Introduction

Despite the efforts of the child protection system, child fatalities remain a serious problem.¹ Although the untimely deaths of children due to illness and accidents have been closely monitored, deaths that result from physical assault or severe neglect can be more difficult to track. Intervention strategies targeted at resolving this problem face complex challenges.

Unless otherwise noted, statistics in this fact sheet are taken from Child Maltreatment 2002 (U.S. Department of Health and Human Services, 2004).

How Many Children Die Each Year From Child Abuse and Neglect?

The National Child Abuse and Neglect Data System (NCANDS) reported an estimated 1,400 child fatalities in 2002. This translates to a rate of 1.98 children per 100,000 children in the general population. NCANDS defines "child fatality" as the death of a child caused by an injury resulting from abuse or neglect, or where abuse or neglect were contributing factors.

Many researchers and practitioners believe child fatalities due to abuse and neglect are underreported. States' definitions of key terms such as "child homicide," "abuse," and "neglect" vary (therefore, so do the numbers and types of child fatalities they report). In addition, some deaths officially labeled as accidents, child homicides, and/or Sudden Infant Death Syndrome (SIDS) might be attributed to child abuse or neglect if more comprehensive investigations were conducted or if there was more consensus in the coding of abuse on death certificates.

Recent studies in Colorado and North Carolina have estimated as many as 50 to 60 percent of deaths resulting from abuse or neglect are not recorded (Crume, DiGuiseppi, Byers, Sirotnak, Garrett, 2002; Herman-Giddens, Brown, Verbiest, Carlson, Hooten, et al., 1999). These studies indicate that neglect is the most underrecorded form of fatal maltreatment.

Are Child Abuse and Neglect Fatalities Increasing?

The rate of child abuse and neglect fatalities reported by NCANDS has increased slightly over the last several years from 1.84 per 100,000 children in 2000 to 1.96 in 2001 and 1.98 in 2002. However, experts do not agree whether this represents an actual increase in child abuse and neglect fatalities, or whether it may be attributed to improvements in reporting procedures. For example, statistics on approximately 20 percent of fatalities were from health departments and fatality review boards for 2002, compared to 11.4 percent for 2001, an indication of greater coordination of data collection among agencies.

A number of issues affecting the accuracy and consistency of child fatality data from year to year have been identified, including:

• Variation among reporting requirements and definitions of child abuse and neglect.

• Variation in State child fatality review processes.

• The amount of time (as long as a year, in some cases) it may take a fatality review team to declare abuse or neglect as the cause of death.

• Miscoding of death certificates.

What Groups of Children Are Most Vulnerable?

Research indicates very young children (ages 3 and younger) are the most frequent victims of child fatalities. NCANDS data for 2002 demonstrated children younger than 1 year accounted for 41 percent of fatalities, while children younger than 4 years accounted for 76 percent of fatalities. This population of children is the most vulnerable for many reasons, including their dependency, small size, and inability to defend themselves.

D

How Do These Deaths Occur?

In 2002, more than one-third (38 percent) of child maltreatment fatalities were associated with neglect alone. Physical abuse alone was cited in more than one-quarter (30 percent) of reported fatalities. Another 29 percent of fatalities were the result of multiple maltreatment types.

View Child Abuse and Neglect Fatalities by Maltreatment Type, 2002.

D

Fatal child abuse may involve repeated abuse over a period of time (e.g., battered child syndrome), or it may involve a single, impulsive incident (e.g., drowning, suffocating, or shaking a baby). In cases of fatal neglect, the child's death results not from anything the caregiver does, but from a caregiver's failure to act. The neglect may be chronic (e.g., extended malnourishment) or acute (e.g., an infant who drowns because she is left unsupervised in the bathtub).

Who Are the Perpetrators?

No matter how the fatal abuse occurs, one fact of great concern is that the perpetrators are, by definition, individuals responsible for the care and supervision of their victims. In 2002, one or both parents were involved in 79 percent of child abuse or neglect fatalities. Of the other 21 percent of fatalities, 16 percent were the result of maltreatment by nonparent caretakers, and 5 percent were unknown or missing. These percentages are consistent with findings from previous years.

There is no single profile of a perpetrator of fatal child abuse, although certain characteristics reappear in many studies. Frequently the perpetrator is a young adult in his or her mid-20s without a high school diploma, living at or below the poverty level, depressed, and who may have difficulty coping with stressful situations. In many instances, the perpetrator has experienced violence first-hand. Most fatalities from physical abuse are caused by fathers and other male caretakers. Mothers are most often held responsible for deaths resulting from child neglect. However, in some cases this may be because women are most often responsible (or assumed to be responsible) for children's care (U.S. Advisory Board on Child Abuse and Neglect, 1995).

How Do Communities Respond to Child Fatalities?

