MONDAY, Nov. 7, 2005 (HealthDay News) -- 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 a baby."
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.