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Abstract
In the past century with improvements in public health and in the prevention and treatment of disease, causes of death such as homicide have eclipsed natural causes in children. Fatal child abuse has emerged as an entity with growing recognition and understanding, particularly in the United States and United Kingdom. The causes are multifactorial and range from family stresses, psychodynamics, other violence, and other risks. This paper serves as a primer for physicians who will encounter children and adolescents with sentinel injuries associated with fatality as well as those who will review these deaths in health care systems or in the community. It is not designed for pathologists and forensic scientists but does provide an overview of the nature of the problem and what can be done, from child death review and responding to family needs, to providing preventative services and supports.
Keywords: Pediatrics, children, child abuse, neglect, mortality, public health
Abbreviations
AAP American Academy of Pediatrics
AHT Abusive head trauma
CDR Child death review
CM Child maltreatment
CPS Child protective services
ED Emergency department
IPV Intimate partner violence
ICD International Classification of Disease
NCANDS National Child Abuse and Neglect Data System
TBI Traumatic brain injury
WHO World Health Organization
Introduction
In the 60 years since the publication of C Henry Kempe's (1922-1984) landmark article, "The battered child syndrome," there has been a growing recognition of the fatal child abuse within the medical and forensic communities in the United States (1-3). With four million reports and over 675,000 substantiated victims of child maltreatment annually, the US child protection system continues to document the effects of maltreatment and violence on children (4). Mental and physical injuries place a heavy burden on children and society (5,6), and the Adverse Childhood Experiences study has noted the powerful relationship between adverse childhood experiences and several conditions of adulthood including risk and attempted suicide, alcoholism, depression, illicit drug use, and other lifestyle changes which have direct and indirect costs (7-11). Child maltreatment fatality is a sentinel event that has been undercounted in the US, leading to inadequate community responses and increasing child deaths. While they often attract the attention of the public and popular press (3), tragic and preventable deaths of children from abuse and neglect continue unabated...