The response to the problem of child abuse and neglect fatalities is often hampered by inconsistencies, including:

• Inaccurate reporting of the number of children who die each year as a result of abuse and neglect.

• Lack of national standards for child autopsies or death investigations.

• The different roles child protective services (CPS) agencies in different jurisdictions play in the investigation process.

• The use in some States of medical examiners or elected coroners who do not have specific child abuse and neglect training.

To address some of these inconsistencies, multidisciplinary/multi-agency child fatality review teams have emerged to provide a coordinated approach to the investigation of child deaths. These teams, which now exist at a State, local, or State/local level in every State and the District of Columbia², are comprised of prosecutors, coroners or medical examiners, law enforcement personnel, CPS workers, public health care providers, and others. Child fatality review teams offer many benefits, including improved interagency communication, identification of gaps in community child protection systems, and the development of data information systems that can guide agency policy and practice (National Center on Child Fatality Review, 2003).

The teams review cases of child deaths and facilitate appropriate follow-up. Follow-up may include ensuring that services are provided for surviving family members, providing information to assist in the prosecution of perpetrators, and developing recommendations to improve child protection and community support systems.

How Can These Fatalities be Prevented?

When addressing the issue of child maltreatment, and especially child fatalities, prevention is a recurring theme. Well-designed, properly organized child fatality review teams appear to offer hope for defining the underlying nature and scope of fatalities due to child abuse and neglect. The child fatality review process helps identify risk factors that may assist prevention professionals, such as those engaged in home visiting and parenting education, to prevent future deaths.

In 2003, the Office on Child Abuse and Neglect, within the Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services, launched a Child Abuse Prevention Initiative to raise awareness of the issue in a much more visible and comprehensive way than ever before. The Prevention Initiative is an opportunity to work together in communities across the country to keep children safe, provide the support families need to stay together, and raise children and youth to be happy, secure, and stable adults. For more information, visit the Prevention Initiative Web site at http://nccanch.acf.hhs.gov/topics/prevention/index.cfm.

Summary

While the exact number of children affected is uncertain, child fatalities due to abuse and neglect remain a serious problem in the United States. Fatalities disproportionately affect young children and are most often caused by one or both of the child's parents. Child fatality review teams appear to be among the most promising current approaches to responding to and preventing child abuse and neglect fatalities.

References

Crume, T., DiGuiseppi, C., Byers, T., Sirotnak, A., & Garrett, C. (2002). Underascertainment of child maltreatment fatalities by death certificates, 1990-1998. Pediatrics (110) 2. http://pediatrics.aappublications.org/cgi/reprint/110/2/e18.pdf (PDF 76KB).

Herman-Giddens, M., Brown, G., Verbiest, S., Carlson, P., Hooten, E., Howell, E., & Butts, J. (1999). Underascertainment of child abuse mortality in the United States. Journal of the American Medical Association (282) 5. 463-467.

National Center on Child Fatality Review. A 'How To' Guide for Child Fatality Review Teams. Accessed April 2004 from www.ican-ncfr.org/documents/How_To.pdf (PDF 243KB).

National Clearinghouse on Child Abuse and Neglect Information. (2003). Child fatalities resource listing. Accessed April 2004 from http://nccanch.acf.hhs.gov/pubs/reslist/rl_dsp.cfm?subjID=19.

U.S. Advisory Board on Child Abuse and Neglect. (1995). A nation's shame: Fatal child abuse and neglect in the United States. Washington, DC: U.S. Department of Health and Human Services.

U.S. Department of Health and Human Services, Children's Bureau. (2004). Child maltreatment 2002. Washington, DC: U.S. Government Printing Office.

For More Information

Keeping Kids Alive: The MCH (Maternal and Child Health) Center for Child Death Review
Phone: (517) 324-7330 or (800) 656-2434
Web site: www.childdeathreview.org

National Center on Child Fatality Review
Phone: (626) 455-4586
Web site: http://ican-ncfr.org

National Fetal-Infant Mortality Review Resource Center
Phone: (202) 863-2587
E-mail: nfimr@acog.org
Web site: www.acog.org/goto/nfimr

¹ This fact sheet provides information regarding child deaths as a result of abuse or neglect by a parent or primary caregiver. Other child homicides, such as those committed by acquaintances and strangers, and other causes of death, such as unintentional injuries, are not discussed here. For information about leading causes of child death, visit the Centers for Disease Control and Prevention Web site at http://webapp.cdc.gov/sasweb/ncipc/leadcaus10.html. Statistics regarding child homicide can be obtained from the U.S. Department of Justice at http://www.ojp.usdoj.gov/bjs/homicide/homtrnd.htm. back
² For information about child fatality review efforts in your State, visit the National Center on Child Fatality Review Web site at www.ican-ncfr.org/state_links.shtml. back