Child Abuse Deaths Research Articles

Underascertainment of child abuse mortality in the United States.

Mortality figures in the United States are believed to underestimate the incidence of fatal child abuse. To describe the true incidence of fatal child abuse, determine the proportion of child abuse deaths missed by the vital records system, and provide estimates of the extent of abuse homicides in young children. Retrospective descriptive study of child abuse homicides that occurred over a 10-year period in North Carolina from 1985-1994. The Medical Examiner Information System was searched for all cases of children younger than 11 years classified with International Classification of Diseases, Ninth Revision codes E960 to E969 as the underlying cause of death and homicide as the manner of death. A total of 273 cases were identified in the search and 259 cases were reviewed after exclusion of fetal deaths and deaths of children who were not residents of North Carolina. Child abuse homicide. Of the 259 homicides, 220 (84.9%) were due to child abuse, 22 (8.5%) were not related to abuse, and the status of 17 (6.6%) could not be determined. The rate of child abuse homicide increased from 1.5 per 100000 person-years in 1985 to 2.8 in 1994. Of all 259 child homicides, the state vital records system underrecorded the coding of those due to battering or abuse by 58.7%. Black children were killed at 3 times the rate of white children (4.3 per 100000 vs 1.3 per 100000). Males made up 65.5% (133/203) of the known probable assailants. Biological parents accounted for 63% of the perpetrators of fatal child abuse. From 1985 through 1996, 9467 homicides among US children younger than 11 years were estimated to be due to abuse rather than the 2973 reported. The ICD-9 cause of death coding underascertained abuse homicides by an estimated 61.6%. Using medical examiner data, we found that significant underascertainment of child abuse homicides in vital records systems persists despite greater societal attention to abuse fatalities. Improved recording of such incidences should be a priority so that prevention strategies can be appropriately targeted and outcomes monitored, especially in light of the increasing rates.

Evaluating child homicide inquests as a learning process: A social constructionist analysis of a Canadian experience

The death of a child who is known to protection agencies is perhaps the gravest critical incident affecting child welfare today. The media coverage that these tragedies receive has fuelled public demand for solutions to this social problem. In response, several countries have conducted judicial or public investigations into child homicide deaths. However, there has been very little critical analysis of these proceedings as a learning or problem-solving process. This paper suggests that a social constructionist understanding of organizations as cultures provides a useful perspective from which to conduct an inquest into the inquest process itself. This framework is applied to a Coroner's inquest held in Ontario, Canada, in 1997. Under such an analysis, the inquest proceedings are seen to be a “storying of experience”, not an impartial and comprehensive exploration of the facts. It is argued that the interpretation of the child abuse death was limited by a bureaucratic orientation. While this orientation did result in a number of promising solutions, the solutions that were emphasized tended to be those which reflected the paradigms, practices and needs of the dominant stakeholders in these proceedings. The potential dangers of several of the resulting recommendations are considered. An acknowledgement of the subjectivity inherent in current inquests, coupled with a deliberate effort to integrate insights from other paradigms and perspectives would be a critical first step toward improving our understanding of how to prevent child homicide deaths. The paper ends with several recommendations.

A proposed system for reviewing child abuse deaths

Child Abuse ReviewVolume 7, Issue 4 p. 280-286 Meeting Notes A proposed system for reviewing child abuse deaths Peter Reder, Corresponding Author Peter Reder Consultant Child Psychiatrist Riverside Mental Health Trust, LondonCentre for Relationship Studies, Riverside Mental Health Trust, 1 Wolverton Gardens, London W6 7DYSearch for more papers by this authorSylvia Duncan, Sylvia Duncan Consultant Clinical Psychologist Baker and Duncan Child Care Consultants, Woking, SurreySearch for more papers by this author Peter Reder, Corresponding Author Peter Reder Consultant Child Psychiatrist Riverside Mental Health Trust, LondonCentre for Relationship Studies, Riverside Mental Health Trust, 1 Wolverton Gardens, London W6 7DYSearch for more papers by this authorSylvia Duncan, Sylvia Duncan Consultant Clinical Psychologist Baker and Duncan Child Care Consultants, Woking, SurreySearch for more papers by this author First published: 05 January 1999 https://doi.org/10.1002/(SICI)1099-0852(199807/08)7:4<280::AID-CAR489>3.0.CO;2-7Citations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume7, Issue4July/August 1998Pages 280-286 RelatedInformation

Child abuse and sudden infant death syndrome.

