Fatal Abuse Research Articles

Child Welfare Workers' Training, Knowledge, and Practice Concerns Regarding Child Maltreatment Fatalities: An Exploratory, Multi-State Analysis

Research has rarely focused on child welfare professionals as agents of prevention for maltreatment fatalities. This study presents results on 426 child welfare workers' training, knowledge, and practice concerns regarding fatalities. Workers' knowledge of risk varied and revealed deficits in knowledge of parent and household risk factors. Receipt of training had a minor impact on knowledge. More than 25% of workers reported that a parent had disclosed potential intent to kill his/her child. Workers worried that a child will die on their caseloads; they reported assessing for risk, but wanting additional training. Implications are discussed for both research and practice communities.

Can buy me love: the effect of child welfare expenditures on maltreatment outcomes

I consider the effect of state level child welfare expenditures on child abuse victimization and fatality rates. The main result is that these expenditures are strongly associated with improved child maltreatment outcomes. Further, the well known negative association between income and child abuse is overstated if one fails to control for relevant policy differences that are correlated with economic circumstances. The effect of income diminishes further upon controlling for social attitudes correlated with income. The source of identification is a set of large and explicitly exogenous changes in child welfare expenditures induced by the circa 2000 recession. I show that endogeneity problems are small and tend to work against the result.

Consequences of infant maltreatment on child wellbeing

Child maltreatment is a major public health and social welfare problem. Evidence consistently shows that infants under one are more at risk of fatal injury, physical abuse and neglect than any other age group, mainly because they are almost completely dependent on others for their overall wellbeing and development. This article discusses the impact of infant maltreatment on children’s health and wellbeing. It highlights the sizeable body of literature on the relationship between types of infant maltreatment and a variety of negative developmental, health and mental health consequences.

Fatal child abuse: a study of 13 cases of continuous abuse.

A parent who continuously physically abuses her/his child doesn’t aim to kill the child but commits an accidental filicide in a more violent outburst of anger. Fatal abuse deaths are prevented by recognition of signs of battering in time. Out of 200 examined intra-familial filicides, 23 (12%) were caused by child battering and 13 (7%) by continuous battering. The medical and court records of the victim and the perpetrator were examined. The perpetrator was the biological mother and the victim was male in 69 per cent of the cases. The abused children were either younger than one year or from two-and-a-half to four years old. Risk factors of the victim (being unwanted, premature birth, separation from the parent caused by hospitalization or custodial care, being ill and crying a lot) and the perpetrator (personality disorder, low socioeconomic status, chaotic family conditions, domestic violence, isolation, alcohol abuse) were common. The injuries caused by previous battering were mostly soft tissue injuries in head and limbs and head traumas and the battering lasted for days or even an year. The final assault was more violent and occurred when the parent was more anxious, frustrated or left alone with the child. The perpetrating parent was diagnosed as having a personality disorder (borderline, narcissistic or dependent) and often substance dependence (31%). None of them were psychotic. Authorities and community members should pay attention to the change in child’s behavior and inexplicable injuries or absence from daycare. Furthermore if the parent is immature, alcohol dependent, have a personality disorder and is unable to cope with the demands the small child entails in the parent’s life, the child may be in danger.

Child Maltreatment Fatalities: Predicting Rates and the Efficacy of Child Welfare Policy

Scientists have studied child maltreatment fatalities (CMFs) for several decades, yet little research has examined the social context in which CMFs occur and whether prevention efforts are effective. Using state-level data from 2006–2008, we examine the social context in which CMFs occur and conduct a five-year follow-up to a study that found media attention predicted CMF-related legislation (Douglas, 2009). The results indicate that the social context in which children live are important; poverty and region are the strongest predictors of CMFs and states that passed legislation to prevent future maltreatment fatalities did not experience a decline in the death rate. Implications for policy and practice are discussed.

Fatal child maltreatment in england

AimsThis paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England.MethodsInformation on all notified cases of fatal maltreatment between April 2005...

Fatal child maltreatment in England, 2005–2009

Objective This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England. Methods Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment). Results A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0–17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death. Conclusions Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.

Can Whole-Body MRI Secure the Diagnosis of Suspected Infant Abuse?

