Fatal Child Abuse Research Articles

No Surprise: The Rate of Fatal Child Abuse and Neglect Fatalities Is Related to Poverty.

In this issue of Pediatrics , Farrell et al1 describe research linking poverty with child maltreatment fatalities. The American Academy of Pediatrics has addressed the overall issue of the effects of poverty in a recent policy statement.2 An increasing number of reports linking ecology with outcomes for both adults and children have been published describing risk factors for overall health, brain health, and lifetime health trajectories.3,4 Given the sociologic, economic, medical, and myriad other challenges related to poverty, it is not surprising that the authors report a significant increase in fatal child maltreatment related specifically to socioeconomic status. What may be surprising is that although this fact is both intuitive … Address correspondence to Robert W. Block, MD, FAAP, Department of Pediatrics, University of Oklahoma/Tulsa University School of Community Medicine, 4502 E. 41st St, Tulsa, OK 74114. E-mail: rblock{at}aap.net

Injury Prevention and State Law as Strategies for the Reduction of Child Maltreatment Fatalities

This review focuses on one state’s multidisciplinary legislative efforts to decrease the incidence of child maltreatment, including fatalities and near-fatalities. Such efforts have encompassed primary and secondary prevention modalities, including early support to parents, training, and education about recognition and reporting of child maltreatment for professionals who interact with children, review of all child deaths, and multidisciplinary in-depth case review of the most serious child maltreatment cases. Although reliable trends can be difficult to determine based upon the complexity of the problem and multiple confounding variables, there are a number of indicators that suggest these cumulative efforts are beginning to have a favorable impact on the most serious child maltreatment cases, although heightened awareness has likely contributed to an increase in the total number of reported cases. Multidisciplinary collaborative efforts including governmental, academic, and non-profit entities may affect meaningful change in legislation and other interventions to decrease the incidence of the most serious cases of child maltreatment.

Characteristics, Classification, and Prevention of Child Maltreatment Fatalities.

Preventing child maltreatment fatalities is a critical goal of the U.S. society and the military services. Fatality review boards further this goal through the analysis of circumstances of child deaths, making recommendations for improvements in practices and policies, and promoting increased cooperation among the many systems that serve families. The purpose of this article is to review types of child maltreatment death, proposed classification models, risk and protective factors, and prevention strategies. This review is based on scientific and medical literature, national reports and surveys, and reports of fatality review boards. Children can be killed soon after birth or when older through a variety of circumstances, such as with the suicide of the perpetrator, or when the perpetrator kills the entire family. Death through child neglect may be the most difficult type of maltreatment death to identify as neglect can be a matter of opinion or societal convention. These deaths can occur as a result of infant abandonment, starvation, medical neglect, drowning, home fires, being left alone in cars, and firearms. Models of classification for child maltreatment deaths can permit definition and understanding of child fatalities by providing reference points that facilitate research and enhance clinical prediction. Two separate approaches have been proposed: the motives of the perpetrator and the circumstances of death of the child victim. The latter approach is broader and is founded on an ecological model focused on the nature and circumstances of death, child victim characteristics, perpetrator characteristics, family and environmental circumstances, and service provision and need. Many risk factors for maternal and paternal filicide have been found, but most often included are young maternal age, no prenatal care, low education level, mental health problems, family violence, and substance abuse. Many protective factors can be specified at the individual, family, and community level. Early interventions for children and families are facilitated by the increased awareness of service providers who understand the risk and protective factors for intentional and unintentional child death. There is currently no roadmap for the prevention of child maltreatment death, but increased awareness and improved fatality review are essential to improving policies and practices. Prevention strategies include improving fatality review recommendations, using psychological autopsies, serious case reviews, and conducting research. We recommend a public health approach to prevention, which includes a high level of collaboration between agencies, particularly between the military and civilian. The adoption of a public health model can promote better prevention strategies at individual, family, community, and societal levels to address and improve practices, policies, and public attitudes and beliefs about child maltreatment. The process of making recommendations on the basis of fatality review is important in terms of whether they will be taken seriously. Recommendations that are too numerous, impractical, expensive, lack relevance, and are out of step with social norms are unlikely to be implemented. They can be helpful if they are limited, focused, lead to definitive action, and include ways of measuring compliance.

