RD90 - Review of Caretaker Homicide and Undetermined Child Death, 1998-1999 and Child Death in Virginia, 2002


Executive Summary:
The Virginia State Child Fatality Review Team, hereafter called the Team, was established by the General Assembly in 1995. The purpose of the Team, outlined in § 32.1-283.1, is to systematically analyze deaths among Virginia's children. Prevention and intervention recommendations are a crucial component of each Team review. Reviewed deaths may include violent and unnatural deaths, sudden child deaths in the first eighteen months of life, and deaths where the cause and manner was not determined with reasonable medical certainty.

Governed by the principles and practices of public health, the Team conducts death reviews to learn about the causes and circumstances of individual deaths in order to develop suggestions for prevention, education and training that may reduce child deaths in the future.

This report presents conclusions and recommendations from Virginia's State Child Fatality Review Team after its review of 1998 and 1999 caretaker homicide and undetermined child deaths in Virginia. It also provides a description of all 2002 child deaths in Virginia. The findings of the report are summarized below.

The report was prepared for use by all Virginians - the Governor, members of the General Assembly, child advocates, policy makers, parents and citizens - with the firm conviction that injuries and deaths to children can be reduced.

Part One: Caretaker Homicide and Undetermined Child Death. The Team examined 53 cases of caretaker homicide and 28 cases of undetermined child death.

Caretaker Homicide

• The majority of caretaker homicide death is preventable and, as such, represents a significant public health challenge for the Commonwealth. The Team concluded that 72% of these deaths were definitely or probably preventable.

• Approximately four of every ten caretaker homicide deaths occurred among infants. More than eight out of ten of these deaths occurred among children under the age of five.

• The majority of injuries occurred at the child's home.

• Black children were overrepresented among these deaths to young children. While black children comprised roughly 23% of all Virginia children in 1998 and 1999, they were the victims of 42% of caretaker homicide deaths.

• Many families who lost a child in a caretaker homicide death lived at or below the poverty level.

• More than one-half of caretaker homicide deaths to children were caused by severe beatings which resulted in blunt force traumas. Gunshot wounds were the second leading cause of death among reviewed cases.

• Autopsy findings revealed that 31% of children had injuries suggesting chronic abuse by a caretaker.

• Team members reviewed three categories of caretaker homicide child death: abandoned or discarded infants, family annihilations; and child abuse and neglect-related deaths. Roughly seven out of ten deaths were child abuse and neglect-related deaths.

• Caretakers were described with the following characteristics: they lacked understandings of age-appropriate developmental needs or disciplinary strategies for their children; they were quick to anger; they had a history of violence and conflict with their intimate partners; they struggled financially and with stable housing; and, while some could not find stable and safe childcare arrangements, others had heavy child care responsibilities. Team members noted unique struggles for military families and a remarkable degree of social chaos and stress in these children's families, which cumulated to put infants and children at profound risk for abuse and neglect.

• As described by caretakers, some of the provocations for child abuse or neglect include: frustrations with crying and/or sleepless infants with complex feeding needs or with failed toilet training attempts; feelings of jealousy toward the child; and concerns over childcare payments.

• The Team's review highlighted the importance of family and friends, of health care providers, and of the child protective services system in recognizing, reporting and responding to child abuse and neglect complaints.

Undetermined Child Death

• Undetermined child deaths are those in which no definitive cause and/or manner of death can be found after death investigation. Team review revealed that most undetermined child deaths, 64%, were definitely or probably preventable.

• Roughly seven of every ten undetermined child deaths occurred among infants.

• Black children were dramatically overrepresented among these deaths to young children, comprising 71% of undetermined child death victims.

• Many families who lost a child to undetermined child death lived at or below the poverty level.

• The majority of these children were being supervised by a parent or both parents at the time of their injury or death.

• Team review revealed that family and child sleeping arrangements were not safe in 16 of these 28 child deaths. For instance, children were placed for sleep on their stomachs, or in adult beds, or with adults or other children, or with adult bed coverings, or with adults who were using drugs or alcohol.

• Team members focused on safe and age-appropriate sleeping practices when discussing reasonable interventions to prevent these child deaths.

At the conclusion of its review, The State Child Fatality Review Team made recommendations emphasizing eight target areas for change: legislative proposals; primary prevention efforts; public education initiatives; health care providers; social services; the judiciary, prosecution; and parents, caretakers, and citizens of the Commonwealth.

Part Two: Child Deaths in Virginia. In 2002, 1,087 of Virginia's children ages 0 to 17 died.

Child Injury Death.

• A total of 224 child deaths were due to injuries.

• Motor vehicle accidents were the leading cause and drowning was the second leading cause of unintentional injury death among children.

• Unintentional injury death rates for males were more than twice the rate for females. Similar disparities were found among males and females from all race and ethnic backgrounds.

• The very young and teenagers were most likely to be the victims of homicide. Of all homicides committed against children, 43.6% were to children under the age of five and 35.9% were committed against teenagers between the ages of 15 and 17. Firearms were used in 46.2% of all homicides.

• Death rates for homicide reveal profound disparities. Rates for Black male children far exceeded those for Black females and White males and females.

• Suicides occurred among children over the age of 10 and were most frequent among 15 to17 year olds. Firearms were used in 44.8% of these deaths.

• White males had the highest death rate for suicide, followed by Black males. No suicides occurred among Black females in 2002.

Natural Death to Children.

• A total of 863 child deaths were due to natural causes. Most of these deaths, 690, occurred in the first year of life.

• Males of all race or ethnic backgrounds were more likely than their female counterparts to die from natural causes.

• Leading causes of natural deaths to infants included conditions originating in the perinatal period, congenital anomalies, Sudden Infant Death Syndrome, and infectious and parasitic diseases.

• The deaths of 71 Virginia infants were attributed to Sudden Infant Death Syndrome (SIDS).

• Overall infant mortality rates revealed a clear race disparity. The risk of death among Black infants was more than twice that for White infants. Black infants had nearly double the rate of SIDS deaths when compared to White infants.