Child Abuse & Neglect 28 (2004) 7–8 Invited Commentary What we can learn from the spectrum of infant physical abuse in Alaska Marcia E. Herman-Giddens * North Carolina Child Advocacy Institute, School of Public Health, UNC-CH, 1450 Russell Chapel Road, Pittsboro, NC 27312, USA In this issue, the article on infant physical abuse in Alaska by Gessner, Moore, Hamilton, and Muth (2004) provides valuable data on the entire spectrum of intentional injury to infants from birth to 1 year of age. As the authors point out, data are sparse when it comes to examining the complete picture of physically abused infants—from minor injuries to death. The authors, in providing this analysis, have taken advantage of the relatively small infant population in Alaska and their unique access to data from child protective services, infant and maternal mortality reviews, the Alaska Trauma Registry, and the single pediatric tertiary care hospital. Gessner et al. (2004) point out that they found one of the highest rates of fatal infant physical abuse reported in the literature (20 per 100,000). In comparison, the rate for the US as a whole in the year 2000 was 9.07 (The National Center for Injury Prevention and Control, 2003). Alaska was exceeded in their high infant homicide rates for this age group by Nevada, Washington, DC, Missouri, Arkansas, and Oklahoma according to data from 1993 through 1997 collected by The National Center on Child Fatality Review (2003). (The Center’s data show infant homicide rate for these years for Alaska of 11.71 per 100,000 rather than 20 per 100,000 as reported in this paper, the latter likely due to the authors’ careful detection of cases.) Rather than focusing on ranking, it is more useful to see how the authors’ findings can help in detection and prevention. Looking at their numbers in a more “real life” way, one of every 280 infants born in the study period received an intentional minor injury, one of every 1221 was injured severely enough to require hospitalization, and one of every 5060 killed. Because fatality data are often the only data available to states, it is interesting to look at the ratios; for example, for every fatality, approximately 23 infants were nonfatally injured. The fatality to severe injury ratio was approximately 1:4. This may provide a rough estimate of what is happening in other states. Given the study’s finding that quite a few infants were hospitalized for trauma suggestive of abuse but never reported or evaluated for maltreatment, this ratio may be low. * Corresponding author. 0145-2134/$ – see front matter © 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.chiabu.2003.11.016