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

Fatal child abuse is the severest consequence of violence against children. Yet, little is known about this phenomenon, as routine data do not describe it. Child death review (CDR) teams have been established to systematically review deaths from birth to adolescence as a public health response to better identify child abuse deaths, to develop policy and to improve the child protection response. This article describes the incidence of fatal child abuse and injury patterns associated with such deaths. CDR teams reviewed all child fatalities from 1 January to 31 December 2014 at two pilot sites in South Africa (SA). Data were collected on demographics, causes and circumstances of the death, and family social context. We assessed the feasibility of CDR teams in the SA setting to strengthen the identification of child abuse deaths and influence practice. A total of 707 cases were reviewed. Over half (52.4%) of the deaths were due to natural causes. A third were caused by murder, with nearly half (44%) of all murders attributed to fatal child abuse. The burden of fatal child abuse and neglect was found among the <1-year age group. Abandonment at birth was most common, followed by blunt force injuries and strangulation/asphyxiation deaths. CDR teams are effective in better identifying deaths due to child abuse and neglect via a multidisciplinary approach and regular case reviews.

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

Fatal child abuse is the severest consequence of violence against children. Yet, little is known about this phenomenon, as routine data do not describe it. Child death review (CDR) teams have been established to systematically review deaths from birth to adolescence as a public health response to better identify child abuse deaths, to develop policy and to improve the child protection response. This article describes the incidence of fatal child abuse and injury patterns associated with such deaths. CDR teams reviewed all child fatalities from 1 January to 31 December 2014 at two pilot sites in South Africa (SA). Data were collected on demographics, causes and circumstances of the death, and family social context. We assessed the feasibility of CDR teams in the SA setting to strengthen the identification of child abuse deaths and influence practice. A total of 707 cases were reviewed. Over half (52.4%) of the deaths were due to natural causes. A third were caused by murder, with nearly half (44%) of all murders attributed to fatal child abuse. The burden of fatal child abuse and neglect was found among the <1-year age group. Abandonment at birth was most common, followed by blunt force injuries and strangulation/asphyxiation deaths. CDR teams are effective in better identifying deaths due to child abuse and neglect via a multidisciplinary approach and regular case reviews.

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

Risk factors for fatal and non-fatal child maltreatment in families previously investigated by CPS: A case-control study

The objective of this study was to identify individual, family and caregiver risk factors for serious child maltreatment, resulting in hospitalization or death, among children and families investigated by Child Protective Services (CPS). We conducted a matched case-control study of 234 children who sustained fatal or serious nonfatal maltreatment due to physical abuse or neglect and whose mother was named in a CPS investigation between 1999 and 2013. A total of 702 children and their caregivers were included in the study with 234 cases matched 2:1,resulting in 468 controls. Data on potential risk factors were abstracted from three county administrative databases. Differences between cases and controls were calculated and multivariable conditional logistic regression was used to estimate risk models. Variables associated with increased risk for serious maltreatment included male child gender,younger caregivers, three or more children under the age of 5 living in the home, families in which a biologic child was not living with either parent, and scoring moderate or high on the Structured Decision Making Risk Tool®. Caregiver involvement in intimate partner violence (IPV) and child enrollment in public health insurance appears to mitigate the risk of serious maltreatment.

Can cognitive maps provide insight into women who hurt their children?

