Starling S P, Holden J R, Jenny C
Department of Pediatrics, School of Medicine, University of Colorado Health Sciences Center, Denver.
Pediatrics. 1995 Feb;95(2):259-62.
Abusive head trauma is the most common cause of morbidity and mortality in physically abused infants. Effective prevention requires the identification of potential perpetrators. No study has specifically addressed the relationship of the perpetrators of abusive head trauma ("shaken baby syndrome") to their victims. The objectives of this study were to identify the abusers and their relationship to victims in these cases.
We reviewed the medical charts of 151 infants who suffered abusive head trauma to determine the perpetrator of the abuse. Caretakers were classified by level of certainty: confession to the crime, legal actions taken, or strong suspicion by the staff. The relationship of abusers to victims was analyzed.
Male victims accounted for 60.3% of the cases. Twenty-three percent of the children died, although death rates for boys and girls did not vary significantly. Male perpetrators outnumbered females 2.2:1, with fathers, step-fathers, and mothers' boyfriends committing over 60% of the crimes. Fathers accounted for 37% of the abusers, followed by boyfriends at 20.5%. Female baby-sitters, at 17.3%, were a large, previously unrecognized group of perpetrators. Mothers were responsible for only 12.6% of our cases. All but one of the confessed abusers were with the child at the time of onset of symptoms.
Our data suggest male caretakers are at greater risk to abuse infants. Baby-sitters are a concerning risk group, because they represent a significant proportion of abusers, and they more easily escape prosecution. In addition, no prevention efforts have been directed at baby-sitters. These statistics could help change the focus of efforts to prevent abusive head trauma.
虐待性头部外伤是受身体虐待婴儿发病和死亡的最常见原因。有效的预防需要识别潜在的施虐者。尚无研究专门探讨虐待性头部外伤（“摇晃婴儿综合征”）的施虐者与其受害者之间的关系。本研究的目的是在这些案例中识别施虐者及其与受害者的关系。
我们回顾了151例遭受虐待性头部外伤婴儿的病历，以确定虐待行为的施虐者。看护者按确定程度分类：承认犯罪、已采取法律行动或工作人员强烈怀疑。分析了施虐者与受害者的关系。
男性受害者占病例的60.3%。23%的儿童死亡，尽管男孩和女孩的死亡率没有显著差异。男性施虐者的数量是女性的2.2倍，父亲、继父和母亲的男友实施了超过60%的犯罪行为。父亲占施虐者的37%，其次是男友，占20.5%。女性保姆占施虐者的17.3%，是一个此前未被充分认识的庞大施虐者群体。母亲仅占我们所研究病例的12.6%。除一名施虐者外，所有承认犯罪的施虐者在症状出现时都与孩子在一起。
我们的数据表明男性看护者虐待婴儿的风险更高。保姆是一个令人担忧的风险群体，因为他们占施虐者的很大比例，而且更容易逃脱起诉。此外，尚未针对保姆开展预防工作。这些统计数据可能有助于改变预防虐待性头部外伤工作的重点。
