Child Fatalities Essay

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According to data from the National Center for Health Statistics, approximately 53,854 children from birth to age 19 died in the United States in 2002, a rate of 66.5 per 100,000 children. The cause of child deaths can vary from those considered “natural” (e.g., congenital anomalies, respiratory disease, sudden infant death syndrome) to those identified as “unintentional” (e.g., motor vehicle accident, drowning, fires) or “intentional” (e.g., homicides, suffocation, poisoning). Intentional child fatalities as well as many incidents involving unintentional death are considered forms of child maltreatment, as each year a significant number of child deaths are due to acts of either child physical abuse or child neglect. The prevalence of child fatalities due to various forms of child maltreatment in the United States is presented in this essay, along with a discussion of what can be done to prevent child deaths.

Prevalence Of Child Fatalities Due To Child Abuse And Neglect

The National Child Abuse and Neglect Data System (NCANDS), which produces an annual report on child maltreatment in the United States, estimates that in 2002 approximately 1,400 children died in the United States as a result of abuse and neglect. The overall rate of child fatalities for these children, from birth to 17 years old, was 2 child deaths per 100,000 children. Of these 1,400 child deaths, approximately one third resulted from child physical abuse. Physical abuse– related child deaths often result from head injury, drowning, or asphyxiation. Another 38% of child victims died as a result of child neglect (i.e., caretakers failed to provide for the children’s basic needs, such as medical care or adequate supervision). Child deaths from child neglect frequently involve hazards associated with unsafe or unsupervised environments, including scald burns, plastic bag suffocation, house fires, and hypothermia. A significant percentage of child deaths are due to some combination of physical abuse and neglect, as approximately 29% of children died as a result of multiple forms of maltreatment in 2002.

The large majority (76%) of 2002 child fatalities due to child abuse and neglect were children under the age of 4 years, with 41% under the age of 1 year at the time of their deaths. Boys were at greater risk than girls, with fatality rates of 2.4 and 1.8, respectively, per 100,000 children. In terms of who was responsible for the child’s death, in more than 80% of cases, the perpetrators were the child’s parents, most frequently the child’s mother. Additional perpetrators included other relatives (7%), unmarried partners (3%), or other individuals in the child’s life, such as daycare providers, foster parents, school employees, and others (6%).

Misclassified Homicide

The number of child fatalities documented by NCANDS is certainly cause for concern, but even more alarming is the fact that such statistics are likely underestimates of the actual number of children who die at the hands of their parents. These numbers do not reflect, for example, child deaths due to maltreatment reported to other authorities, such as law enforcement agencies, hospitals, or coroners. Also excluded are homicide cases that are misclassified as accidents or medical conditions.

One example of a misclassified homicide that is sometimes masked by a medical diagnosis is sudden infant death syndrome (SIDS). SIDS is defined as the sudden unexpected and unexplained death of an infant, often occurring during sleep. SIDS is essentially a default diagnosis that describes a child who inexplicably stops breathing. Because so little is known about the condition, it is sometimes difficult to distinguish between SIDS and homicide. There is evidence that some cases attributed to SIDS are actually the result of asphyxia or deliberate smothering by a parent or caretaker.

The relationship between SIDS and child maltreatment has been somewhat controversial because there is significant disagreement concerning how frequently misdiagnoses occur. Research on the topic has uncovered several indicators that might help distinguish between SIDS and homicide, such as recurring life-threatening incidents that are poorly explained and typically witnessed by only a single caregiver, evidence of physical maltreatment, a family history of previous involvement with child protective services, and a death scene that suggests neglect. In addition, most states now require autopsies for all inexplicable infant deaths, as well as an examination of the scene of death and medical history of the child. Although in the overwhelming majority of deaths of this nature some type of medical condition or accidental suffocation is likely the cause of death, sometimes inexplicable deaths are the result of child abuse or neglect.

Child Death Review Teams

Within the past 30 years, there has been increased interest in understanding the causes of child fatalities in an effort to reduce preventable deaths in children. The establishment of child death review teams both nationally and internationally has been instrumental in this effort. The common mission of such teams is to prevent child fatalities by identifying appropriate system changes and increasing awareness about the causes of child death. Child death review began in the late 1970s in Los Angeles where the first team was formed by the Inter-Agency Council on Child Abuse and Neglect. Today, there are hundreds of child death review teams across the United States, Canada, and Australia.

Child death review teams are typically composed of community professionals that represent multiple agencies. Teams typically include representatives from a variety of disciplines, such as physicians, child welfare workers, lawyers, social workers, and mental health professionals. Although the functions of these teams vary, most evaluate cases in which a child has died (a) to identify the prevalence of deaths from child maltreatment, (b) to improve the policies and procedures of child protective services to prevent future child deaths, (c) to protect siblings of children whose causes of death are unexplained, and (d) to increase professional and public awareness of child death due to child abuse and neglect.

The American Academy of Pediatrics published a policy statement outlining recommendations for the investigation and review of unexpected deaths. One recommendation addresses the need to create state laws to establish child death review teams, and specifies that the child death review process should involve multiple groups and agencies. The policy statement also suggests that autopsies be required in all questionable deaths of children younger than 18 years. The academy also recommends that death scene investigators have special training in child abuse, child development, and SIDS. Other recommendations include the involvement of pediatricians, both as members of child death review teams and as advocates for proper investigation, and death certification in cases of child fatality. Finally, the academy recommended that data from child death review teams be used to develop initiatives to prevent child death.

Bibliography:

  1. American Academy of Pediatrics, Committees on Child Abuse and Neglect and Community Health Services. (1999). Investigation and review of unexpected infant and child deaths. Pediatrics, 104, 1158–1159.
  2. Block, R. W. (2002). Child fatalities. In J. E. B. Myers, L. Berliner, J. Briere, C. T. Hendrix, C. Jenny, & T. A. Reid (Eds.), The APSAC handbook on child maltreatment (2nd ed., pp. 293–301). Thousand Oaks, CA: Sage.
  3. Durfee, M., Durfee, D. T., & West, M. P. (2002). Child fatality review: An international movement. Child Abuse & Neglect, 26, 619–636.
  4. S. Department of Health and Human Services, Administration on Children, Youth and Families. (2004). Child maltreatment 2002. Washington, DC: Government Printing Office.

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