Source: Perez-Rossello JM, Connoly S, Newton A, et al. Wholebody MRI in suspected infant abuse. AJR. 2010; 195(3): 744– 750; doi: 10.2214/AJR.09.3364Investigators from Children’s Hospital of Boston assessed the utility of whole-body MRI as compared to skeletal survey (SS) for finding skeletal and soft tissue injuries in infants with suspected physical abuse. They retrospectively analyzed imaging studies performed in 21 infants who met entry criteria from March 2003 to October 2005 and who underwent whole-body 1.5 Tesla magnetic resonance imaging (MR) within 5 days of the SS. Sixteen infants also had a follow-up SS; the combined findings of both surveys were referred to as the “summary skeletal survey.”Fifty-two body areas were analyzed on the MR and SS. Each examination type was reviewed for mean total number of injuries. Coronal and sagittal MR images were obtained using STIR sequences. Slice thicknesses were 3 to 5 mm. SS were performed using departmental protocol and the recommendations of the American College of Radiology. A pediatric radiologist monitored the SS studies and requested additional views, if necessary. MR images were reviewed independently by two board-certified pediatric radiologists who were aware of the history but were blinded to the SS findings. Bones, soft tissues, and solid organs were studied for abnormality. A third radiologist, blinded to the MR findings, studied the SS radiographs. The cervical spine was not evaluated as the whole-body examination began at the shoulder.Overall concordance rate was 95% for pre-MR SS versus follow-up SS, 87% for initial SS versus MR, and 89% for summary SS versus MR. There was no statistical difference between the average of 4.7 areas of abnormality seen on MR and the 5.4 fractures seen on the SS. Of the total of 167 fractures in the 21 children, 40.7% were seen by SS only, 31.7% by MR alone and 27.5% by both techniques. MR had a high specificity (95%) but a low sensitivity (40%). Radiography (24 of 37) was superior to MR (2 of 37) in finding metaphyseal corner fractures. MR sensitivity to this classic finding in child abuse was only 31%. MR was superior to SS for soft tissue injuries. Soft tissue injuries included 84 instances of muscle edema and 54 of subcutaneous edema, as well as 15 joint effusions, 12 pleural effusions, 3 intra-abdominal free fluid, 1 liver laceration, and 1 ligamentous injury of the spine.The authors emphasize the limited ability of MR to detect metaphyseal corner fractures and rib fractures, the most specific fractures for nonaccidental trauma and responsible for 90% of noncranial skeletal injuries in infant abuse fatalities. The authors conclude that MR cannot replace, but may complement, the SS.Dr Cohen has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The best imaging for the infant with suspected physical abuse continues to be “old-fashioned” skeletal radiographs. Since Caffey’s landmark article1 in 1946 describing the imaging findings of the battered child, consistently achieving the goal of early diagnosis has been a major challenge. The medical, social, and legal consequences of missed diagnosis are of obvious major importance. The current study showed that 7 of 21 cases of child abuse would not have been diagnosed by MR alone. The absence of ionizing radiation makes MR an appealing imaging option. However, despite the accompanying radiation exposure, the pediatrician should not be dissuaded from ordering SS, which provide far superior identification of classic child abuse findings like metaphyseal corner fractures and rib fractures and which provide better information on the ages of the injuries.2 This study also demonstrates the superior ability of MR to pick up soft tissue injuries which can obscure fractures on SS and require follow-up. Scintigraphy may play a complementary role.Notably, some fractures were not identified on either study. Clinicians should use their judgment based on history, physical, and radiologic findings to identify and manage possible cases of physical abuse. When child abuse is suspected, an open dialogue between pediatricians and their radiologic colleagues is vital.

Factors related to sibling removal after a child maltreatment fatality

Objectives Many children who die from abuse or neglect are survived by siblings. However, little data are available about what happens to these siblings after the victim's death, such as whether they are removed from their home. Even less is known about how decisions are made regarding sibling removal following a child fatality. This study examined social-ecological factors related to the likelihood that siblings would be removed from their homes after a child maltreatment fatality. Methods This study utilized Oklahoma child death review and child welfare data from 1993 to 2003 for 250 families to examine which sibling, caregiver, alleged perpetrator, family, community, and maltreatment characteristics were related to sibling removal following a child maltreatment fatality. Results Logistic regression analyses indicated that younger sibling age, more previous family reports to child welfare, and type of maltreatment (i.e., abuse rather than neglect) predicted greater likelihood of sibling removal. Conclusions The sibling and family factors found to be related to sibling removal are consistent with literature indicating that these variables are associated with death from child maltreatment. Few caregiver and family variables were predictive of sibling removal, despite evidence that such variables are related to child maltreatment fatalities. Further research that investigates siblings’ return to their homes and subsequent CPS referrals would help to clarify whether decisions about sibling removal were useful in protecting siblings from future maltreatment. Practice implications It may be important for child welfare workers to consider more caregiver and family factors when making removal decisions after a child maltreatment fatality.

