Fatal Child Abuse Research Articles

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)

The spectrum of intent in fatal child abuse

The spectrum of intent in fatal child abuse

The Spectrum of Intent in Fatal Child Abuse

To the Editor. —We want to correct the reference to our estimate of the magnitude of fatal child abuse and neglect made in the Special Communication entitled Origins and Clinical Relevance of Child Death Review Teams. 1 A report on our complete work, a joint effort of the Centers for Disease Control and the University of Missouri School of Medicine, will soon be published in Pediatrics . Using cause-of-death data, Federal Bureau of Investigation data, the Missouri Child Fatality Study, and the results from other research, we estimated that, from 1979 to 1988, the annual number of child abuse and neglect fatalities averaged between 949 and 2022. The Special Communication attributes the following to us: Over 1000 American children die each year of intentional [our emphasis] injuries at the hands of a caretaker. It was not our wish to suggest that these fatalities are either intentional or unintentional. We believe that

The Spectrum of Intent in Fatal Child Abuse-Reply

<h3>In Reply.</h3> —McClain et al state that they did not use the word "intentional" to describe their data on child abuse and neglect, thereby raising an important issue about nomenclature. Their estimate may include cases that are "completely unintentional." They state that "it is not as important to assign blame as it is to identify addressable risk factors." We regret this misquote but are left with a dilemma. What terms should be used to differentiate fatal child abuse and neglect from child deaths unrelated to abuse or neglect? Perhaps it would be more useful to address the "responsibility" of behavior rather than the "intent" of thought. This still leaves us with a judgment as to what distinguishes an individual case of fatal child abuse and neglect from other deaths. For an individual case we may still want to address our judgment of the caretaker's apparent intent as we make our

Child maltreatment as a community problem

This report reviews research on the community dimensions of child maltreatment and presents a study conducted in the United States designed to illuminate further the importance of social environmental effects on family functioning. The study involves 77 community areas within the Chicago, Illinois, metropolitan area. Child maltreatment rates are related to indicators ofsocioeconomic and demographic well being for these neighborhoods and for the subunits within them. The results reveal a strong influence of socioeconomic and demographic factors on child maltreatment rates. A further analysis involves selecting pairs of neighborhoods for additional study. In this phase of the research the character of socioeconomically similar areas with contrasting patterns of child maltreatment is revealed. The high-risk areas are characterized by social disorganization and lack of social coherence, in contrast to the low-risk areas which evidence a stronger social fabric. These effects extend to differences in child abuse fatalities.

Active surveillance of child abuse fatalities

Monitoring abuse related deaths of infants and young children yields information necessary to the formulation of sound public policy. Birth and death certificates were correlated with information in the state Child Abuse and Neglect Registry on 104 abuse related fatalities. Significant findings include: very young age of parents at the first pregnancy; high rate of single parenthood; significantly lower educational achievement of victims' mothers; late, inadequate prenatal care; complications during pregnancy; and low birth weight among victims. The authors suggest Active Surveillance as a model for collecting information pertaining to child fatalities. Using Active Surveillance, a review team examines information from state agencies pertaining to children and families to review or determine cause of death and to collect demographic data on victims and perpetrators. Active Surveillance decreases the possibility of misidentifying abuse related deaths as accidental, and allows state agencies to follow abuse fatalities, collecting pertinent information and adjusting policy accordingly. The authors argue that, using Active Surveillance, states and nations may monitor success in preventing child abuse fatalities just as they now use infant mortality to monitor progress in public health, thus creating a stable and reliable standard for measuring progress in eliminating one type of child abuse.

When vocabularies of motive fail: The example of fatal child abuse

Many social theorists emphasize people's capacity for empathic understanding, shared meanings, and forgiveness. They argue that norm violators can achieve social redemption by offering excuses and justifications. The findings from this study show that this is not always true. Evidence from the case records of caretakers accused of killing their children showed that the majority did not try to explain their actions by invoking excuses and justifications. They either pretended they had no idea what happened to the child or constructed a fictional cause of the child's death which made themselves appear innocent. The minority who attempted to explain why they killed a child received little or no forgiveness. These findings show that some norm violations cannot be translated into acceptable vocabularies of motive.

Child maltreatment fatalities.

Child maltreatment fatalities.

Child Abuse by Drowning

Drowning as a form of subtle fatal child abuse is difficult to distinguish from accidental immersion or from sudden unexpected natural death when the circumstances of immersion are concealed. Homicidal drownings are unwitnessed, usually occurring in the home, and the victims are young, either infants or toddlers. Accidental drownings are more likely to involve toddlers or older children in public areas such as swimming pools, drainage ditches, lakes, and rivers. This is especially true in rural areas. In cities, bathtubs remain a major site of accidental childhood drownings. Perpetrators of deliberate drownings often fit the sociopathologic profile of a child abuser. Because there is often a survival interval between immersion and death, pathologic findings consistent with postimmersion syndrome suggest the cause of death. Foreign material in the lungs, if immersion was other than in clear tap water, and injuries of the face are other positive correlating factors. A thorough investigation of the circumstances and cooperation between the investigating agency and the pathologist are essential to determine the correct manner of death in these cases.

