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.

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

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

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.