Children are one of the most vulnerable groups in our society. Child fatalities due to maltreatment represent the worst case scenario in attempts to protect children. Despite the efforts of the child protection system, child fatalities remain a serious problem. Although the untimely deaths of children due to illness and accidents have been closely monitored, the same cannot be said of children who have died as the result of physical assault or severe neglect. Intervention strategies targeted at resolving this problem face complex challenges.

ld Fatalities Due to Maltreatment Are Increasing

Although child deaths caused by abuse and/or neglect are relatively infrequent, the rate of child maltreatment fatalities, confirmed by Child Protective Services (CPS) to have been the result of child maltreatment, has steadily increased over the last decade. The National Child Abuse and Neglect Data System (NCANDS) reported that in 1997 there were an estimated 1,196 child fatalities, or 1.7 children per 100,000 in the general population. (This estimate was based on reports from 41 States that reported a total of 967 fatalities.) The U.S. Advisory Board on Child Abuse and Neglect in A Nation's Shame: Fatal Child Abuse and Neglect in the United States, reported that a more realistic estimate of annual child deaths as a result of abuse and neglect, both known and unknown to CPS agencies, is about 2,000, or approximately five children per day. Experts such as Ryan Rainey from the National Center for Prosecution of Child Abuse believe that the number of child deaths from maltreatment per year may be as high as 5,000.

The Actual Number of Child Fatalities May Be Underreported

Determining the actual numbers of children who die annually from abuse is complex. Many researchers and practitioners believe that child fatalities are underreported because some deaths labeled as accidents, child homicides, and/or Sudden Infant Death Syndrome (SIDS) might be attributed to child maltreatment if more comprehensive investigations were conducted. It is difficult to distinguish a child who has been suffocated from a child who has died as a result of SIDS, or a child who was dropped, pushed, or thrown from a child who dies from a legitimate fall. Some researchers and practitioners have gone so far as to estimate that there may be twice the number of deaths as a result of abuse and/or neglect as are reported by NCANDS if cases unknown to CPS agencies are included.

There is a Lack of Standard Terminology for Child Fatalities

To further complicate the issue, different terminology is used to discuss child fatalities, sometimes interchangeably. NCANDS defines "child fatality" as a child dying from abuse or neglect, because either (a) the injury from the abuse or neglect was the cause of death, or (b) the abuse and/or neglect was a contributing factor to the cause of death. Researchers such as Finkelhor and Christoffel use the term "child abuse homicide" to define a childhood death resulting from maltreatment (either assault or neglect) by a responsible caretaker. Law enforcement and criminal justice agencies also use the term "child abuse homicide," but their definition, while including the caretaker as perpetrator, also includes the "criminal act of homicide by non-caretakers" (death at the hands of another, felony child endangerment, and criminal neglect). More specifically, the term "infanticide" is increasingly used to define the murdering of children younger than 6 or 12 months by their parents.

Young Children are the Most Vulnerable

Research supports that very young children (age 5 and younger) are the most frequent victims of child fatalities. NCANDS data for 1997 from a subset of States demonstrated that children 3 or younger accounted for 77 percent of fatalities. This population is the most vulnerable for many reasons including their small size and inability to defend themselves. The fatal abuse usually occurs in one of two ways: repeated abuse and/or neglect over a period of time (battered child syndrome) or in a single, impulsive incident of assault (drowning, suffocating, or shaking the baby, for example).

Primary Caretakers are the Most Frequent Perpetrators

No matter how the fatal abuse occurs, one fact of great concern is that most of the perpetrators are, by definition, primary caretakers such as parents and other relatives.

Though there is no single profile for the perpetrator of fatal child abuse, there are consistent characteristics that reappear in studies. Frequently the perpetrator is a young adult in his/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.

The Response to Fatal Child Abuse or Neglect Is Complex

The response to the problem is often hampered by inconsistencies:

The inaccurate reporting of the number of children who die each year as a result of abuse and neglect
The lack of national standards for child autopsies or death investigations
The different roles that CPS agencies play in the investigation process
The use in many States of an elected coroner who is not required to have any medical or child abuse and neglect training rather than a medical examiner.
Child Fatality Review Teams

To address some of these inconsistencies, multidisciplinary/multiagency Child Fatality Review Teams have emerged in many States to provide a coordinated approach to the investigation of child deaths. These teams are comprised of prosecutors, coroners or medical examiners, law enforcement personnel, CPS workers, public health care providers, and others.

The teams review cases of child deaths and facilitate appropriate follow-up. The follow-up may include assuring 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. In addition, teams can assist in determining avenues for prevention efforts and improving training for front-line workers. Well-designed, properly organized Child Fatality Review Teams appear to offer the greatest hope for defining the underlying nature and scope of fatalities due to child abuse and neglect and for offering solutions.

Prevention Services Are Key

When addressing the issue of child maltreatment, and especially child fatalities, prevention is a recurring theme. In 1995, the U.S. Advisory Board on Child Abuse and Neglect recommended a universal approach to the prevention of child fatalities that would reach out to all families through the implementation of several key strategies. These efforts would begin by providing services such as home visitation by trained professionals or paraprofessionals, hospital-linked outreach to parents of infants and toddlers, community-based programs designed for the specific needs of neighborhoods, and effective public education campaigns.

REFERENCES

Christoffel, K.K. (1992). Child abuse fatalities. In S. Ludwig, & A.E. Kornberg. (Eds.), Child abuse. A medical reference (2nd ed.). New York: Churchill Livingstone, Inc.

Department of Justice. Office of Juvenile Justice and Delinquency Programs. (1994, February 16-17). Child fatality review teams: A multi-agency approach. (Participant Guide). National Training Teleconference.

Finkelhor, D. (1997). In G. Kaufman Kantor, & J. Jasinski (Eds.), Out of the darkness: Contemporary perspectives on family violence. Thousand Oaks, CA: Sage Publications.

Kaplan S.R. (1996). Child fatalities and child fatality review teams. Washington, DC: ABA Center on Children and the Law.

Lewit, E.M. (1994). Reported child abuse and neglect. In The future of children (Sexual Abuse of Children),(4)2.

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.

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U.S. Department of Health and Human Services, Children's Bureau. (1999). Child maltreatment 1997: Reports from the states to the national child abuse and neglect data system. Washington, DC: U.S. Government Printing Office.

National Center on Child Abuse and Neglect. (1992). National child abuse and neglect data system: 1990 summary data component, Working Paper 1. Washington, DC: U.S. Department of Health and Human Services.

Walsh, B. (1994). Section II: Criminal Investigation of Physical Abuse and Neglect. In J. Briere, L. Berliner, J.A. Bulkley, C. Jenny, & T. Reid (Eds.), The APSAC handbook on child maltreatment. Chicago, IL: American Professional Society on the Abuse of Children (APSAC).

Wang, C.T., & Daro, D. (1998). Current trends in child abuse reporting and fatalities: The results of the 1997 Annual Fifty State Survey. Chicago, IL: National Committee to Prevent Child Abuse.

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