Crack and fatal child abuse

Crack and fatal child abuse

Crack and Fatal Child Abuse

To the Editor.— Crack, a preprocessed cocaine alkaloid, emerged in the Bahamas in 1983. 1 In late 1985, crack became available on the streets of New York City. 2 This potent, highly addictive smokable form of cocaine has been associated with physical complaints as well as psychiatric complaints that include depression, irritability, paranoia, and violent behavior. 3 The incidence of child abuse and neglect is known to be higher in families in which parents or caretakers are alcoholics or narcotic addicts. Reporting of child abuse and neglect has increased nationally 212% from 1976 to 1986 to more than 2 million cases a year. The number of fatalities also has risen. 4 At our hospital, since March 1988 we have seen three unrelated patients, ages 1 month, 2 years, and 3 years, as victims of fatal child abuse from battering. In two of the cases crack was specifically noted to have

Caffeine Toxicity: A Case of Child Abuse by Drug Ingestion

The case of a 14-month-old child who died of caffeine toxicity is presented. The evidence for prolonged toxicity associated with inappropriate delay in the seeking of medical care and the presence of various recent and healing injuries are diagnostic of child abuse. Fatal caffeine toxicity and child abuse by drug/substance administration are uncommonly reported. Relevant medical literature is reviewed.

Incarcerated mothers' perceptions and interpretations of their fatally maltreated children

Fatally maltreated children are an elusive component in the complex interaction that has led to their premature deaths. Retrospective research with women imprisoned for fatal child maltreatment indicated recurring themes of maternal interpretations of their children as rejecting and developmentally abnormal, either advanced or delayed. Separations and difficulties during reunions were critical. The fatality was not a one-time event, but the exit point of a recurrent cycle of abusive interaction.

Violent Death in Children in a Metropolitan County: Changing Patterns of Homicide, 1958 to 1982

Death rates from homicide in children younger than 15 years of age in the United States have increased during the last 30 years. Previous studies have suggested a typology consisting of fatal child abuse in young children and community violence in older children. We reviewed the data from the Cuyahoga County, Ohio, coroner's office pertaining to homicides in children less than 15 years of age between 1958 and 1982 and obtained similar findings. The homicide rates for city children increased from 1.1 to 6.7/100,000 in the first 20 years and then stabilized. Nonwhite boys had the highest death rates except in one period. Assailants were usually adolescent and young adult men of the same race; however, 43% of children less than 5 years of age were killed by women. The older the child, the more likely the homicide was to have been committed by a nonrelative, outside of the home, and with a firearm. Overall, firearms are the leading cause of homicide (36.2%). The temporal characteristics of child homicides are also described.

Criminal disposition of persons involved in 72 cases of fatal child abuse.

Seventy-two cases of fatal child abuse were studied to determine the numbers of cases in which charges were filed, indictments returned, and convictions obtained. The sentences given and amount of time served were also examined. All of the cases reviewed involved children six years of age or under who were in the care of their parent(s) or substitute caretaker(s) when the injuries or conditions occurred which resulted in their deaths. Charges were filed in less than one-half of the cases, and convictions were obtained in less than one-third of these cases. The sentences given and actual time served varied considerably. The results of the present study illustrate the need for improved training of medical personnel, law enforcement officials and prosecuting attorneys in the investigation and prosecution of cases of fatal child abuse.

Multitherapeutic approach to clinical treatment for a child at risk for maternal filicide

ABOUT ONE-QUARTER of all victims of homicide in England and Wales are children under 16 years of age and parents are responsible for 81% of this number reports Gibson [1]. Christoffel and Liu [2] state that 3% of U.S. deaths in the 1- to 4-year-age group are due to homicide; from another perspective, the U.S. infant homicide rate in their study is 5.3 per 100,000 live births. In recent years in the U.S., child homicide has been among the five leading causes of death in early childhood [3]. International data on fatal child abuse [4], show a world-wide distribution. Clearly homicide in childhood is a major problem. This paper describes a case illustrating a multitherapeutic approach to the clinical treatment of a family with a child at risk for maternal filicide, followed by a discussion of the empirical basis and characteristics of such an approach.

Childhood histories of women imprisoned for fatal child maltreatment

A history of childhood maltreatment is the most consistently reported characteristic of abusive parents. Retrospective research with nine women imprisoned for fatal child abuse revealed childhood histories of maltreatment. Detailed life histories indicated that the meaning of the abuse to the individual had an important impact on later abusive parenting. The types of childhood abuse varied. Childhood abuse was one in a set of factors contributing to abusive parenting. Retrospective studies underline the need for prospective research on long-term outcomes of childhood abuse.

Fatal child abuse

The purpose of the present study was to identify demographic variables and medical causes of death associated with child deaths, secondary to abuse, at one pediatric hospital. Abuse and neglect reporting forms, social service records, and autopsy reports were reviewed. A total of 72 known deaths occurred between 1965 and 1984. The majority of children were under two years of age, and the most common cause of death was head trauma. Less than one half of the children who died presented to the emergency department with visible signs of injury. Male abusers outnumbered females; boyfriends of the victims' mothers were the most frequent perpetrators. Emergency department personnel should have a high index of suspicion about abuse in cases of inadequately explained conditions in children. All cases of children who die unexpectedly, or from inadequately explained conditions, should be referred to the coroner, and autopsies should be performed.

Fatal child abuse

Fatal child abuse