How Many Children are Maltreated? - Deaths From Child Maltreatment

fatalities certificates fatality abuse

Child fatality is the most severe result of abuse and neglect. In 2002 CPS and other state agencies, including coroners' offices and fatality review boards, reported an estimated 1,390 deaths from child maltreatment, up from 1,373 deaths in 2001 and 1,306 deaths in 2000. The 2002 national fatality rate was nearly two deaths per one hundred thousand children in the general population. The District of Columbia reported the highest rate (11.6 per one hundred thousand), followed by West Virginia (7.5 per one hundred thousand) and Missouri (3.8 per one hundred thousand). (See Table 4.3.)

Children younger than four years of age accounted for a majority (76.1%) of deaths. Of these, infants younger than a year old comprised 41.2% of the fatalities.

FIGURE 4.4

More males under age one (18.8 per one hundred thousand boys of the same age) died from maltreatment than did females under age one (12.4 per one hundred thousand girls of the same age). Very young children are more likely to be victims of child fatalities because of their small size, their dependency on their caregivers, and their inability to defend themselves.

Neglect alone was responsible for more than one-third (37.6%) of maltreatment deaths. More than onequarter (29.9%) of fatalities resulted from physical abuse. Another 28.9% of fatalities resulted from a combination of maltreatment types. (See Figure 4.6.) States also provided data on the victims' prior contact with CPS agencies. About 12% of the victims' families had received family preservation services during the five years before the deaths occurred.

Perpetrators of Fatalities

The 2002 report showed nearly four of five maltreatment deaths (78.9%) were inflicted by one or both parents of the victims. Mothers alone accounted for about one-third (32.6%) of the deaths, while fathers were the perpetrators in 16.6% of the deaths. In about one-fifth (19.2%) of cases, both parents were responsible for causing their children's death.

According to the National Clearinghouse on Child Abuse and Neglect Information (Child Abuse and Neglect Fatalities: Statistics and Interventions, Washington, DC, 2004), persons who commit fatal child abuse are often younger adults in their mid-twenties who did not finish high school and are living at or below the poverty level. They are likely to suffer from depression and are unable to cope with stress.

FIGURE 4.5

FIGURE 4.6

Child Fatality Review Teams

Historically, law enforcement, child protection agencies, and public health agencies worked separately in investigating child maltreatment deaths. In response to the increasing number of child deaths, all states have created multidisciplinary child fatality review teams to investigate the deaths and develop solutions to support families in crisis. These teams consist of prosecutors, medical examiners, law enforcement personnel, CPS personnel, health care providers, and other professionals.

State teams are formed to work with local teams, which are responsible for the management of individual cases. The number of child deaths reviewed by a local team depends on the county size. A local team in a large county may review just cases referred by the medical examiner, while a team in a smaller county may review child deaths from all causes.

TABLE 4.3

Child fatalities due to abuse, 2002
State Child population Child file and SDC fatalities Agency file fatalities Total child fatalities Fatalities per 100,000 children
Notes: SDC is Summary Data Component.
A national estimate of 1,400 fatalities was derived by multiplying the national rate of 1.98 by the total population—total population for all 51 states equals 72,894,483—and dividing by 100,000. The estimate was then rounded to the nearest 100.
SOURCE: "Table 4-1. Child Fatalities, 2002," in Child Maltreatment 2002, U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, Children's Bureau, 2004, http://www.acf.hhs.gov/programs/cb/publications/cm02/cm02.pdf (accessed October 27, 2004)
Alabama 1,107,108 29 29 2.62
Alaska 192,428 1 1 0.52
Arizona 1,476,856 21 21 1.42
Arkansas 677,522 13 13 1.92
California1 9,452,391 129 129 1.36
Colorado 1,151,118 25 25 2.17
Connecticut 872,853 9 2 11 1.26
Delaware 189,698 0 0 0 0.00
District of Columbia 112,128 7 6 13 11.59
Florida 3,882,271 97 97 2.50
Georgia 2,268,477 51 51 2.25
Hawaii 295,514 7 7 2.37
Idaho 370,439 2 2 0.54
Illinois 3,254,523 70 70 2.15
Indiana 1,594,857 58 58 3.64
Iowa 698,045 15 15 2.15
Kansas 696,519 1 1 0.14
Kentucky 931,588 23 23 2.47
Louisiana 1,185,674 37 37 3.12
Maine 279,058 0 3 3 1.08
Maryland 1,379,925 33 33 2.39
Massachusetts 1,463,340 17 17 1.16
Michigan
Minnesota 1,252,125 16 16 1.28
Mississippi 760,747 7 7 0.92
Missouri 1,397,461 52 1 53 3.79
Montana 216,320 4 4 1.85
Nebraska 439,393 6 7 13 2.96
Nevada 572,590 3 3 0.52
New Hampshire 308,371 0 0 0.00
New Jersey 2,127,391 22 8 30 1.41
New Mexico 500,506 3 3 0.60
New York 4,613,251 68 68 1.47
North Carolina 2,068,840 26 26 1.26
North Dakota 146,812 2 2 1.36
Ohio 2,879,927 72 72 2.50
Oklahoma 873,560 23 23 2.63
Oregon 855,107 21 21 2.46
Pennsylvania 2,863,452 49 3 52 1.82
Rhode Island 239,248 1 1 0.42
South Carolina 979,163 13 3 16 1.63
South Dakota 195,625 5 5 2.56
Tennessee 1,404,661 18 18 1.28
Texas 6,102,316 206 206 3.38
Utah 713,012 12 12 1.68
Vermont 139,662 0 0 0 0.00
Virginia 1,779,408 22 22 1.24
Washington 1,513,360 1 14 15 0.99
West Virginia 389,171 13 16 29 7.45
Wisconsin 1,338,064 14 14 1.05
Wyoming 122,344 3 3 2.45
Total 70,324,219 1,097 293 1,390
Rate 1.98
Number Reporting 50 43 19 50 50

Are Child Maltreatment Fatalities Properly Reflected in Death Certificates?

Although child fatality review teams have been formed in every state and the District of Columbia, NCANDS remains the sole national system that tracks child maltreatment deaths, typically just those cases that reach CPS. Experts believe that there are likely more deaths each year due to child abuse and neglect than are reported to CPS and other agencies. According to researchers Tessa L. Crume, Carolyn DiGuiseppi, Tim Byers, Andrew P. Sirotnak, and Carol J. Garrett, although the federal government had concluded in 1993 that death certificates underreported child maltreatment fatalities, to date it has not done anything to remedy the problem. To determine whether child maltreatment is ascertained in death certificates, the researchers compared data collected by a child fatality review committee (CFRC) on child fatalities in Colorado between 1990 and 1998 with the death certificates issued for those fatalities ("Underascertainment of Child Maltreatment Fatalities by Death Certificates, 1990–1998," Pediatrics, vol. 110, no. 2, August 2002).

Crume and her colleagues found that only half of the maltreatment deaths were ascertained by death certificates. Of the 295 deaths confirmed by the CFRC to have resulted from maltreatment, just 147 were noted in the death certificates as such. Female children and non-Hispanic African-American children were more likely to be linked to higher ascertainment in the death certificates. Maltreatment was also more likely to be confirmed as the contributing factor when the death involved violence, such as bodily force, the use of firearms, or the use of sharp or blunt objects. A lower proportion of deaths (less than 20%) was attributed to less obvious child maltreatment, including neglect and abandonment.

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