Major Risk Factors 

While total homicides in the United States fell in the 1990s, the number of child abuse fatalities increased to about 1,400 child deaths in 2002.  Experts do not know if this increase is due to a rise in the actual number of deaths or if it can be attributed to the improvement in reporting procedures. Most experts believe that the actual number of fatalities due to abuse and neglect is actually considerably higher.  Recent studies estimate as many of 50-60% of child abuse and neglect deaths in the U.S. are not recorded as such.

A number of explanations have been offered for the discrepancies between reported cases and estimated actual cases of child abuse and neglect.  It is believed that many deaths are disguised, misdiagnosed or mislabeled as accidental or natural deaths.  Many abuse and neglect deaths can only be diagnosed by thorough scene investigations and autopsies.  Even then, findings may mimic other unintentional injuries or natural causes.  As a society, it is difficult for anyone to believe that a person could deliberately kill a child through an abusive or neglectful action.  There are usually no witnesses to an act that leads to a child abuse homicide.  Because the perpetrators are usually parents or other caregivers, the first responders to a child death scene, medical personnel or investigators will often accept explanations given for the events that caused the death.  Neglect deaths in particular are very difficult to identify because the neglect often results in illnesses and infections that can be attributed to natural causes.

Difficulties in accurate reporting are further complicated by the variations on the terminology used to describe fatal abuse and neglect.  For example, fatal inflicted head trauma is also called inflicted cerebral trauma, abusive head trauma, shaken baby syndrome (SBS), shaken impact syndrome or abusive brain trauma.

In 2002, the National Child Abuse and Neglect Data System (NCANDS) reported that child maltreatment fatalities were most often the result of neglect (38%), followed by physical abuse (30%), and then combinations of maltreatment types (29%).

There are many forms of physical abuse and neglect that can lead to death.  Physical abuse is the infliction of injury by punching, beating, kicking, biting, burning, shaking or otherwise physically harming a child.  Common forms of physical abuse causing death are by punches or kicks to the abdomen, by intentional burns or by poisonings.  Many children who die from physical abuse have been abused over time, but a one-time event often causes a death.

The leading cause of death to infants and young children due to child maltreatment is from physical abuse involving children who receive 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 does 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 do not cause extensive, severe head injuries.

Infants are at greatest risk of child maltreatment  homicide in their first week of life, with the first day of their life being the day of highest risk.

Most children die from abuse when a caregiver loses patience with the child.  The most common precipitating “triggers” are inconsolable crying, bedwetting, fussy eating and disobedient behavior.

In cases of fatal neglect, the child’s death usually results from a caregiver’s failure to act. Chronic neglect includes depriving a child of food, clean environments or safe shelter.  Deaths can result from malnutrition, failure to thrive, illnesses and/or starvation.  Medical neglect includes failure to seek medical care when a child is ill.  Many neglect cases result from failure to adequately supervise a child, often for extended periods of time.  Negligence on the part of a caretaker can lead to bathtub drownings, suffocations, falls, poisonings and other types of fatal “accidents.

Young children are the most vulnerable victims.  National statistics show that children under seven years of age account for 88% of all maltreatment deaths.  Of those deaths, roughly half were to children under the age of one with males accounting for 61% of these infant fatalities.  Michigan’s numbers are similar: for the maltreatment deaths reported to NCANDS in 2002, 90% of victims were under age seven, 60% of those were under age one and 46% of those infant victims were male.

Fathers and other male caretakers are responsible for over three-quarters of fatal abuse, while mothers account for the majority of neglect.  In 2002, one or both parents were involved in 79% of child abuse or neglect fatalities in the U.S.  Fatal abuse is often interrelated with poverty, domestic violence and substance abuse.  A study by the National Center on Addiction and Substance Abuse found that children of substance-abusing parents were almost three times more likely to be abused and more than four times more likely to be neglected than children of parents who are not substance abusers. While no single profile fits every case, several factors seem to characterize many child abusers.  They are more likely to be a young adult in his or her mid-20’s who:

• Lives near or below the poverty level.

• Has not finished high school.

• Is depressed or unable to cope with stress.

• Was also a victim of child abuse.

• Is a victim or perpetrator of domestic violence.

• Has a problem with drugs or alcohol.

• Immaturity of parents.

• Lack of Parenting Skills

• Unrealistic expectations about children’s behavior and capabilities.

• Social isolation.

Persons who neglect their children are more likely to be suffering from postpartum depression, substance abuse, domestic violence or mental illness. A 1999 study by the National Center on Addiction and Substance Abuse found that children of substance-abusing parents were almost three times likelier to be abused and more than four times likelier to be neglected than children of parents who are not substance abusers.  Other studies suggest that an estimated 50% to 80% of all child abuse cases substantiated by CPS involve some degree of substance abuse by the child’s parents.

National studies report that it is difficult to predict a fatal abuse event.  In the U.S., the majority of child victims and their perpetrators had no prior contact with CPS at the time of the death, yet many children had previous injuries that were not reported.