Ann Botash reviews the current literature regarding the association of retinal hemorrhage and subarachnoid bleeds in infants who have suffered head trauma. Particular emphasis is placed on differentiating these findings from those in children who suffer other forms of trauma, especially cardiopulmonary resuscitation. The office practitioner needs appropriate skills in performing careful retinal examination and when to refer patients to an ophthalmologist for specific evaluation. The current literature on sudden infant death syndrome is reviewed in this section by Steven Blatt and Victoria Meguid. Specific studies about sleep position are analyzed and the rationale for the "back to sleep" movement is explained from a physiologic standpoint. The impact of maternal smoking and poor prenatal care is also reviewed in the form of a number of epidemiologic studies. It is important for the clinician to recognize that there is often a fine line differentiating sudden infant death syndrome and infanticide. The pediatrician needs to be aware of the importance of careful investigation of death scenes to insure that we are not missing other causes of death in those patients who are labeled as having died of sudden infant death syndrome.

Autism, child abuse, and sudden infant death syndrome.

The current literature regarding the standard and nonstandard therapies for children with autism is reviewed. A long term, comprehensive, individualized, multidisciplinary approach remains the best treatment. Physicians caring for the victims of child abuse are frequently asked to render an opinion regarding soft-tissue bruising. A review of the literature suggests that estimation of the age of a bruise should not rely solely on color, but rather should be the result of careful history, a through physical examination, and possibly laboratory testing. The need for a standardized and systematic approach to sudden infant death syndrome is also reviewed. The psychological effects on the parents following sudden infant death is discussed and reveals maternal anxiety and depression and, to a lesser degree, paternal anxiety and depression following the loss of a child. Currently, sleep position continues to be a risk factor for sudden infant death syndrome, although immunizations may not be.

Child Abuse and Sudden Infant Death

In times past, parents were usually blamed when an infant died suddenly and unexpectedly. A more caring attitude evolved with the adoption of the term ‘cot death’ or ‘sudden infant death syndrome’ (SIDS). Recent research looking at the factors responsible for SIDS has focused on aspects of child care and parental behaviour. Epidemiological studies confirm that several risk factors associated with child maltreatment are also to be found in many families who experience a sudden infant death. Social deprivation and other well-known associated features linked to maltreatment are correlated with sudden death in infancy. It is suggested that both physical abuse (suffocation is the most usual mechanism proposed) and neglect (failure to thrive, failure to recognize and treat illness) are important mechanisms. Infanticide (filicide) has existed widely over past centuries and its continuation in modern times is reflected in the highest murder rates of all age groups in infancy. However, much fatal abuse and neglect remains hidden, as demonstrated from the results of detailed fatality reviews. The evidence linking child abuse and neglect with sudden unexpected death in infancy is reviewed.

Child Abuse and Sudden Infant Death

In times past, parents were usually blamed when an infant died suddenly and unexpectedly. A more caring attitude evolved with the adoption of the term ‘cot death’ or ‘sudden infant death syndrome’ (SIDS). Recent research looking at the factors responsible for SIDS has focused on aspects of child care and parental behaviour. Epidemiological studies confirm that several risk factors associated with child maltreatment are also to be found in many families who experience a sudden infant death. Social deprivation and other well-known associated features linked to maltreatment are correlated with sudden death in infancy. It is suggested that both physical abuse (suffocation is the most usual mechanism proposed) and neglect (failure to thrive, failure to recognize and treat illness) are important mechanisms. Infanticide (filicide) has existed widely over past centuries and its continuation in modern times is reflected in the highest murder rates of all age groups in infancy. However, much fatal abuse and neglect remains hidden, as demonstrated from the results of detailed fatality reviews. The evidence linking child abuse and neglect with sudden unexpected death in infancy is reviewed.