Efforts to organize information relative to complex, multifaceted issues such as fatal and nonfatal child abuse can be daunting but are essential to the development of adequate strategies for recognition of at-risk mothers and, ultimately, for prevention-focused interventions. The purpose of this exploratory descriptive pilot study using quantitative and qualitative techniques was to determine what constellation of antecedents broadly categorized as vulnerabilities and triggers may be associated with fatal or nonfatal abuse from the viewpoint of the mother/perpetrator. Due to challenges in accessing the study population, a convenience sample of 88 women incarcerated for fatal and nonfatal abuse was drawn from four women’s prisons in three Southwestern United States. A structured questionnaire consisting of 68 paired comparisons was administered to participants. Participants rated the vulnerabilities and triggers for dissimilarity and ranked their relative importance. Priority ratings were obtained from responses to content analysis questions. Multidimensional scaling (MDS) and clustering methodologies were used to generate cognitive maps of the concepts in relation to one another. The two groups shared common underlying structures consisting of three disparate clusters, “Family Intimacy”, “Negative Emotion”, and “Abuse”. They diverged in vulnerabilities and triggers that had the most profound impact on their thinking and behavior. Both groups had a similar underlying structure for antecedents to these crimes, but evaluative responses showed differences between women convicted of fatal versus nonfatal abuse.

Testing if Social Services Prevent Fatal Child Maltreatment Among a Sample of Children Previously Known to Child Protective Services

The purpose of this article was to examine the potential impact of child welfare services on the risk for fatal child maltreatment. This was conducted using a subsample of children who were identified as "prior victims" in the National Child Abuse and Neglect Data System from 2008 to 2012. At the multivariate level, the analyses show that case management services act to protect children from death as do family support services, family preservation services, and foster care, but that the results vary by type of maltreatment experienced. The author recommends that before strong conclusions are drawn, additional research in this area is warranted.

Analysis on Determination of Punishment in Sentencing for Cases Involving Child Maltreatment Fatalities

본 연구는 2001~2015년까지 아동학대 사망사례 55건의 판결문(피고인 81명, 판결문 95건)에 제시된 가해자에 대한 양형 실태를 분석하였다. 주가해행위자에 대한 양형분석 결과, 집행유예 및 3년 미만의 비교적 경미한 처벌을 받은 경우가 약 40%였으며 선고형량이 법정형 하한 미만이거나 양형기준의 권고형량을 하한이탈한 판결의 비중이 높은 것으로 나타나 그동안 아동학대 사망사건 가해자에 대한 처벌수위가 매우 관대했던 것으로 분석되었다. 양형요소에 대한 분석 결과, '아동을 성실하게 양육해 온 점', '아동의 사망으로 인한 심적 고통, 죄책감', '훈육 목적 등 참작할만한 동기'와 같이 판사의 아동학대에 대한 인식이나 주관적 성향에 따라 달리 판단될 수 있는 양형요소가 형을 감경하는데 영향력이 큰 것으로 분석되었다. 방조자의 경우 피해아동의 사망을 방지할 수 있는 지위에 있었음에도 대부분 집행유예 또는 벌금형으로 매우 경미한 처벌을 받고 있음이 드러났다. 판결문에 대한 내용분석을 통해 초범, 우발적 범행, 친권자 및 양육자, 유족과의 합의, 훈육 등 그동안 아동학대 사망사건에서 관행적으로 언급되어 온 양형요소에 대한 재고찰이 필요함을 논의하고, 앞으로 판사들의 아동학대에 대한 교육 및 인식 개선, 아동학대 고유의 양형기준의 재정비가 필요함을 제언하였다.

English

INTRODUCTION: The aim of this retrospective study has been a statistical valid and descriptive data analysis of judicial decisions of the Federal Court of Justice (BGH) in consideration of the results of the regional court, which adjudged cases of fatal child abuse in a familial environment. Methods: Over a twelve year period (1999 to 2011), all cases of fatal child abuse adjudged and published by the BGH have been analyzed. Furthermore, as far as received, an analysis of the decisions of the regional courts has been performed. Results: In 60 rulings, 77 victims (35 female, 31 male, 11 unknown) have been found, with a total of 70 offenders (39 female, 31 male). In most cases the biological parents had been the perpetrator (n=67). The main cause of death has been suffocation (n=22), followed by impacts of head injury (n=15). Female offenders (n=36) performed suffocation more often than male offender (n=10), whereas impacts of head injury often have been set by male offender (n=21). In cases of one or more siblings (n= 32) the youngest child was statistical significant (p=0.003369) more often the victim than the others. Conclusions: The rulings of the BGH and those of the according regional courts can provide a wide range of information about the circumstances of fatal child abuse and might be a good source of data for a cost-effective, retrospective study of fatal child abuse, with the input of information of different areas of expertise (medical, legal, social). Language: en

25 Years of Supporting Professionals in Safeguarding Children

25 Years of Supporting Professionals in Safeguarding Children

Pediatricians' Role in Preventing Child Maltreatment Fatalities: A Call to Action.

