Children living with non-related adults face a significantly higher risk of
death from inflicted injury than children living with both biological parents, a
new study finds.
In fact, they’re 50 times more likely to suffer a fatal inflicted injury,
according to a study in the November issue of Pediatrics.
However, in households with just a single parent and no unrelated adults,
children were at no increased risk for an inflicted-injury death.
These findings don’t mean that biological parents aren’t responsible for many
child inflicted-injuries, however. According to study author Patricia Schnitzer,
an assistant professor in the School of Nursing at the University of
Missouri-Columbia, “For the majority of children, the perpetrators were
biological parents. But when you make comparisons using a control group, the
risk for inflicted-injury death was almost 50 times as high for kids who lived
with unrelated adults in the household.”
Inflicted-injury deaths are the leading cause of mortality in infants and are
responsible for one-third of deaths in children under 5 in Missouri, according
to background information in the study. Nearly all of these injuries are
inflicted by adult caregivers, according to the study.
To gain a better understanding of what types of situations might place a
child at risk, Schnitzer, along with Dr. Bernard Ewigman from the University of
Chicago, collected data on all children under 5 years of age who died in
Missouri between January 1992 and December 1999.
One hundred and forty-nine children died of inflicted injuries during that
period. The researchers then age-matched two children who died of natural causes
with each child who died of an inflicted injury to act as a control group.
Fifty-six percent of the children who died of inflicted injuries were less
than 1 year old, and 90 percent of them were under 3. Almost three-quarters of
the injuries were from striking or shaking the child.
Most of the perpetrators of violence against children were male — 71.2
percent. Nearly 35 percent of those who inflicted injuries on these youngsters
were their fathers, while 24.2 percent were the boyfriends of the child’s
mother. One out of five fatal injuries was caused by the child’s mother,
according to the study.
In homes with unrelated adults living in the household, these unrelated
individuals were overwhelmingly the perpetrators of the crime against the child
— 83.9 percent. Only one-third of the fatal injuries occurred in homes with two
biological parents, the study found.
The youngsters were more than twice as likely to live in households where
abuse or neglect had already been reported. They were also more likely to have
siblings under 5 in the home, and to have been born to young, unmarried women
with less than a high school education and a low income.
“It’s very important that parents of both genders have an understanding of
child development, so they know that infants cry and toddlers have trouble with
toilet training,” said Schnitzer. Additionally, she said, “Be aware of who you
leave your children with and know that child care can be frustrating. Know who’s
watching your kids.”
Dr. Karen Hopkins is a pediatrician and developmental behavioral specialist
at New York University Medical Center. She said, “Unrelated adults don’t have
the same emotional attachment to the child and don’t have the same patience
level or frustration level that a parent does. Some of these men may be a little
immature and easily frustrated, and it’s easy to think of picking up a baby and
shaking it. I don’t think most people realize just how dangerous it is to shake
Randolph McLaughlin, executive director of the Hale House Center in New York
City, which offers foster care and low-income day care, said this study “points
to the need for greater oversight” in the child-welfare system.
“In many instances, there is no oversight and children are at risk in these
difficult settings,” McLaughlin said. “We have to look at alternatives.
Sometimes, parents need a safety valve.”
He recommended providing low-cost day care to low-income parents and some
sort of temporary respite care where parents could drop off a child for a few
hours if they’re feeling overwhelmed.
All three experts said educating new parents and anyone involved in the care
of a child is crucial, and education programs need to receive more funding.
The American Academy of Family Physicians offers advice on protecting your family against violence.
SOURCES: Patricia Schnitzer, Ph.D., R.N., assistant professor, School
of Nursing, University of Missouri-Columbia; Karen Hopkins, M.D., pediatrician
and developmental behavioral specialist, New York University Medical Center, and
clinical associate professor, New York University School of Medicine, New York
City; Randolph McLaughlin, executive director, Hale House Center, New York City;
November 2005, Pediatrics
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