Assessing the needs of siblings following a child abuse death

Child Abuse ReviewVolume 4, Issue 5 p. 382-388 Mental Health NotesFree Access Assessing the needs of siblings following a child abuse death Peter Reder, Peter Reder Consultant Child Psychiatrist in the Child and Family Consultation Centre, Director of the Centre for Relationship Studies, Riverside Mental Health Trust, 1 Wolverton Gardens, London W6 7DQSearch for more papers by this authorGeraldine Fitzpatrick, Geraldine Fitzpatrick Consultant Child Psychiatrist and Clinical Director, Pathfinder Child Mental Health Services, St George's Hospital, LondonSearch for more papers by this author Peter Reder, Peter Reder Consultant Child Psychiatrist in the Child and Family Consultation Centre, Director of the Centre for Relationship Studies, Riverside Mental Health Trust, 1 Wolverton Gardens, London W6 7DQSearch for more papers by this authorGeraldine Fitzpatrick, Geraldine Fitzpatrick Consultant Child Psychiatrist and Clinical Director, Pathfinder Child Mental Health Services, St George's Hospital, LondonSearch for more papers by this author First published: December 1995 https://doi.org/10.1002/car.228Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References Baker, T. (1995). What constitutes reasonable contact? In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Black, D. (1995). Parents who have killed their partner. In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Bowlby, J. (1979). On knowing what you are not supposed to know and feeling what you are not supposed to feel. Canadian Journal of Psychiatry, 24, 403– 408. Coleman, R. and Cassell, D. (1995). Parents who misuse drugs and alcohol. In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. d'Orban, P.T. (1979). Women who kill their children. British Journal of Psychiatry, 134, 560– 571. Fitzpatrick, G. (1995). Assessing treatability. In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Greenland, C. (1987). Preventing CAN Deaths: An International Study of Deaths due to Child Abuse and Neglect. Tavistock, London. Harris Hendricks, J., Black, D. and Kaplan, T. (1993). When Father Kills Mother; Guiding Children Through Trauma and Grief. Routledge, London. James, G. (1994). Study of Working Together ‘Part 8’ Reports. Discussion Report for ACPC Conference 1994. Department of Health, London. Kaplun, D. and Reich, R. (1976). The murdered child and his killers. American Journal of Psychiatry, 133, 809– 813. Reder, P. and Duncan, S. (1995). The meaning of the child. In P. Reder and C. Lucey (Eds), Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Reder, P., Duncan, S. and Gray, M. (1993). Beyond Blame: Child Abuse Tragedies Revisited. Routledge, London. P. Reder and C. Lucey (Eds) (1995). Assessment of Parenting: Psychiatric and Psychological Contributions. Routledge, London. Resnick, P.J. (1969). Child murder by parents: a psychiatric review of filicide. American Journal of Psychiatry, 126, 325– 334. Resnick, P.J. (1970). Murder of the newborn: a psychiatric review of neonaticide. American Journal of Psychiatry, 126, 1414– 1420. Wilkins, A.J. (1985). Attempted infanticide. British Journal of Psychiatry, 146, 206– 208. Citing Literature Volume4, Issue5Special Issue: FREE ACCESS ISSUE on Fatal Child AbuseDecember 1995Pages 382-388 ReferencesRelatedInformation

Assessing the needs of siblings following a child abuse death

Assessing the needs of siblings following a child abuse death

Fatal child abuse—how preventable is it?

AbstractInfant and child homicide rates have remained stable over the last 20 years. They represent the most visible part of the spectrum of fatal child abuse. By contrast, infant mortality and child deaths from accidents and SIDS have all declined. The prevention strategies used to combat these deaths would appear to have been more successful than the protection strategies used against child abuse deaths. International comparisons of infant homicide rates have shown that measures of family stress, available resources and the cultural variables of low status of women and the culture of violence were all associated with increased infant homicide rates. The paper argues for a change in our culture towards children to prevent fatal child abuse. Copyright © 1995 John Wiley &amp; Sons, Ltd.

Closure, covert warnings, and escalating child abuse

Research into prevention of child abuse deaths is notoriously difficult, both clinically and methodologically. Korbin (1989) supports the conclusions of Fontana and Alfaro (1987) that it may not be possible to predict which child maltreatment case might result in a fatality. Our study was retrospective, concerned a selected group of cases and was unable to compare cases in which closure or approaches to professionals did not culminate in a child's death. Nonetheless, it points to particular patterns that occur which may help alert practitioners in the field. It is our hope that clinical research based on these observations will enhance the practice of child protection in the future.

