Preventing Child Fatalities

The death of a child from abuse or neglect is a terrible, powerful thing. Upon learning of such a tragedy, people everywhere experience fear, shame, and outrage. They hunger to know how and why this has happened, and resolve that such a thing should never happen again.

Legislators and others in positions of authority have responded to child fatalities and the public outcry that follows by creating a child welfare system charged with keeping children safe and promoting their well being. In many states they have also created a complex system of local and statewide organizations designed to help us understand, respond to, and prevent child deaths. To learn more about NC's child fatality prevention system, see North Carolina's Response to Child Fatalities.

Child welfare workers are on the front lines in our efforts to prevent child maltreatment deaths. Every time they respond to a report of abuse or neglect, conduct a child protective services investigation, or assess an adoptive or foster home, child welfare workers are trying to ensure the safety of children. In order to succeed in their efforts, they seek to follow (and refine) protocols and procedures, always keeping in mind that the assessment of risk is an ongoing, continuous process. To help them with this process, we provide the following information about child abuse fatalities.

Facts About Child Fatalities

It is not possible to say with complete accuracy how many children in the United States are killed each year by their caretakers. This is due in part to differences in state laws, in the way child deaths are investigated and classified, and in how this information is recorded. Observers also question the accuracy of the available national data on child fatalities because they believe that many child homicides go unclassified or unreported. Official reports probably undercount child abuse homicides by between 20% and 60% (Schlosser, 1992; Herman-Giddens, 2001).

We can speak with some confidence, however, about recent data on child fatalities in North Carolina. From 1985 through 1999, 356 children under 11 years of age are known to have been killed by their parents or caregivers. Children above this age were much less at risk; between 1993 and 1999, only ten children between 11 and 17 years old died in this way (Herman-Giddens, 2001).

We also know that child abuse deaths are increasing in North Carolina: between 1985 and 1994 rates of child abuse homicides rose at about 12.5% a year. Currently, every two weeks or so, a child in North Carolina is killed by his or her caregiver (Herman-Giddens, 2001).

The Children

Most of the children killed as a result of maltreatment in North Carolina are unknown to child protective services (CPS). Between 60% and 70% of families experiencing a child maltreatment death have no CPS involvement in the year prior to the death (Herman-Giddens, 2001).

Child maltreatment deaths occur in the greatest numbers among infants, followed by toddlers and preschool children. Children younger than 6 years are most vulnerable because of their small size, incomplete verbal skills, and limited contact with adults other than their primary caregivers (Herman-Giddens, 2001).

Maltreatment fatality victims are often only children or youngest siblings. Being born with a low birth weight and complications during pregnancy have both been identified as risk factors for infants (Schlosser, 1992).

Depending on the age of the victim, gender appears to be a risk factor for homicide as well. In a 1996 study, Kunz and Bahr examined records of 3,459 children killed by their parents. They found that "in the first week of a child's life, the risk of being killed by a parent was equal for males and females. From 1 week to 15 years, males were the victims in about 55% of all parent-child homicides; the percentage of male victims increased to 77% in the 16—18 year-old group."

It is not clear whether race is a risk factor for child homicide. In their review of the literature, Kunz and Bahr concluded that the research on this topic is inconclusive and in need of further study.

The Perpetrators

Research has found that children are most often killed by their parents or members of their families. Herman-Giddens et al. (1999) found that 63.5% of child maltreatment fatality victims were killed by their biological parents.

Herman-Giddens and colleagues (1999) also found that most of the time (65.5%) the killer was male—usually the father or step-father, although 18.2% of the time it was the mother's boyfriend. Others have found that in neglect-related deaths and homicides of newborns, the mother is usually the perpetrator (Schlosser, 1992; Kunz & Bahr, 1996).

Young children killed by their parents are most often beaten, shaken, or suffocated to death. Older maltreatment fatality victims, especially teenagers, are more likely to be killed with guns or other weapons (Herman-Giddens, 2001). Parents who kill their children tend to be young, often in their twenties (Schlosser, 1992; Kunz & Bahr, 1996). Mothers who kill their children are often single, gave birth to their first child as a teenager, have low educational attainment, did not receive adequate prenatal care for the child, and experienced complications during pregnancy (Schlosser, 1992). In their study, Overpeck et al. (1998) found a strong association between infant homicide and childbearing at an early age, especially if the mother had given birth previously.

Kunz and Bahr (1996) found that the age of the child had a lot to do with the gender of the murderer. "Among infants in the first week of life," they tell us, "mothers were almost always the ones who committed the homicide. Between the first week of life and the teenage years, mothers and fathers were about equally likely to kill their child. During the 13 to 15 year age group, fathers committed 63% of all homicides, and this increased to 80% among the 16 to 18 year age group" (p. 359).

Practice Implications

The research on child maltreatment fatalities underscores the importance of risk assessment. The risk factors found on North Carolina's risk assessment tool—especially the high risk factors—are based on what we know about the victims of child maltreatment and their families. Social workers should use this assessment tool as a guide as they continuously measure the relative risk and safety of every child they meet. When there are barriers to providing effective intervention (e.g., families with multiple CPS reports, families that seem resistent to intervention, etc.), social workers should seriously consider requesting a review of the case by their local community child protection team (CCPT). The underlying, unaddressed conditions within these families often contribute to child fatalities. Review by the CCPT can mobilize community resources to prevent a tragic outcome. For more on CCPTs, see North Carolina's Response.

Social workers should also continue to expand their awareness of the factors that may increase or reduce the risk of a child fatality. A word of caution, however: even if the people they encounter have so-called high risk traits, social workers should be careful not to judge them rashly. Instead, they should bear in mind the fundamental social work belief that every person has innate value and is worthy of respect, regardless of his or her actions or characteristics.

References

Herman-Giddens, M. E., Brown, G., Verbiest, S., Carlson, P. Hooten, E. G., Butts, J. B. (1999). Under-ascertainment of child-abuse mortality in the United States. Journal of the American Medical Association (JAMA), 282(5), 463-467.

Herman-Giddens, M. E. (Ed.). (2001). Not invisible, not in vain. Raleigh, NC: North Carolina Child Advocacy Institute.

Kunz, J. & Bahr, S. J. (1996). A profile of parental homicide against children. Journal of Family Violence, 11(4), 347-362.

McKee, G. R., & Shea, S. J. (1998). Maternal filicide: A cross-national comparison. Journal of Clinical Psychology, 54(5).

Overpeck, M. D., Brenner, R. A., Trumble, A. C., Trifiletti, L. B., Berendes, H. W. (1998). Risk factors for infant homicide in the United States. New England Journal of Medicine, 339(17), 1211-1216.

Schlosser, P., Pierpont, J., & Poertner, J. (1992). Active surveillance of child abuse fatalities. Child Abuse and Neglect, 16, 3-10.