* Abbreviations: CAN — : child abuse and neglect CECANF — : Commission to Eliminate Child Abuse and Neglect Fatalities CPS — : child protective services The death of any child is a tragedy. When that death is caused by abuse or neglect, sorrow is often coupled with anger: How could this have happened? More importantly, was this preventable? A federal commission, the Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF), is working to turn anger into action to stop these tragedies.1 At least 1500 children die every year at the hands of those who are supposed to care for and protect them. We say “at least” because we do not have reliable data about the number of deaths from child maltreatment. There is no national standard for counting these deaths, and the data about child fatalities come from multiple sources that do not coordinate or share data. Most experts, including the US Government Accountability Office, believe that child abuse and neglect (CAN) fatalities are significantly undercounted.2,3 Recognizing that even 1 death from CAN is 1 too many, Congress passed the Protect Our Kids Act that created CECANF in 2012.4 CECANF, a 12-member panel appointed by the president and Congress, began its work in February 2014. Commissioners have 2 years to study the extent and causes of CAN fatalities and to submit a report to Congress that includes concrete recommendations for a national strategy to eliminate CAN fatalities. In June 2014, CECANF began a series of public hearings across the country. Commissioners reached out to experts from a broad range of disciplines. Local legislators, child welfare leaders, law enforcement officials, federal policy experts, data experts, … Address correspondence to Rachel P. Berger, MD, MPH, Children’s Hospital of Pittsburgh of UPMC, 4401 Penn Ave, Pittsburgh, PA 15224. E-mail: rachel.berger{at}chp.edu

Bruising caused by traditional Chinese massage therapy (ba sha) complicating the assessment of a case of fatal child abuse

Precise evaluation of bruises and patterned skin lesions in infants and children is an essential requirement in cases of potential abuse. Such injuries may be markers of more significant internal injuries and/or may be supportive of an assault rather than an accident. On occasion, however, unusual patterned skin lesions may be identified that have been inflicted as part of traditional therapeutic techniques. A five-year-old boy from a rural Chinese community is reported who died from ligature strangulation. In addition to bruises from abusive trauma he had a series of unusual patterned, often-paired, bruises over the anterior and posterior aspects of both shoulders, unrelated to the ligature mark. Upon further police inquiries it transpired that his grandmother and mother had been using traditional Chinese therapeutic massage or “ba sha” to treat an episode of vomiting. The term means “to pull out fever” and involves firm pinching of the skin between the thumb and index finger, often on the neck, chest or back. An awareness of the potential manifestations of traditional therapies is important in contemporary forensic practice so that injuries caused by these treatments are not confused with non-therapeutic inflicted injury.

Invisible Children, Dying to Save Others: A Discussion of Three Fatal Child Abuse Cases and the Prevention of Future Deaths

This article discusses three fatal child abuse cases (two from the United Kingdom and one from Australia). Using an interactionist framework, it identifies two critical signs — the ‘invisibility’ of the child and certain dysfunctional parent representations — as the precursors to death in these cases. Reviewing the child death inquiry findings, it argues that acknowledging these critical indicators of risk has significant implications for preventing death in similar cases where child protection workers know the child in question.

Using Theory to Examine Fatal Child Maltreatment Among a Sample of Children Known to Child Protective Services

The purpose of this study was to use theory to test different models to predict fatal maltreatment: parental psychopathology, social/economic stress, and ecological theory. These models were tested using a subsample of children who were identified as “prior victims” in the National Child Abuse & Neglect Data Set from 2008 to 2012. At the multivariate level, the analyses suggest a statistically significant relationship between social/economic stress variables, including partner violence, inadequate housing, and financial problems. Repeated reports to child protective services and interactions between the age of child and financial problems often acted as protective factors. Implications for research and the child welfare field are discussed.