Fatal Child Abuse and Sudden Infant Death Syndrome (SIDS): A Critical Diagnostic Decision

We read with interest Dr Robert Reece's thorough article on "Fatal Child Abuse and Sudden Infant Death Syndrome: A Critical Diagnostic Decision," in the February issue of Pediatrics.1 Ever timely is this issue of the interplay between abuse and SIDS, as Reece and those at the Cleveland Child Protection Program have reported. A decade ago, we presented a paper entitled "SIDS—Child Abuse: Diagnostic Interface."2 The findings were based on both written surveys and follow-up telephone contacts.

Investigation and Review of Unexpected Infant and Child Deaths

A significant proportion of infant and child deaths are preventable. Of the 55 861 deaths of children aged 14 and younger in the United States in 1989, more than three fourths occurred in children under the age of 2 years.1 Approximately one third of the latter were unexpected, including those due to sudden infant death syndrome (SIDS) or trauma, or deaths that were otherwise unexplained. Child abuse deaths occur in greatest numbers among infants, followed by those in toddlers and preschool children.2 Children younger than 6 years of age are most vulnerable to abuse because of their small size, incomplete verbal skills, and often limited contact with adults other than their primary caretakers.3 With few exceptions, throughout the United States there is no uniform system for the investigation of infant and child deaths. Many jurisdictions lack appropriately trained pathologists, interagency collaboration hat would facilitate sharing of information about the family, and a surveillance system to evaluate data regarding infant deaths. As a result, progress in the understanding of SIDS is inhibited, cases of child abuse and neglect may be missed, familial genetic diseases go undiagnosed, public health threats may be unrecognized, and inadequate medical care may be undetected. Lack of adequate infant and child death investigation is an impediment to preventing illness, injury and death of other children at risk. Adequate death investigation requires the participation of numerous individuals including medical examiner/coroner, public health officials, the patient's physician, the pathologist, and personnel from agencies involved with child welfare and social services and law enforcement.

Fatal Child Abuse and Sudden Infant Death Syndrome: A Critical Diagnostic Decision

Distinguishing between an unexpected infant death due to sudden infant death syndrome (SIDS) and one due to fatal child abuse challenges pediatricians, family physicians, pathologists, and child protection agencies. If child abuse is suspected, the physician must fuffill mandated legal obligations to report the case to the appropriate authorities. Coroners, medical examiners, and pathologists have the added responsibility of rendering a medicolegal opinion as to the cause and manner of death. Child protection agencies need to ensure that other children in the home are not at risk. Law enforcement personnel and prosecutors need to proceed if the law has been broken. All agree that the state of our knowledge in this area is incomplete and ambiguity exists in some cases. For everyone concerned, it is necessary and desirable, within the limits of our capability, to know the cause and manner of an infant death. This process requires application of current knowledge, a desire to know the reasons for the deaths, the resources necessary to conduct essential procedures, and the sensitivity and wisdom to perform the task without causing distress to innocent family members. The history relevant to this decision is a relatively short one. In the first half of this century, searching for the reasons infants die was the lonely province of a few clinicians, researchers, and pathologists who examined the retrospective traces of infant deaths. Bergman1 recounts the slow progression of knowledge about sudden unexpected infant death in the pathologists' laboratories and morgues where Werne and Garrow2 and then Adelson and Kinney3 proposed etiologies for "crib death" other than suffocation.

