where adults monitor kids’ well-being.

As a result, reports have fallen precipitously. In Orange County, for instance, their numbers dropped from 2,293 in February to 1,709 in March — when residents spent half the month under stay-at-home orders.

Though less populous, other counties had similar declines — Seminole went from 596 to 490, Osceola from 571 to 460 and Lake from 411 to 388. When the April numbers come in, Casel expects them to fall even further.

“All of us need to pay a little more attention right now,” he said. “You don’t have to be an expert to say, ‘Hmm, something doesn’t feel right.’ Normally you might not pick up the phone and call the abuse hotline because you know that the next day that child goes to school and there will be other eyes watching. Well, now there aren’t. It could be that the only eyes are yours.”

Between widespread job losses, a dysfunctional unemployment application system, long-term social isolation and the need for parents to suddenly become their children’s educators, families are under unprecedented strain.

And while the pandemic has had a global economic impact, Central Florida has been especially hard hit. Nearly a third of the region’s workers come from the largely shuttered retail, leisure and hospitality sectors — second nationally only to Las Vegas. Tens of thousands of local employees have been laid off, furloughed or otherwise had their paychecks cut.

While child abuse happens in families of all income levels, Anna Gassman-Pines, a Duke University public policy professor who has studied the impact of parental unemployment on children, said the research is clear that financial stress is a risk factor.

But the most common type of child maltreatment is neglect — not abuse.

“In a lot of cases, neglect is driven by poverty,” Gassman-Pines said. “Families working in the service industry were already in a tenuous financial situation before this crisis.”

In severe cases of physical or sexual abuse, either the child or the abuser must be removed from the home. But Casel said most referrals to child-welfare agencies don’t lead to such drastic measures.

“During the Great Recession, yes, we had an increase in families, but most of our families stayed intact because they were simply struggling and needed our help,” he said. “It didn’t mean they were bad people trying to hurt kids. And the distinction matters. We suspect this will be a similar dynamic.”

Throughout the state’s stay-at-home order, child-welfare workers have continued to do investigations, set up counseling sessions and help families with food and other aid — even though many visits are being conducted online.

“If any family is struggling with any issue, they can always have 24-hour access to us [at chsfl.org/contact/],” said Sherri Gonzales, executive director of the nonprofit Children’s Home Society for Central Florida. “They always have someone to reach out to.”

The agency can help connect families to a range of educational and social resources including Early Head Start and a first-time parents program, for instance, to help guide them over the often rocky terrain of raising young children.

“This is a tough time, even for the best parents,” said Plumley, the pediatric surgeon. “But if you absolutely are at your wit’s end, try to step away from the situation. Call a friend, take a walk if you can … or, if it’s a baby, you can put them in a crib and just step [back] for a moment.”

Parents also can call the Childhelp National Child Abuse Hotline — at 1-800-4-A-CHILD (1-800-422-4453) — which is dedicated to trying to prevent abuse. The free, confidential service provides professional crisis counselors 24 hours a day, seven days a week, in 170 languages.