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updated 3/7/2011 11:41:28 AM ET 2011-03-07T16:41:28

A new study on child abuse — the first to look at the differences in head trauma perpetrated by men and women — may shed some light on this type of abuse, but raises even more questions about how many cases go undetected.

The study looked at 48 cases of abusive head trauma in children brought to a Long Island hospital between 1998 and 2008. In 34 of those cases, perpetrators were identified. Seventeen were male and the other 17 female.

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"When it comes to victims of abusive head trauma, there seemed to be differences between the sex of the perpetrators," said study researcher Dr. Debra Esernio-Jenssen, now medical director of the of the child protection team in the department of pediatrics at the University of Florida. "Victims of males not only had more severe clinical outcomes, but male perpetrators were more likely to confess and be convicted."

In all six cases in which a child died, the perpetrator was a man.

Fourteen men were convicted, while only five women were. And 15 of the 17 male perpetrators confessed to the abuse, but only three of 17 women did.

For the purposes of the study, the researchers identified the perpetrators as "individuals that were the focus of a law enforcement or child-protection services investigation. Usually it was an individual who was alone with the victim when the victim became symptomatic," Esernio-Jenssen said.

The study also found that female abusers tended to be older — an average age of 34, versus 27 for men.

While the study was too small to draw definitive conclusions, the researchers said, it highlights some of the unknowns about this type of abuse. In recent years, many questions have been raised about the reporting and detection of child abuse.

For example, the researchers expressed concern that many cases of child abuse may go unreported. They cited research from the University of North Carolina showing that more than 2 percent of mothers admit to shaking children as a form of discipline on surveys -- likely a low estimate.

The difficulties of studying child abuse
"It was an interesting study. It's a little difficult to make broad generalizations from it," said Dr. Lee Benjamin, an assistant professor of emergency medicine and pediatrics at Duke University Hospital and a spokesman for the American College of Emergency Physicians.

One issue with studying patterns in child abuse based on emergency visits, he said, is that "[we] will miss a lot of patients that don't come to the [ER], because they're not recognized as sick enough to be needing emergency care." Benjamin was not involved with the study.

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But further research in this area might help prevent the abuse that brings children to the ER in the first place, he said.

"If we can identify what children are at risk...hopefully we can prevent these injuries from occurring and help to identify them more quickly when they do seek medical care," Benjamin added.

Male and female abusers, and the ER
"Even though more men commit violent crimes, we certainly know there are women who have killed their children," said Dr. Leigh Vinocur, a spokeswoman for the American College of Emergency Physicians and an ER physician at the University of Maryland School of Medicine. "In good ERs, they'll investigate abuse."

"Anything that's unexplained, even babies that come in with SIDS, this is something you tell the parents has to be investigated," Vinocur said.

A larger study could help in examining child abuse, she said.

"If there were correlations in a larger study of outcomes with [male or female] perpetrators, that could aid investigations in the future," she said.

But Vinocur noted ER physicians can pick up on a number of observations — bruises in multiple places on babies not yet walking, bruises in various stages of healing in multiple places, or caretakers changing stories about what happened.

Sometimes, she said, parents will bring a child to the ER with one story, and then it will change as they move from triage nurse to ER nurse to ER physician.

"You'd be surprised, when there's abuse, sometimes the story changes within that amount of time," Vinocur said.

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