O2053: Social and Demographic Characteristics of Child Maltreatment Fatalities Found in Child Death Review

Background: While risk factors have been identified among young children, less is known about child maltreatment fatalities among older children. Data from vital statistics and violent death reports is often limited in understanding the full nature of abuse and neglect causing or contributing to child fatalities. There are also differences between the causes in infants and young children compared to older children and adolescents. I this research, we sought to describe the social and demographic characteristics of children where abuse or neglect was determined to cause or contribute to their death, compare characteristics and circumstances of the deaths by cause and manner of death and type of maltreatment, and explore the role of abuse and neglect in child suicides.

Methods: We used secondary analysis of deaths due to child abuse or neglect among children ages 5–17 years old occurring during 2009–2018 and documented in the National Fatality Review-Case Reporting System. We compared child, family, and social characteristics were by child age (5–10 years vs. 11–17 year-olds), and by cause and manner of death. Frequencies and proportions are reported and compared using chi-square statistics. We compared these findings with those in the National Violent Death Reporting System as well as other sources and to younger children ages 0-5 years.

Results: 1478 maltreatment-related deaths were identified. Higher proportions of older children were non-Hispanic white, had a history of chronic disease or disability, had problems in school, and had a history of mental health issues. Forty-three percent of the maltreatment deaths were due to homicide and 10 % by suicide. Higher proportions (65 %) of younger children (5–10 years old) died by homicide, compared to older children (35 % among ages 11-17y). While 58 % of deaths overall were related to neglect, 68 % of deaths in older children were related to neglect, including 80 % of suicides. When compared to the NVDS, we found many more cases of neglect related cases, particularly among older (11-17y) children. Neglect predominated among older children as a cause or contributor to fatality, compared to abuse which predominated in infants and young children (0-5y).

Conclusion: The causes of child maltreatment deaths among children 5–17y vary by age. Child neglect caused and/or contributed to most child suicides. We note that child death review records provide a more complete picture of the contribution of abuse and neglect to fatalities than do vital statistics or violent death reports alone. We also found that it is important to be able to identify and learn from these neglect deaths as they comprise the majority of fatal maltreatment overall, their case characteristics are different from abuse, they are particularly relevant if we are to prevent suicide, and there are different factors to be addressed for older children.