Child deaths at hands of guardians examined

Monday, November 7, 2005 | 12:00 a.m. CST; updated 3:42 p.m. CDT, Thursday, July 17, 2008

Children living with adults unrelated to them are 50 times more likely to die of inflicted injuries than children living with their two biological parents, an MU study has found.

“We expected risk to be higher in households with unrelated adults,” said Patricia Schnitzer, the study’s lead author. “We didn’t expect it necessarily to be quite as high as what we found; that result was a bit surprising.”

Schnitzer, an assistant professor of nursing at MU, and Bernard Ewigman, a professor of family medicine at the University of Chicago and a former MU researcher, examined information from Missouri’s Child Fatality Review Program. It reviews all child deaths in Missouri and includes information such as who lived with the child and, in the case of injury deaths, how the injury occurred and who inflicted it.

Their findings will be published this week in the peer-reviewed journal Pediatrics.

The study included children younger than 5 who died from an injury inflicted by a parent or adult caregiver from Jan. 1, 1992, through Dec. 31, 1999. Seventy-three percent of the deaths were caused by shaking or striking the child. Other deaths were caused by injuries such as burns, drowning and suffocation.

More than 80 percent of the time, the boyfriend of the child’s mother was the unrelated adult living in the household and, in 74 percent of these households, was the perpetrator. Schnitzer said the fatal injuries often occurred when their mothers were out of the home and they were left in the care of their mother’s boyfriend.

Richard Hicks, assistant prosecuting attorney for the Boone County Prosecuting Attorney’s Office, said he is not surprised by the findings. In the majority of abuse cases he has seen, the offender is not the biological father. Rather, the abuser is usually a boyfriend, stepfather or male caregiver that lives in the home, he said.

Hicks said that in shaken baby cases, the perpetrator is often the mother’s boyfriend who becomes frustrated while taking care of the child.

“We see that an awful lot,” Hicks said.

The study also noted that children living with just one biological parent are at no increased risk of inflicted injury death if no other adults live in the household. Schnitzer said this finding is significant because it goes against a perception that children who live in single-parent homes are at an increased risk of child abuse and neglect.

“We feel it is important to know not only that it is a single-parent household, but are there other people living there,” Schnitzer said. “And what’s the relationship of those people to the child.”

Schnitzer said that unlike past studies, this study found no increased risk for children in households with stepparents or foster parents. This finding might be explained by the fact that there were very few children in the study who lived in households with stepparents or foster parents, she said.

In terms of individual risk factors, Schnitzer said that children who died of inflicted injuries tended to have young mothers with less education and late or no pre-natal care and who had other children younger than 5 in the household.

Jan Stock, executive director of Rainbow House, a crisis home for children, said a lot of children come there from homes that frequently have people coming in and out, including their mother’s boyfriend. She said a woman might continue living with a boyfriend who is endangering her children for many reasons, including low self-esteem.

“I don’t think women want their kids to get harmed,” Stock said. “But they do make choices that cause their children to get harmed because of their own codependency, insecurity, or because they feel like they need the other person financially or to take care of them.”

Stock said that a lot of the time, parents don’t realize they are putting their children in danger because they came from a home where abuse was present.

“There are so many ways people make choices and there are so many ways that kids get hurt as a result of those choices,” Stock said. “The bottom line is, people make choices that put children in danger.”

Educationstrategies and policy changes might help reduce child abuse, Schnitzer said.

These strategies include training parents on early childhood development and strengthening policies that provide financial resources to low-income mothers so they have access to high quality day care.

Schnitzer also said programs that provide pre-natal and early childhood home visitation by nurses have been shown to reduce child abuse and neglect by low-income, unmarried mothers.


For the study, two children who died of natural causes were used as controls for each child who died of inflicted injuries.

There were five classifications of households in the study:

  • Households with two biological parents only.
  • Households with one biological parent only.
  • Households with one or two biological parents and adult relatives such as grandparents.
  • Households with stepparents or foster parents.
  • Households with one biological parent and an unrelated adult.

Because the study used more than two categories, households with two biological parents only were designated as the reference category to which the others were compared.

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