The identity of abusers and their relationship to victims was studied by reviewing medical charts of 151 head injured children, aged 24 months or younger, seen at the Children’s Hospital, Denver, CO from Jan 1982 - Jan 1994. All infants had documented intracranial bleeding and other injuries. Male infants were abused more frequently than female (60% v 40%); and 23% died. Male perpetrators outnumbered females 2.2:1. Fathers and boyfriends were the most common perpetrators: 37% and 20%, respectively. From 1989 to 1993, the percentage of infants abused by men nearly doubled. Female baby-sitters were a large, previously unrecognized group of perpetrators, accounting for 17%. Mothers were responsible for only 12%. 
COMMENT. These findings should focus attention on baby-sitters as a previously unrecognized group of abusers. Despite an increase in support services and media publicity, non-accidental head injury (“shaken baby syndrome”) remains the leading cause of death or long-term disability among child abuse cases. Subtle or mild trauma is particularly difficult to diagnose, often mistaken for viral illness, feeding problems, or infant colic. Shaking injuries are rare after the second year. The most common age for whiplash abuse is 5 months, when the head is large in relation to the body, and the neck muscles and head control are weak. (Brown JK, Minns RA, 1993). See Progress in Pediatric Neurology II, Chicago, PNB Publ, 1994. pp387-396, for an overview of head injury in children by Dr J Keith Brown, Edinburgh, and various recent articles and editorial commentaries.