Child Death Review Research Articles

Developing an understanding of fatal child abuse and neglect: Results from the South African child death review pilot study

Developing an understanding of fatal child abuse and neglect: Results from the South African child death review pilot study

Unintentional asphyxia, SIDS, and medically explained deaths: a descriptive study of outcomes of child death review (CDR) investigations following sudden unexpected death in infancy.

A comprehensive child death review (CDR) program was introduced in England and Wales in 2008, but as yet data have only been analyzed at a local level, limiting the learning from deaths. The aim of this study is to describe the profile of causes and risk factors for sudden unexpected death in infancy (SUDI) as determined by the new CDR program. This was a descriptive outcome study using data from child death overview panel Form C for SUDI cases dying during 2010-2012 in the West Midlands region of England. The main outcome measures were: cause of death, risk factors and potential preventability of death, and determination of deaths probably due to unintentional asphyxia. Data were obtained for 65/70 (93%) SUDI cases. 20/65 (31%) deaths were initially categorized as due to medical causes; 21/65 (32%) as SIDS; and 24/65 (37%) as undetermined. Reanalysis suggested that 2/21 SIDS and 7/24 undetermined deaths were probably due to unintentional asphyxia, with 6 of these involving co-sleeping and excessive parental alcohol consumption. Deaths classified as "undetermined" had significantly higher total family and environmental risk factor scores (mean 2.6, 95% CI 2.0-3.3) compared to those classified as SIDS (mean 1.6, 95% CI 1.2-1.9), or medical causes for death (mean 1.1, 95% CI 0.8-1.3). 9/20 (47%) of medical deaths, 19/21 (90%) SIDS, and 23/24 (96%) undetermined deaths were considered to be potentially preventable. There were inadequacies in medical provision identified in 5/20 (25%) of medically explained deaths. The CDR program results in detailed information about risk factors for SUDI cases but failed to recognize deaths probably due to unintentional asphyxia. The misclassification of probable unintentional asphyxial deaths and SIDS as "undetermined deaths" is likely to limit learning from these deaths and inhibit prevention strategies. Many SUDI occurred in families with mental illness, substance misuse and chaotic lifestyles and most in unsafe sleep environments. This knowledge could be used to better target safe sleep advice for vulnerable families and prevent SUDI in the future.

Child deaths in South Africa: Lessons from the child death review pilot.

South Africa (SA) has not met the child mortality target for the Millennium Development Goals, despite having invested substantially in programmes and policies to achieve these targets. The scale-up of the prevention of mother-to-child transmission programmes reduced HIV transmission from mother to child, but this has not been sustained owing to limitations in community-based child health services.Child mortality has declined, but has now plateaued.Children continue to die from preventable and treatable causes of death.Current data sources are incomplete, and do not provide information on deaths occurring out of health facilities.The child death review (CDR) pilot explores the pattern of child deaths and informs prevention strategies to improve child survival in SA. In this editorial we draw on the conclusions of the CDR pilot,where multiagency teams were established to investigate non-natural and unexpected deaths referred to two mortuary sites in order to strengthen child health and protection response systems and to prevent child deaths.

The South African child death review pilot: A multiagency approach to strengthen healthcare and protection for children.

Child mortality trends in South Africa (SA) show a decrease, but remain high and appear to have plateaued. To attain the new sustainable development goals, we need a better understanding of causes of death and the associated factors. To describe the SA child death review (CDR) pilot, the pattern of child deaths reviewed and the factors associated with these deaths. CDR teams were established at two pilot sites, Salt River mortuary (Western Cape Province) and Phoenix mortuary (KwaZulu-Natal Province). All child deaths were reviewed by a multidisciplinary team at the pilot sites for the period 1 January 2014 - 31 December 2014. The CDR pilot reviewed 711 cases. Over half (53.3%) were natural deaths, as opposed to 42.6% non-natural deaths. Most infant deaths (83.9%) were due to natural causes, while 91.7% of deaths in the 15 - 17-year-old age group were due to injuries. The leading cause of deaths reviewed (30.8%) was respiratory tract infection (RTI), mainly among infants (51.6%). Homicide was the second most common cause of death and affected children of all ages, with the highest burden (52.8%) in the 15 - 17-year age group. Child abuse and neglect accounted for 11.3% of deaths. RTI was shown to be more likely after the neonatal period (odds ratio (OR) 2.92; p<0.000) and in preterm infants (OR 1.98; p=0.005). CDR teams have been effective in improving identification of the causes of out-of-hospital deaths, as well as by identifying remediable factors critical to reducing child deaths further.

Implementation of Child Death Review in the Netherlands: results of a pilot study.

