Childhood Abuse More Likely With Male Caregiver, especially Mother’s Boyfriend Interview with:

Amanda Fingarson, DO  Attending Physician, Child Abuse Pediatrics  Ann and Robert H. Lurie Children’s Hospital of Chicago  Assistant Professor of Pediatrics  Feinberg Northwestern School of Medicine      

Dr. Fingarson

Amanda Fingarson, DO
Attending Physician, Child Abuse Pediatrics
Ann and Robert H. Lurie Children’s Hospital of Chicago
Assistant Professor of Pediatrics
Feinberg Northwestern School of Medicine  What is the background for this study?  What are the main findings?

Response: Child physical abuse is a substantial pediatric public health issue, with significant morbidity and mortality. Studies have found that men, particularly children’s fathers and mothers’ boyfriends are common perpetrators of physical abuse. There is still a lack of knowledge, however, about the specific caregiver features that increase a child’s risk for physical abuse.

Our study design was unique, in that it was a multi-center study that compared young children with abusive and accidental injuries.

Our primary finding was that abuse was much more likely when a male caregiver was present, and the resulting injuries were more likely to be severe or fatal. The presence of the mother’s boyfriend was the riskiest scenario, with the highest likelihood of abuse. Similarly, we found that caregiver relationships of less than 1 year increased the odds of abuse. Overall, the likelihood of abuse with female caregivers was much lower, with the exception of female babysitters.  A final important finding of our study was that caregiving arrangements that were different than usual at the time of injury were at increased risk of abuse, suggesting that a stable and consistent caregiver is also important. What should readers take away from your report?

Response: Our study shows the important role that caregiver characteristics play in the likelihood of physical abuse. Given the strong association between certain caregiver features, our study highlights the importance of obtaining a careful psychosocial history that includes caregiver information when assessing for possible physical abuse. Just as it is important to obtain a careful trauma history and thoroughly medically assess for injuries, it is also critical to understand the child’s caregiving environment. 

It is important to remember however, that although our study found that certain caregiver scenarios heighened a child’s risk for abuse, the absence of these caregiver features do not rule out the possibility of abuse. A thoughtful, standardized approach to assessing injured children for possible physical abuse is warranted regardless of known risk factors. What recommendations do you have for future research as a result of this work? 

Response: Further study on this topic could improve physical abuse screening, optimize medical decision making, and inform prevention efforts. While our study did not evaluate prevention programs, our findings highlight the importance of ensuring that such programs reach male caregivers. Our findings also show the importance of educating parents that leaving children in the care of adults who are not usually caregivers, even for brief periods, can be risky, particularly if the person lacks experience in caring for children. 

There are no disclosures. 


Who’s Watching the Children? Caregiver Features Associated with Physical Child Abuse versus Accidental Injury

Amanda K. Fingarson, Mary Clyde Pierce, Douglas J. Lorenz, Kim Kaczor, Berkeley Bennett, Rachel Berger, Melissa Currie, Sandy Herr, Sheila Hickey, Julia Magana, Kathi Makoroff, Marcia Williams, Audrey Young, Noel Zuckerbraun

Publication stage: In Press Corrected Proof
Published online: June 26, 2019



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