| Child Abuse and
| Fatal child abuse or neglect is the fatal
physical injury or negligent treatment of a child by a person who is
responsible for the child’s welfare. It is reported that more than
2,000 children in the U.S. die of child abuse and neglect each year,
and the actual number of abuse and neglect deaths is estimated to be
much higher than that reported by vital statistics data.
Most child maltreatment deaths result from physical abuse, especially
children receiving injuries to their heads. Known as abusive head
trauma, these injuries occur when a child’s head is slammed against a
surface, is severely struck or when a child is violently shaken. There
have been major improvements in the ability to diagnose abusive head
trauma and in investigators’ abilities to recognize when a caregiver’s
explanation for injuries do not match the severity of the injuries. For
example, it is now widely accepted that falls from short heights or a
child being accidentally dropped rarely cause extensive and severe head
The next most common cause of physical abuse deaths is punches or kicks
to the abdomen, leading to internal bleeding. Other forms of fatal
physical abuse include immersion into hot water, drowning and
smothering. Many children who die from physical abuse have been abused
over time, but a one-time event often causes a death. The most common
reason given by caretakers who fatally injure their children is that
they lost patience when the child would not stop crying. Other common
reasons given by the abusers include bedwetting, fussy eating and
Fatalities from neglect include a number of different ways in which
caregivers fail to adequately provide for or supervise their children.
Caregivers may fail to provide food and nurturing to their child,
leading to malnutrition, failure to thrive, starvation or dehydration.
Caregivers may fail to seek medical care when their child is ill,
leading to more serious illness and death. Neglect cases can also
result from intentional or grossly negligent failure to adequately
supervise a child, resulting in bathtub drowning, suffocations,
poisonings and other types of fatal incidents.
Young children are the most vulnerable victims. National statistics
show that children under six years of age account for 86% of all
maltreatment deaths and infants account for 43% of these deaths.
Fathers and mothers’ boyfriends are most often the perpetrators in the
abuse deaths; mothers are more often at fault in the neglect
fatalities. Fatal abuse is interrelated with poverty, domestic violence
and substance abuse.
National studies report that it is difficult to predict a fatal abuse
event. In the U.S., studies find that the majority of child victims and
their perpetrators had no prior contact with Child Protective Services
(CPS) at the time of the death, yet many children had previous injuries
that were not reported to CPS systems.
- Younger children, especially under the age of
- Parents or caregivers who are under the age of
- Low income, single-parent families
experiencing major stresses.
- Children left with male caregivers who lack
emotional attachment to the child.
- Children with emotional and health problems.
- Lack of suitable childcare.
- Substance abuse among caregivers.
- Parents and caregivers with unrealistic
expectations of child development and behavior.
for Case Review
- Autopsy reports
- Scene investigation reports and photos
- Interviews with family members
- Names, ages and genders of other children in
- Day Care Licensing investigative reports
- EMS run reports
- Emergency Department reports
- Prior CPS history on child, caregivers and
person supervising child at time of death
- Child’s health history
- Criminal background checks on person
supervising child at time of death
- Reports of home visits from public health or
- Any information on prior deaths of children in
GAO Report on Child Maltreatment
- Training hospital emergency room staff to
improve their ability to identify child abuse fatalities and improve
reporting to the appropriate agencies.
- Providing an advisory on the mandated
reporting of child abuse and neglect to local human service agencies,
hospitals and physicians.
- Case management, referral and follow-up of
infants sent home with serious health or developmental problems.
- Media campaigns to enlighten and inform the
general public on known fatality-producing behaviors, i.e., violently
shaking a child out of frustration.
- Crisis Nurseries which serve as havens for
parents “on the edge” where they can leave their children for a
specified period of time, at no charge.
- Intensive home visiting services to parents of
at-risk infants and toddlers.
- Education programs for parents such as the
Parent Effectiveness Training (P.E.T.), the Parent Nurturing Program
and Systematic Training for Effective Parenting (S.T.E.P.).