BackgroundChild mortality in the Netherlands declined gradually in the past decades. In total 1130 children and youth aged 0 to 19 years died in 2014 (i.e. 29.4 per 100,000 live births). A better understanding of the background and the circumstances surrounding the death of children as well as the manner and cause of death may lead to preventive measures. Child Death Review (CDR) is a method to systematically analyze child deaths by a multidisciplinary team to identify avoidable factors that may have contributed to the death and to give directions for prevention. CDR could be an addition to further reduce avoidable child deaths in the Netherlands. The purpose of this study is to explore the strengths, weaknesses, opportunities and threats (SWOT) of the pilot-implementation of CDR in a Dutch region. The results are translated in recommendations for future implementation of the CDR method in the Netherlands.MethodsChildren who lived in the pilot region and died aged 29 days after birth until 2 years were, after parental consent, included for reviewing by a regional CDR team. Eighteen logs and seven transcribed records of CDR meetings concerning 6 deceased children were analyzed using Atlas ti. The SWOT framework was used to identify important themes.ResultsThe most important strengths identified were the expertise of and cooperation within the CDR team and the available materials. An important weakness was the poor cooperation of some professional groups. The fact that parents and professionals endorse the objective of CDR was an important opportunity. The lack of statutory basis was a threat.ConclusionsMany obstacles need to be taken away before large-scale implementation of CDR in the Netherlands becomes possible. The most important precondition for implementation is the acceptance among professionals and the statutory basis of the CDR method.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1500-9) contains supplementary material, which is available to authorized users.

Death Scene Investigation and Autopsy Practices in Sudden Unexpected Infant Deaths

To describe and compare sudden unexpected infant death (SUID) investigations among states participating in the SUID Case Registry from 2010 through2012. We analyzed observational data from 770 SUID cases identified and entered into the National Child Death Review Case Reporting System. We examined data on autopsy and death scene investigation (DSI) components, including key information about the infant sleep environment. We calculated the percentage of components that were complete, incomplete, and missing/unknown. Most cases (98%) had a DSI. The DSI components most frequently reported as done were the narrative description of the circumstances (90%; range, 85%-99%), and witness interviews (88%, range, 85%-98%). Critical information about 10 infant sleep environment components was available for 85% of cases for all states combined. All 770 cases had an autopsy performed. The autopsy components most frequently reported as done were histology, microbiology, and other pathology (98%; range, 94%-100%) and toxicology (97%; range, 94%-100%). This study serves as a baseline to understand the scope of infant death investigations in selected states. Standardized and comprehensive DSI and autopsy practices across jurisdictions and states may increase knowledge about SUID etiology and also lead to an improved understanding of the cause-specific SUID risk and protective factors. Additionally, these results demonstrate practices in the field showing what is feasible in these select states. We encourage pediatricians, forensic pathologists, and other medicolegal experts to use these findings to inform system changes and improvements in DSI and autopsy practices and SUID prevention efforts.

Stakeholders' opinions on the implementation of Child Death Review in the Netherlands.

BackgroundThe death of a child is an enormous tragedy for both the family and others involved. A child’s death appeals to everyone’s responsibility to take measures to prevent similar deaths in the future. Child Death Review (CDR) is an interagency approach in which a child’s death is systematically analyzed by a multidisciplinary team. The aim of CDR is to identify avoidable factors that give direction to prevention and to improve death statistics. CDR is not yet implemented in the Netherlands. The purpose of this study is to determine Dutch stakeholders’ opinions regarding the facilitating and impeding factors in the implementation of CDR in the Netherlands.MethodsFour focus groups were conducted: three with professionals who are involved in children’s deaths and one with parents who have lost a child under the age of 2 years. The recorded discussions were transcribed and analyzed using Atlas ti. The facilitating and impeding factors were measured using the measurement instrument for determinants of innovations (MIDI). The MIDI identifies facilitating and impeding determinants associated with the innovation, user, organization and social-political context.ResultsImprovement of the quality of (health) care and obtaining a clear explanation for the child’s death (user and innovation) were identified as benefits of CDR. The emotional burden for professionals and parents and the time implications were considered to be drawbacks of CDR (user and innovation). The multidisciplinary approach (innovation), parental consent and the use of anonimyzed data (user) were considered as facilitators to implementation. Insufficient information (innovation), potential legal consequences for professionals and organizations (user), insufficient ratification by organizations (organization) and confidentiality (social-political context) were identified as impeding implementation.ConclusionsThe determinants identified as facilitating and the recommendations provided to overcome the barriers can be used as input for the strategy for implementation of CDR. A pilot study is necessary to determine to what extent the chosen implementation strategy is effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-016-1966-x) contains supplementary material, which is available to authorized users.

Paediatric suicide in the USA: analysis of the National Child Death Case Reporting System

ImportanceSuicide is a leading cause of death among youths. The relationship between mental health, psychosocial factors and youth suicidality needs further analysis.ObjectiveTo describe paediatric suicide in the USA and the...

Crib Bumpers Continue to Cause Infant Deaths: A Need for a New Preventive Approach

To assess whether clutter (comforters, blankets, pillows, toys) caused bumper deaths and provide an analysis of bumper-related incidents/injuries and their causal mechanisms. Bumper-related deaths (January 1, 1985, to October 31, 2012) and incidents/injuries (January 1, 1990, to October 31, 2012) were identified from the US Consumer Product Safety Commission (CPSC) databases and classified by mechanism. Statistical analyses include mean age, 95% CIs, χ(2) test for trend, and ANOVA with a paired-comparisons information-criterion post hoc test for age differences among injury mechanisms. There were 3 times more bumper deaths reported in the last 7 years than the 3 previous time periods (χ(2)(3) = 13.5, P ≤ .01). This could be attributable to increased reporting by the states, diagnostic shift, or both, or possibly a true increase in deaths. Bumpers caused 48 suffocations, 67% by a bumper alone, not clutter, and 33% by wedgings between a bumper and another object. The number of CPSC-reported deaths was compared with those from the National Center for the Review and Prevention of Child Deaths, 2008-2011; the latter reported substantially more deaths than CPSC, increasing the total to 77 deaths. Injury mechanisms showed significant differences by age (F4,120 = 3.2, P < .001) and were caused by design, construction, and quality control problems. Eleven injuries were apparent life-threatening events. The effectiveness of public health recommendations, industry voluntary standard requirements, and the benefits of crib bumper use were not supported by the data. Study limitations include an undercount of CPSC-reported deaths, lack of denominator information, and voluntary incident reports.

Developing a Revised Typology of Child Homicide

The problem of child homicide continues to be of major concern to researchers, policy makers and child welfare advocates everywhere. In particular, there is debate around the fundamental issues of defining and classifying such deaths. Here, a revised typology of child homicide is developed, by way of an update of the categories of fatal assault first delineated in Lawrence (2004). Taking into consideration significant advances in the field over the past decade, the typology is based primarily upon the developmental stages of the child, with the concept of homicide as the extreme manifestation of aggregate violence and maltreatment also central. The problem is further placed into the context of (1) child death research and review, it being argued that child homicide should ideally be studied as a sub-set of the entire cohort of child deaths for a particular jurisdiction, and (2) child maltreatment generally, in that wherever practicable child homicide research should consider fatalities in conjunction with other serious or near-fatal cases of abuse and neglect.

Responding to child deaths: the work of Australia's Victorian Child Death Review Committee

The Victorian Child Death Review Committee (VCDRC) in Australia is a multidisciplinary Ministerial Advisory Committee established to review the deaths of children either currently child protection clients or known to the statutory child protection system. The Committee provides advice about each child death as well as insights into what are the surrounding patterns and issues. Key to this role is examining the contribution of the service sectors to the protection of children and the routine practices that are in place to respond to children and vulnerability. This paper provides a snapshot of the cases referred to the VCDRC and the key messages for practice drawn from them. What emerges is that often the threshold for when statutory child protection services must be involved in child and family matters can be ambiguous and that agreement about intervention, the level and nature of need or risk, and when cumulative harm and neglect require statutory responses are not always shared between agencies. It is clear that the lack of common frameworks about what constitutes child protection intervention challenges services. It is recommended that there be and used agreed definitions and frameworks to ensure shared understandings and collaborative responses across the service and legal systems.

Cause-specific mortality among children and young adults with epilepsy: Results from the U.S. National Child Death Review Case Reporting System

We investigated causes of death in children and young adults with epilepsy by using data from the U.S. National Child Death Review Case Reporting System (NCDR-CRS), a passive surveillance system composed of comprehensive information related to deaths reviewed by local child death review teams. Information on a total of 48,697 deaths in children and young adults 28days to 24years of age, including 551 deaths with epilepsy and 48,146 deaths without epilepsy, was collected from 2004 through 2012 in 32 states. In a proportionate mortality analysis by official manner of death, decedents with epilepsy had a significantly higher percentage of natural deaths but significantly lower percentages of deaths due to accidents, homicide, and undetermined causes compared with persons without epilepsy. With respect to underlying causes of death, decedents with epilepsy had significantly higher percentages of deaths due to drowning and most medical conditions including pneumonia and congenital anomalies but lower percentages of deaths due to asphyxia, weapon use, and unknown causes compared with decedents without epilepsy. The increased percentages of deaths due to pneumonia and drowning in children and young adults with epilepsy suggest preventive interventions including immunization and better instruction and monitoring before or during swimming. State-specific and national population-based mortality studies of children and young adults with epilepsy are recommended.

Infant Death Scene Investigation

The sudden unexpected death of an infant is a tragedy to the family, a concern to the community, and an indicator of national health. To accurately determine the cause and manner of the infant's death, a thorough and accurate death scene investigation by properly trained personnel is key. Funding and resources are directed based on autopsy reports, which are only as accurate as the scene investigation. The investigation should include a standardized format, body diagrams, and a photographed or videotaped scene recreation utilizing doll reenactment. Forensic nurses, with their basic nursing knowledge and additional forensic skills and abilities, are optimally suited to conduct infant death scene investigations as well as train others to properly conduct death scene investigations. Currently, 49 states have child death review teams, which is an idea avenue for a forensic nurse to become involved in death scene investigations.

Cardiovascular deaths in children: General overview from the National Center for the Review and Prevention of Child Deaths

Cardiovascular conditions rank sixth in causes of death in 1- to 19-year-olds. Our study is the first analysis of the cardiovascular death data set from the National Center for the Review and Prevention of Child Deaths, which provides the only systematic collection of cardiovascular deaths in children. We developed an analytical data set from the National Center for the Review and Prevention of Child Deaths database for cardiovascular deaths in children 0 to 21 years old, reviewing 1,098 cases from 2005 to 2009 in 16 states who agreed to participate. Cardiovascular cases were aged 4.8 ± 6.6 years; 55.3%, ≤1 year; 24.6%, ≥10 years; male, 58%; white, 70.5%; black, 22.3%; Hispanic, 19.5%. Prior conditions were present in 48.5%: congenital heart disease, 23%; cardiomyopathies, 4.6%; arrhythmia, 1.7%; and congestive heart failure, 1.6%. Deaths occurred most frequently in urban settings, 49.2%; and in the hospital, 40.4%; home, 26.1%; or at school/work/sports, 4.8%. Emergency medical services were not evenly distributed with differences by age, race, ethnicity, and area. Autopsies (40.4%) occurred more often in those >10 years old (odds ratio [OR] 2.9), blacks (OR 1.6), or in those who died at school/work/sports (OR 3.9). The most common cardiovascular causes of death included congenital heart disease, 40.8%; arrhythmias, 27.1%; cardiomyopathy, 11.8%; myocarditis, 4.6%; congestive heart failure, 3.6%; and coronary artery anomalies, 2.2%. Our study identified differences in causes and frequencies of cardiovascular deaths by age, race, and ethnicity. Prevention of death may be impacted by knowledge of prior conditions, emergency plans, automated external defibrillator programs, bystander cardiopulmonary resuscitation education, and by a registry for all cardiovascular deaths in children.

What do bereaved parents want from professionals after the sudden death of their child: a systematic review of the literature.

BackgroundThe death of a child is a devastating event for parents. In many high income countries, following an unexpected death, there are formal investigations to find the cause of death as part of wider integrated child death review processes. These processes have a clear aim of establishing the cause of death but it is less clear how bereaved families are supported. In order to inform better practice, a literature review was undertaken to identify what is known about what bereaved parents want from professionals following an unexpected child death.MethodsThis was a mixed studies systematic review with a thematic analysis to synthesize findings. The review included papers from Europe, North America or Australasia; papers had to detail parents’ experiences rather than professional practices.ResultsThe review includes data from 52 papers, concerning 4000 bereaved parents. After a child has died, parents wish to be able to say goodbye to them at the hospital or Emergency Department, they would like time and privacy to see and hold their child; parents may bitterly regret not being able to do so. Parents need to know the full details about their child’s death and may feel that they are being deliberately evaded when not given this information. Parents often struggle to obtain and understand the autopsy results even in the cases where they consented for the procedure. Parents would like follow-up appointments from health care professionals after the death; this is to enable them to obtain further information as they may have been too distraught at the time of the death to ask appropriate questions or comprehend the answers. Parents also value the emotional support provided by continuing contact with health-care professionals.ConclusionAll professionals involved with child deaths should ensure that procedures are in place to support parents; to allow them to say goodbye to their child, to be able to understand why their child died and to offer the parents follow-up appointments with appropriate health-care professionals.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2431-14-269) contains supplementary material, which is available to authorized users.