Underascertainment of child abuse fatalities in France: Retrospective analysis of judicial data to assess underreporting of infant homicides in mortality statistics

Objectives Test the hypothesis of an underestimation of infant homicides in mortality statistics in France; identify its causes; examine data from the judicial system and their contribution in correcting this underestimation. Methods A retrospective, cross-sectional study was carried out in 26 courts in three regions of France of cases of infant deaths submitted to the courts, 1996–2000, with follow-up of their files until case closing (1996–2008). For each case, cause of death established by the courts was compared with ICD cause of death as coded in official mortality statistics. Results We examined 247 cases. Shortcomings in investigations were noted (autopsies: 75% of cases; fundus examination: 11%; diagnosis of sudden infant death syndrome [SIDS] without autopsy: 41%). Eighty deaths were considered homicides by the courts. Homicide rates in the court study are 2–3.6 times higher than those in mortality statistics. Nearly 1/3 of “accidental” deaths and 1/4 of deaths from unknown cause in mortality statistics are homicides. Mechanisms of underascertainment are: physicians’ inappropriate death certification and underreporting of suspicious cases; inadequate investigation of cases; incomplete communication of final medical and forensic results to the mortality statistics department. Conclusions In a country where neither transportation of the body to a hospital nor autopsy is obligatory, judicial data can make an important contribution to correcting mortality statistics. Practice implications This study led to the first French protocol for investigating sudden unexpected deaths in infancy (SUDI). The protocol includes a physician “training” section focused on understanding the symptomatology and risk factors of violence, as well as the quality of death certification.

Using capture-recapture methods to better ascertain the incidence of fatal child maltreatment

Objectives To (1) test the use of capture-recapture methods to estimate the total number of child maltreatment deaths in a single state using information from death certificates, child welfare reports, child death review teams, and uniform crime reports; and to (2) compare these estimates to the number of maltreatment deaths identified through an in-depth “gold standard” review. Methods Child maltreatment deaths were identified in four existing administrative data sources: (1) death reports in our state vital statistics (DC); (2) child death review team reports (CDR); (3) homicide reports filed by our state police agency as uniform crime report (UCR) supplements for the FBI; and (4) abstracted reports of a minor's death from our state child protective services (CPS) agency. Capture-recapture pair-wise and pooled comparisons were then applied to estimate the numbers of abuse and total maltreatment deaths and were compared to the number of cases identified by independent case review. Results There were a total of 194 child maltreatment deaths in Michigan during 2000–2001 with 66 due to physical abuse. Capture-recapture analysis estimated the mean number of total child maltreatment deaths as 101.02 (95%CI = 92.52, 109.53), with abuse deaths of 64.55 (60.85, 68.25). Most pair-wise and pooled comparisons worked equally well for abuse deaths, but estimates for total child maltreatment deaths were low. Conclusions Capture-recapture methods applied to existing administrative datasets produced accurate estimates of child abuse deaths but were not useful in producing reliable estimates of total child maltreatment deaths due to undercounting neglect-related deaths in all existing administrative data sets. The underlying assumptions for capture-recapture methods were not met for neglect deaths. Local and/or state teams conducting ongoing intensive case review may yet remain the best way to identify the total number of child maltreatment deaths. Practice implications Capture-recapture methods allow for more accurate estimation of the true number of child physical abuse deaths than does using single existing sources of child fatality information, but deaths from causes other than abuse are undercounted. Child maltreatment fatality surveillance requires a systematic process and standard criteria for identifying cases of maltreatment, particularly neglect-related child deaths.

