The study was based on an analysis of North Carolina records, but researchers said the results reflect the situation nationwide because all states use the same system to classify deaths.
Caregivers commit 85 percent of the homicides of children 10 and under, and strangers are the killers only 3 percent of the time, said Dr. Marcia Herman-Giddens, lead author of the study.
"So far, we as a society have not cared enough to do what we need to do to get accurate data on child abuse homicides," she said. "If you don't have good data about the problem, good numbers, you can't possibly begin to do anything about it."
Herman-Giddens, who teaches maternal and child health at the University of North Carolina, said the problem is that all states use the International Classification of Diseases to record deaths, and the system's specifications are flawed.
For example, three children who are stabbed to death would not be listed as abuse victims because the classification system says abuse deaths result from a string of events, not an isolated episode, she said.
Her study counted child abuse deaths if they resulted from a single episode such as a shooting or from a string of events, and came at the hands of caregivers -- including babysitters and boyfriends of mothers.
With that system in mind, the researchers analyzed records from medical examiners, police and other sources on the 259 homicides of children 10 and younger in North Carolina from 1985 through 1996.
Of those, the state's system underreported the number of deaths from battering or abuse by 58.7 percent, the researchers said. Biological parents committed 64 percent of the killings.
Translated to a national scale, the study suggests that 6,500 more children than national statistics reflect were victims of homicide due to abuse from 1985 through 1996. The researchers estimated that in 1996, 835 children died at the hands of caregivers nationwide.
Sidney Johnson, president of Prevent Child Abuse America, which was not involved in the study, said it gives credibility to what some experts have been saying for years that twice as many children are abused as reports indicate.
Herman-Giddens said death certificates need to be redesigned to accommodate information related to abuse, and medical examiners and coroners need better training to recognize such deaths.
Written By Brenda C. Coleman