Young children who live in households with one or more unrelated adults are nearly 50 times as likely to die from an inflicted injury, usually being shaken or struck, as children living with two biologic parents, report researchers from the University of Missouri-Columbia and the University of Chicago in the November 2005 issue of the journal Pediatrics.
Contrary to common perception, households with a single parent and no other adults had no increased risk of fatal injury.
In this study of young children who died from inflicted injuries, 21 percent lived in homes with an unrelated adult, compared to only one percent of controls. More than 80 percent of those households consisted of the child's mother and her boyfriend. In 74 percent of those cases, the boyfriend was the perpetrator.
"It is not single parenthood per se that puts a child at risk," said Bernard Ewigman, M.D., M.S.P.H., professor and chairman of family medicine at the University of Chicago. "It is the presence in the household of unrelated adults, usually a male boyfriend, that dramatically increases the risk.
"At the same time, we need to use caution in interpreting these findings," Ewigman said. "Most unrelated adults living in a household with young children do not injure them."
The study, "Child Deaths Resulting from Inflicted Injuries: Household Risk Factors and Perpetrator Characteristics," by Ewigman and Patricia Schnitzer, Ph.D., research assistant professor of family and community medicine at the University of Missouri-Columbia, used data from the Missouri Child Fatality Review Program, developed by Ewigman in 1991, to examine all 149 children under the age of five who died from injuries inflicted by a parent or caregiver in Missouri between January 1, 1992, and December 31, 1999.
They compared their results with 298 randomly selected Missouri households in which a young child of similar age had died, but of natural causes.
Most of the deaths involved very young children; 56 percent were less than one year old and 90 percent were less than three. Seventy-three percent of the fatal injuries were caused by shaking or striking the child.
Children who died from inflicted injuries were more likely than controls to be born to young, unmarried women with less than a high school education and limited income. They were more than twice as likely to have siblings under age five and to live in households previously reported for abuse or neglect.
In this study, the researchers focused on household composition as an independent risk factor for fatal inflicted injuries. They classified households into five groups, those with: