PEDIATRICS Vol. 91 No. 2 February 1993, pp. 338-343
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Estimates of Fatal Child Abuse and Neglect, United States, 1979 Through 1988

Philip W. McClain MS1, Jeffrey J. Sacks MD, MPH1, Robert G. Froehlke MD1, and Bernard G. Ewigman MD, MSPH2

1 From the National Center for Injury Prevention and Control, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, GA
2 From the Department of Family and Community Medicine, School of Medicine, University of Missouri-Columbia

The results of recent surveys in the United States have suggested a rising tide of fatalities due to child abuse or neglect (CAN). Because these surveys lack consistency in case definition and are incomplete in coverage, the use of death certificate data to estimate the number of CAN deaths was explored. To estimate these deaths among children 0 through 17 years old for 1979 through 1988, three models were formulated, each comprising six coding categories: (1) deaths coded explicitly as due to CAN, (2) homicides, (3) injury deaths of undetermined intentionality, (4) accidental injury deaths, (5) sudden infant death syndrome fatalities, and (6) natural-cause deaths. Research studies and crime data were relied on to estimate the proportions of deaths in categories 2 through 6 that were actually due to CAN, and other assumptions were varied to create a range of estimates. For the 10-year period, the estimated mean annual CAN fatalities ranged from 861 to 1814 for ages 0 through 4, and from 949 to 2022 for ages 0 through 17. Child abuse and neglect death rates did not increase over the period; in fact, they were relatively stable for ages 0 through 17 and showed a modest decline for 0 through 4. Ninety percent of fatal CAN occurs among children younger than 5 years old, and 41% occurs among infants. About 85% of CAN deaths are recorded as due to other causes. It is concluded that the magnitude of fatal CAN can be estimated from death certificates. It is recommended that the death coding system be modified to make CAN identification easier and that this study's methodology be refined to provide the basis for ongoing surveillance.

Key Words: child abuse • mortality • surveillance

Submitted on April 24, 1992
Accepted on July 1, 1992




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