Effects of a Citizens Review Panel in preventing child maltreatment fatalities

Though child abuse rates are declining in the United States, there has been no real change in the number of child maltreatment (CM) fatalities (USDHS, 2008 US Department of Health and Human Services. (2008). Child maltreatment 2006: Reports from the states to the national child abuse and neglect data system. Washington, DC: US Government Printing Office.US Department of Health and Human Services, 2008). While year-to-year numbers vary, there were an estimated 1,530 child abuse and neglect deaths....

Child maltreatment fatalities in children under 5: Findings from the National Violence Death Reporting System

Objective To describe the distribution of child maltreatment fatalities of children under 5 by age, sex, race/ethnicity, type of maltreatment, and relationship to alleged perpetrator using data from the National Violent Death Reporting System (NVDRS). Study design Two independent coders reviewed information from death certificates, medical examiner and police reports corresponding to all deaths in children less than 5 years of age reported to NVDRS in 16 states. Results Of the 1,374 deaths for children under 5 reported to NVDRS, 600 were considered attributable to child maltreatment. Over a half of the 600 victims of child maltreatment in this age group were under 1 year old, 59% were male, 42% non-Hispanic Whites, and 38% were non-Hispanic Blacks. Two thirds of child maltreatment fatalities in children under 5 were classified as being due to abusive head trauma (AHT), 27.5% as other types of physical abuse, and 10% as neglect. Based on these data, fathers or their substitutes were significantly more likely than mothers to be identified as alleged perpetrators for AHT and other types of physical abuse, while mothers were more likely to be assigned responsibility for neglect. Conclusions Among children under 5 years, children under 1 are the main age group contributing to child maltreatment fatalities in the NVDRS. AHT is the main cause of death in these data. These findings are limited by underascertainment of cases and fair inter-rater reliability of coding. Practice implications The findings suggest the need to develop and evaluate interventions targeting AHT to reduce the overall number of child maltreatment deaths in young children. These interventions should make special efforts to include fathers and their substitutes.

Inquiries into Fatal Child Abuse in the Netherlands: A Source of Improvement?

In some Western societies, inquiries into fatal abuse of children known to agencies are nowadays a common phenomenon. They have been carried out in the UK for many years, but have recently also emerged in the Netherlands. The main aim of these inquiries is to improve child welfare and protection practice in order to reduce the chance of further child deaths. However, there is reason to critically consider the feasibility of this aim, as British research into child death investigations suggests that they have hardly worked and even may have had counter productive consequences. This paper examines for the first time all Dutch public inquiry reports into child abuse fatalities. It is shown that the problems highlighted in the reports are highly similar to those recurring in their British counterparts. Furthermore, there are considerable similarities between Dutch and British investigations regarding the solutions they propose. Like British inquiries and reviews, Dutch inquiries largely focus on changing procedures, introducing decision-making instruments and increasing monitoring. This one-sided emphasis on bureaucratic measures, the paper argues, does not rate the human side of child protection work at its true value, and makes it questionable whether the inquiries will contribute to improving practice.

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

Child Abuse Fatalities: Pattern of Injury

Child Abuse & Neglect| September 01 2009 Child Abuse Fatalities: Pattern of Injury AAP Grand Rounds (2009) 22 (3): 31. https://doi.org/10.1542/gr.22-3-31 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Child Abuse Fatalities: Pattern of Injury. AAP Grand Rounds September 2009; 22 (3): 31. https://doi.org/10.1542/gr.22-3-31 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: child abuse, fractures, skeletal injury, homicide, fractures in children Source: Ross A, Abel S, Radisch D. Pattern of injury in child fatalities resulting from child abuse. Forensic Science International. 2009;188(1–3):99–102; doi:10.1016/j.forsciint.2009.03.021 To assess the rate and pattern of antemortem fractures in children dying from child maltreatment, researchers from North and South Carolina reviewed case files from child homicide fatalities occurring between 2000 and 2005 in North Carolina and Charleston County, South Carolina. The investigators reviewed reports to identify children with fractures and to categorize these fractures as antemortem or perimortem. Data from 162 child homicide fatalities were reviewed. Filmy percent of all homicide deaths were in infants younger than 9 months and 68% were males. The most common body region injured was craniofacial (47%). Antemortem fractures were identified in 24% of cases and perimortem fractures were identified in 38%. There was a statistical association between finding antemortem and perimortem fractures in the same... You do not currently have access to this content.

