Epidemiology of child homicide in Jefferson County, Alabama

Early Identification of Risk of Child Abuse Fatalities: Possibilities and Limits of Prevention

(1) Background: The aim of the study was to analyse the structure of registered fatal violent crimes against children under 5 years of age and to identify the main characteristics and risk factors of fatal violence against children in order to discuss the possibilities and limits of prevention of these crimes. (2) Methods: Mixed-method design: 1. retrospective statistical analysis of data extracted from Czech statistics about crime. 2. qualitative analysis of autopsy reports and construction of serial case study. The data were pooled from two different sources: 1. Statistics about crime against children aged 0 to 5 (n = 512). 2. Autopsy reports (n = 52) of children up to the age of five. (3) Results: The following indicators and risk factors were identified: mental disorder or cognitive deficits in parents, parents’ immaturity, poor parenting skills, inadequate parenting practices, absence of a deep emotional bond with the mother, lack of parents’ interest in catering to the children’s needs, parents’ addiction, an unprotected, hazardous environment and surroundings, household falling apart, incidence of suspected domestic violence, incidence of multiple bruises and untreated injuries, aggressively dominant parents, poverty, absence of adequate health care, medical neglect of a child, poor health of the child and failure to thrive. (4) Conclusions: The task for the state is to make effective use of all accessible mechanisms to improve the situation in families. Particularly in the context of the newly emerging situation of increasing uncontrolled violence in families in the context of the restrictions of the COVID-19 pandemic, this demand is more than urgent. Close attention should be paid to children who are not registered with pediatricians and fail to attend regular medical examinations. It is also vital to follow families in which violence has already been suspected in the past.

Child homicide in northern Tunisia: a retrospective study of forensic autopsy cases

Background

As far as we know, no previous research has investigated child homicide in Tunisia. In this context, our study was carried out to analyze the epidemiological and medico-legal characteristics of child homicide occurring in northern Tunisia over a 17-year period.

Results

Eighty-seven cases were collected, with a male-to-female ratio of 2.4. The mean age of the victims was 12.6 years for both sexes. We found that 56.3% of the cases were aged between 15 and 18 years. The majority of deaths under 15 years of age occurred at home as a result of intrafamilial homicide. Victims aged more than 15 years were more likely to be assaulted outside the home by a non-family member.

The most frequent method of homicide was sharp force (39%) affecting mostly the heart and the lung, followed by blunt trauma (25%), which affected mainly the head. Sexual assault was diagnosed at autopsy in six victims (6.9%).

Conclusions

The study offers available data concerning the patterns of child homicide in northern Tunisia and may help to implement preventive measures against this kind of crime.

An Exploratory Study of the Prosecution of Fatal Child Maltreatment: Criminal Charges Filed Against Presumed Perpetrators in the United States in 2017

In the United States child maltreatment fatalities (CMFs) do not usually meet the standard for manslaughter or murder, resulting in convictions of lesser crimes and little jail time. This exploratory study examined the charges brought against suspected CMF perpetrators in 2017. Univariate and bivariate analyses were conducted using data obtained from the Nexis Uni newspaper database, that has over 40,000 high quality media sources, for the year 2017. We found that the most frequently used charges were endangering the welfare of a child and murder, the former of which was more related to neglect-deaths and the latter to physical abuse-deaths. There was no difference between charges for male and female perpetrators. Practical implications for research, policy, and practice are discussed.

Child maltreatment fatalities among children and adolescents 5-17 years old

BACKGROUND

Child maltreatment-related fatalities occur among children of all ages. However, few published studies have examined child abuse and neglect deaths among older children and adolescents.

OBJECTIVE

To epidemiologically describe child maltreatment-related fatalities among children in the United States 5-17 years old.

PARTICIPANTS AND SETTING

Ten years of data from the United States National Violent Death Reporting System (2006-2015) were analyzed to examine child maltreatment deaths among children 5-17 years of age.

METHODS

Child fatalities attributed to homicide or undetermined causes were reviewed by the study team to identify deaths related to child abuse and/or neglect, injury mechanisms, relationships between perpetrators and victims, victim and perpetrator characteristics, and circumstances surrounding the deaths.

RESULTS

The study team identified 285 abuse- and/or neglect-related fatalities during the study period. The mean age of the victims was 9.2 years and 54.4 % of victims were male. Suspected perpetrators were most frequently mothers (28.1 %) and fathers (26.3 %). The most common injury mechanism was firearms (20.7 %). A significantly greater percentage of deaths among children 11-17 years were attributable to firearms (31.6 %), compared to deaths among children 5-10 years. Among younger children 5-10 years, blunt force trauma was the most frequent injury mechanism (22.6 %).

CONCLUSIONS

Older children and adolescents are frequently excluded from child maltreatment research. Although child maltreatment deaths are less common among older children compared to younger children, these fatalities have unique characteristics that should be considered when developing prevention strategies.