Estimates of Fatal Child Abuse and Neglect, United States, 1979 Through 1988

The results of recent surveys in the United States have suggested a rising tide of fatalities due to child abuse or neglect (CAN). Because these surveys lack consistency in case definition and are incomplete in coverage, the use of death certificate data to estimate the number of CAN deaths was explored. To estimate these deaths among children 0 through 17 years old for 1979 through 1988, three models were formulated, each comprising six coding categories: (1) deaths coded explicitly as due to CAN, (2) homicides, (3) injury deaths of undetermined intentionality, (4) accidental injury deaths, (5) sudden infant death syndrome fatalities, and (6) natural-cause deaths. Research studies and crime data were relied on to estimate the proportions of deaths in categories 2 through 6 that were actually due to CAN, and other assumptions were varied to create a range of estimates. For the 10-year period, the estimated mean annual CAN fatalities ranged from 861 to 1814 for ages 0 through 4, and from 949 to 2022 for ages 0 through 17. Child abuse and neglect death rates did not increase over the period; in fact, they were relatively stable for ages 0 through 17 and showed a modest decline for 0 through 4. Ninety percent of fatal CAN occurs among children younger than 5 years old, and 41% occurs among infants. About 85% of CAN deaths are recorded as due to other causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Children's Homicide as an Indicator of Effective Child Protection: A Comparative Study of Western European Statistics

SUMMARY It is known that the extreme consequence of child abuse is a dead child. Attempts to determine the success of services to prevent child abuse and subsequent deaths confront the problems inherent in trying to prove a negative. The use of an epidemiological approach resolves some of the methodological problems by measuring 'failure' to protect in an examination of children's homicides rates over time. Between 1973 and 1988 it was found that there was a substantial reduction in baby homicides in England and Wales, equivalent to a fall of 61 per cent and a 57 per cent reduction in Scotland. In a comparison with the other fifteen Western European countries, England and Wales topped the league of improvements in children's homicide, and Scotland was fourth. Such improvements suggest advances by the child protection servi ces. Explanations for the positive British results are considered.

Child abuse and cot deaths

A search was made of the Child Protection Register for children with siblings who died of SIDS. The Child Health Department in Southern Derbyshire Health Authority (population 522,000; 7,100 births per year) undertakes confidential inquiries into all child deaths and registered SIDS deaths are noted. This study looked at all children born between January 1, 1984 and June 30, 1988 whose names appeared on the the Child Protection Register as victims of abuse or who were considered to be at risk for abuse. From a cohort of 288 children on the Child Protection Register, one in 30 of the children on the Register had a sibling whose death was registered as caused by SIDS. In Southern Derbyshire there is an association between child abuse and about 10% of deaths of children diagnosed as SIDS.

Pediatric Emergency Nursing

Emergency medical services for children triage physical assessment developmental considerations socio-cultural issues related to the child health care legal issues transportation of the critically injured/ill child child abuse and neglect sexual abuse psychiatric emergencies sudden infant death syndrome newborn care and resuscitation resuscitation of infants, children and adolescents cardiac emergencies cardiac dysrhythmias respiratory emergencies care of the multiply-injured child head, neck and spinal cord trauma musculoskeletal trauma ophthalmic emergencies burns poisonings ear, nose and throat disorders diabetic emergencies haematologic emergencies infectious disease emergencies gastrointestinal emergencies genitourinary emergencies and disorders seizure disorders care of the paediatric organ transplant recipient.

Preventing CAN Deaths: An International Study of Deaths Due to Child Abuse and Neglect

Dr Greenland has performed a major service to the field of child abuse and neglect studies with this very comprehensive work. The ultimate conclusion of the book is that deaths from child abuse can and should be prevented, and the arguments presented to support the conclusion are powerful. The statement is of vital importance at this time when many social workers, some judges and lawyers, and even a few physicians are accepting the inevitability of child abuse deaths as a price that must be paid to avoid excessive invasion of family life. The literature on deaths from child abuse and neglect is reviewed in three national perspectives, the United States, Canada (emphasizing Ontario), and the United Kingdom. Virtually all published studies on the subject from these countries are cited and the analysis and comments of the author are balanced and fair, clearly expressing the many and sometimes divergent viewpoints of

Premature birth and its later effects: Towards preventive intervention

Premature birth is associated with a substantially increased incidence of cognitive-developmental disorders as well as elevated rates of failure-to-thrive syndrome, child abuse, and sudden infant death syndrome. The research supportive of these relationships is reviewed and summarized. This data base strongly suggests that premature birth serves as an early "red flag" which signals risk for later dysfunction. Two types of preventive intervention are discussed: a) prevention of the sequelae of premature birth and b) prevention of premature birth itself. Intervention programs of both types which have been conducted are reviewed. The results of these programs, together with the data base on prematurity, are used as the basis for a set of parameters to guide future intervention efforts.