Child death in high-income countries

Although high-income countries have made substantial progress towards reducing child mortality,1 rates vary markedly between and within countries,2,3 and modifiable factors continue to be identified in many deaths. In a three-part Series in The Lancet1,4,5 we describe the epidemiology of child mortality and a standardised approach to child death reviews in high-income countries. We delineate patterns of child mortality at different ages into five broad categories (perinatal causes, congenital abnormalities, acquired natural causes, external causes, and unexplained deaths4) and we describe contributory factors across four broad domains—biological and psychological factors, the physical environment, the social environment, and service delivery.

Development of a data set of national cardiovascular deaths in the young

The only systematic collection of cardiovascular (CV) deaths in children resides in the database derived from the Case Reporting System of the National Center for the Review and Prevention of Child Deaths (NCRPCD). We describe the process used to develop an analytical data set to inform our understanding of CV deaths in children from this database. Twenty-five states reporting natural CV deaths during 2005 to 2009 were contacted. Sixteen states agreed to participate. Cases experienced a natural CV death and were 0 to 21 years. Challenges to building a final analytical data set were identified and included reclassification, recategorization, and the development of new variables from existing data, including an algorithm to identify sudden cardiac deaths. The final data set included 1,098 cases. Missing data comprised a mean of 41.7% for most key variables. Cardiovascular cases were aged 4.8 ± 6.6 years; 55.3%, ≤1 year, 24.6%, ≥10 years; male, 58%; white, 70.5%; black, 22.3%; and Hispanic, 19.5%. This manuscript provides the first description of the natural CV death data set from the NCRPCD. We identify potential beneficial changes in the NCRPCD Case Reporting System and review process. Analysis of these data will help determine characteristics of CV deaths and allow the assessment of risk factors that can be used to prevent CV death in the young. The rate of CV death can be lowered using knowledge of associations that can be gleaned from this robust database. Best practices for prevention hold promise for a future with fewer deaths that will need to be reviewed.

Child Maltreatment Fatalities Related to Inadequate Caregiver Supervision.

More than 1,500 children died in the United States in 2011 due to child maltreatment. A substantial portion of these deaths were due to neglect. Previous research has found that a large percentage of child neglect cases involve supervisory neglect; however, the role of inadequate caregiver supervision (ICS) in child maltreatment deaths is unknown. The present study reviewed files from the Child Death Review Board in the state of Oklahoma for the years 2000 to 2003 to examine (a) how many deaths were due to inadequate caregiver supervision and (b) which child, caregiver, family, alleged perpetrator, and incident characteristics predicted risk for death related to ICS. Results indicated that almost half of the child maltreatment deaths were related to ICS. Older children and those living in homes with greater numbers of children were more likely to die from causes related to ICS. In addition, the alleged perpetrators of deaths related to ICS were more likely to be biological parents than alleged perpetrators of non-ICS-related deaths. These findings suggest that interventions to assist caregivers in providing appropriate levels of supervision for their children may be important for reducing children's risk for death.

Child Death Reviews: Developing CLEAR Recommendations

This paper is based on a study commissioned by the Department of Children and Youth Affairs in Ireland. It addresses the topic of recommendations emanating from child death inquiries and reviews; it looks at the factors which privilege some recommendations over others when it comes to implementation and explores whether a more collaborative approach to development might be more beneficial. As part of the study, the researchers to propose a new model for developing recommendations which will address the complexity of child protection practice, reflect its core principles and promote learning.‘New model for developing recommendations which will address the complexity of child protection practice, reflect its core principles and promote learning’The study found that recommendations were generally implemented when they fitted with social norms and aspiration of the time and particularly when they synchronised with policy developments that had already been initiated and required increased investment and public support to reach completion. The research drew a distinction between addressing and implementing recommendations, and overall found that a type of ‘recommendation fatigue’ had evolved following the succession if inquiries. It proposed that in the future, recommendations should be drafted in collaboration with key stakeholders which would provide the team with a range of expert knowledge strengthen the methodological rigour of the process and promote the likelihood that they would be feasible and realistic. The study proposed a new model of CLEAR recommendations (Case for change; Learning orientated: Evidence based; Assigning responsibility and easy to Review). Copyright © 2014 John Wiley &amp; Sons, Ltd.Key Practitioner Messages When inquiry or review recommendations are too numerous, impractical, expensive, lack relevance and are too far out of step with social norms, they are unlikely to be implemented A collaborative approach can ensure that recommendations are informed by relevant sources of information, knowledge and expertise. Recommendations should be framed in a way that illustrates the rationale for change, promotes learning, cites evidence and identifies the organisations responsible for implementation.

Filicide: Recasting Research and Intervention

Filicide: Recasting Research and Intervention