Media Coverage of Agency-Related Child Maltreatment Fatalities: Does It Result in State Legislative Change Intended to Prevent Future Fatalities?

This study investigates whether child maltreatment fatalities among children receiving services from state child welfare agencies spur substantive, as opposed to symbolic, legislative change to direct child welfare policy and practice. Using existing state-level data from three years, this study examined the influence of news stories, state characteristics, and child welfare policy practice factors on the passage of new child welfare legislations. The results suggest that high levels of media attention are indeed associated with new child welfare policy that is preventative in nature. Furthermore, state child welfare policy practice characteristics are also significantly related to the passage of new child maltreatment fatality-related legislation. The author makes recommendations for future research concerning the effectiveness of policy and practice change that results from child maltreatment fatalities.

Pattern of injury in child fatalities resulting from child abuse

According to the US Department of Health and Human Services, in 2005, an estimated 1460 children died of maltreatment. The purpose of this study is to further examine the pattern of bony injuries in child maltreatment fatalities, with an emphasis on the prevalence of antemortem fractures and the presence of associated perimortem fractures. The sample was 162 male and female children. The majority of the data were collected from the case files of the NC Child Fatality Prevention Team at the Office of the Chief Medical Examiner in Chapel Hill, North Carolina ( n = 152) spanning from 2000 to 2005. An additional 10 cases from 2001 to 2006 were included from the Charleston County Coroner's Office, Charleston, SC. Six age categories were used in this study: 0–3 months, 4–6 months, 7–9 months, 10–16 months, 17 months to 2 years, and 2–6 years. Lesions were documented and categorized into four general body loci: craniofacial, thoraco/abdominal, appendicular, and multiple. The peak age categories of death were 0–3 months (25%) and 2–6 years (19%), with 50% of deaths occurring in infants 9 months old or younger. The body locus most frequently affected was craniofacial.

Fatal Abusive Head Trauma Cases

Missed diagnosis of child abuse may lead to chronic abuse with potential for death. This paper reports 3 such cases. This is a retrospective chart review of 38 cases diagnosed as abusive head trauma between January 1, 2004 and December 31, 2006 at a university hospital. We sought to identify fatal cases with a past medical history of physical abuse that was missed by the medical staff. Three cases (7.9%) had a past medical history of physical abuse that was missed by the medical staff. Infants were 2 males and 1 female. Their ages were 2.5, 3.5, and 6 months, respectively. Missed abuse episodes involved rib fractures, a metaphyseal tibial fracture, and a shaking episode, respectively. The intervals that had elapsed between the missed and the fatal abuse episodes were 24 hours, 12 days, and 6 weeks, respectively. Perpetrators of fatal head trauma were all biological fathers. One plead guilty, and 2 were convicted of involuntary manslaughter. The infants were in the care of the perpetrators of the fatal abuse episodes at the time the missed abuse episodes occurred. Physicians assessing children, especially infants, should be alert to indicators of abusive trauma to recognize abuse early on. Including abusive trauma in the differential diagnostic list and taking appropriate steps to rule out or confirm the diagnosis are of paramount importance in establishing child protective services and preventing further abuse and neglect that may at times be fatal.

Filicide and fatal abuse in Japan, 1994–2005: Temporal trends and regional distribution

To describe the recent filicide features in Japan, data were collected from newspaper databases between 1994 and 2005 and compared with several official statistics. From this dataset, 933 cases and 1084 victims under age 15 were identified. Fatal abuse cases were most prevalent (309 cases, or 33.1%), followed by filicide–suicide cases (303, or 32.5%) and unwanted child cases (225, or 24.1%). Infants under the age of one were most at risk (filicide rate: 2.72 per 100,000 for the same aged infants). Annual filicide numbers showed an upward trend between 1994 and 2001 and the average filicide rate per year was 0.42 per 100,000 for children under age 15. Both the number of cases over the period and the filicide rate per year by prefecture ranged widely. Furthermore, the annual filicide rates over the period were strongly correlated with both suicide rates and unemployment rates for the general population ( r = .884 and .926, respectively; p < .001 for both). The measure of filicide per region and the predominating category in a prefecture provides direction for filicide prevention. Result suggests that recent socioeconomic situations have a significant effect on not only filicide–suicide but also the overall filicide rate in Japan.