Rate of deaths due to child abuse and neglect in children 0-3 years of age in Germany.

In recent years, increasing attention has been paid to the issue of (fatal) child abuse and neglect, largely due to the media attention garnered by some headline-grabbing cases. If media statements are to be believed, such cases may be an increasing phenomenon. With these published accounts in mind, publicly available statistics should be analysed with respect to the question of whether reliable statements can be formulated based on these figures. It is hypothesised that certain data, e.g., the Innocenti report published by UNICEF in 2003, may be based on unreliable data sources. For this reason, the generation of such data, and the reliability of the data itself, should also be discussed. Our focus was on publicly available German mortality and police crime statistics (Polizeiliche Kriminalstatistik). These data were classified with respect to child age, data origin, and cause of death (murder, culpable homicide, etc.). In our opinion, the available data could not be considered in formulating reliable scientific statements about fatal child abuse and neglect, given the lack of detail and the flawed nature of the basic data. Increasing the number of autopsies of children 0-3 years of age should be considered as a means to ensure the capture of valid, practical, and reliable data. This could bring about some enlightenment and assist in the development of preemptive strategies to decrease the incidence of (fatal) child abuse and neglect.

The Presence of Maltreatment Fatality-Related Content in Pre-service Child Welfare Training Curricula: A Brief Report of 20 States

The purpose of this study was to assess the presence of evidence-based information about child maltreatment fatalities (CMFs) and risk factors for CMFs in pre-service child welfare training curricula in the United States. In this first paper to examine the extent to which child welfare workers receive content on CMFs in their pre-service child welfare training, we reviewed curricula from 20 states. We searched for content related to risk assessment and fatality characteristics in the following areas: child risk factors, parent risk factors, and family/household risk factors. Our results suggest that workers’ receive very little content regarding CMFs. We discuss the findings with regard to child welfare training and practice.

International issues in abusive head trauma.

In the decades since Dr. John Caffey described a series of children with chronic subdural hematoma and long bone fractures, there has been a substantial increase in the medical recognition of various forms child abuse. In the United States, the term shaken baby syndrome was coined to explain a constellation of injuries assumed to be the result of violent shaking of infants. After improved understanding of the variety of mechanisms that occur when children are abused, abusive head trauma (AHT) has become the recommended terminology. AHT is a more comprehensive term that reflects the brain injuries that children suffer as the result of abuse. AHT continues to include shaking as a mechanism of injury as well as shaking with impact, impact alone, crushing injuries or combinations of several mechanisms. The medical community in the United States has led the way in developing new terminology and research to describe this unique and devastating form of abuse. The globalization of medicine and rapid information transfer has resulted in AHT becoming well-recognized internationally as a form of serious and fatal child abuse. This paper will review the historical basis in the United States for the diagnosis of AHT. We will also review some of the current international issue in epidemiology, diagnosis, legal processes and outcomes in selected countries/regions where child abuse physicians are actively involved in the evaluation of AHT.

Lives at risk: Uncovering factors associated with fatal child maltreatment

Awareness of cases of fatal child maltreatment has risen significantly in recent years suggesting the presence of a serious threat to young children despite extensive child welfare, clinical and legal responses to the issue. The purpose of this study was to identify differences between high risk child maltreatment and fatal risk cases and associated child protective service factors. For this study, 50 cases of fatal and near fatal child maltreatment were compared to a random sample of 50 moderate to severe maltreatment cases to determine predictors of group affiliation using a transactional model of child maltreatment to guide model development. Results indicate that recognition of having a male perpetrator, in cases of physical abuse, in families with approximately two children living in more rural environments notably improved the odds of predicting fatal risk cases. Prior referrals to Adult Protective Services, less out of home care and poor utilization of in-home services were also noted differences in the service records of the groups. Implications regarding early intervention and child protection measures that could be utilized to reduce risk are offered.