Who's Watching the Children? Caregiver Features Associated with Physical Child Abuse versus Accidental Injury

OBJECTIVE

To compare caregiver features and caregiving arrangements of children with physical abuse vs accidental injuries.

STUDY DESIGN

Data came from a prospective, observational, multicenter study investigating bruising and psychosocial characteristics of children younger than 4 years of age. Using logistic regression, we examined how abuse vs accidental injury and severity of injury were associated with caregiver sex, relation to the child, whether caregiving arrangements were different than usual at the time of injury, and length of the main caregiver's relationship with his/her partner.

RESULTS

Of 1615 patients, 24% were determined to have been physically abused. Abuse was more likely when a male caregiver was present (OR 3.31, 95% CI 2.38-4.62). When the male was the boyfriend of the mother (or another female caregiver), the odds of abuse were very high (OR 169.2, 95% CI 61.3-614.0). Severe or fatal injuries also were more likely when a male caregiver was present. In contrast, abuse was substantially less likely when a female caregiver was present (OR 0.25, 95% CI 0.17-0.37) with the exception of a female babysitter (OR 3.87, 95% CI 2.15-7.01). Caregiving arrangements that were different than usual and caregiver relationships <1 year were also associated with an increased risk of abuse.

CONCLUSIONS

We identified caregiver features associated with physical abuse. In clinical practice, questions regarding caregiver features may improve recognition of the abused child. This information may also inform future abuse prevention strategies.

Increasing incidence of nonlethal inflicted injuries in paediatric homicides: A 45-year study

A retrospective study was undertaken at Forensic Science South Australia of all homicides in individuals aged <18 years from January 1970 to December 2014. 166 cases were identified (M:F = 1.5:1). The number of cases steadily declined, with the highest numbers and death rate occurring between 1970 and 1974 (N = 26; 0.37/100,000 population), and the lowest between 2010 and 2014 (N = 8; 0.1/100,000) (p < 0.01). Deaths were due to blunt force trauma (37%), gunshot wounds (19%), asphyxiation (18%), sharp force trauma (8%), poisoning (8%), burns (3%) and neglect (1%), or were undetermined (6%). There was a significant increase in numbers of accompanying nonfatal injuries (3.46 per case for 1970 and 1974, compared to 18.88 per case for 2010 and 2014). Thus, while both the absolute numbers and the rates of paediatric homicides declined significantly, numbers of nonlethal injuries increased. Whatever the underlying reason(s) for the increase in nonlethal injuries, fatal attacks on children in South Australia appear to be becoming more violent.

Suspicious child female deaths in Great Cairo and Giza during 2011-2012

Childhood mortality is a measure of a nation's health. A statistical analysis on suspicious child female deaths was done in two years period from 1st January 2011 to 31st December 2012. It's incidence was (4%) of all autopsied cases. The adolescent group (16-18 yrs) was highly involved 44 cases (27.5%). The majority of cases were known (82%) and they were from Great Cairo (60%) especially poor areas. Incidences were prevalent in March (15%), indoor (58%) and homicide was main manner in (42.5%) of cases. A relative was the main perpetrator in (50%) of homicidal cases. Wounds were observed in (43%) of cases. The head and neck regions were injured (50%) and signs of abuse were detected in (16%) of the studied cases. These results may be a guide for developing prevention policy.

Non-accidental trauma in pediatric patients: a review of epidemiology, pathophysiology, diagnosis and treatment

Non-accidental trauma (NAT) is a leading cause of childhood traumatic injury and death in the United States. It is estimated that 1,400 children died from maltreatment in the United States in 2002 and abusive head trauma (AHT) accounted for 80% of these deaths. This review examines the epidemiology and risk factors for NAT as well as the general presentation and required medical work up of abused children. In addition, potential algorithms for recognizing cases of abuse are reviewed as well as outcomes in children with NAT and potential neurosurgical interventions which may be required. Finally, the evidence for seizure prophylaxis in this population is addressed.

A longitudinal, multilevel analysis of homicide against children aged 0-9 years using state-level characteristics: 1979-2007

Annually, over a thousand children are the victims of homicide in the United States Homicide among younger children, 0-9 years of age, is usually perpetrated by parents and caregivers. Researchers neither have tracked changes in the homicide rate among young children over time nor have they used theory to understand what factors may drive these changes. In this analysis of state-level data, we used longitudinal growth modeling and ecological theory to examine changes in homicide rate against children aged 0-9 years from 1979 to 2007. Our results indicate that states are relatively consistent, over time, in their homicide rates. Furthermore, a cultural context of criminal and risky behavior is positively associated with homicide against children. We discuss implications for future research and prevention.

Child homicide and neglect in France: 1991-2008

The aim of this study is to investigate epidemiological characteristics of the victims and the offenders in children homicide cases and to propose preventive measures. We retrospectively investigated homicides and deaths by neglect involving children aged 15 or less, which have been autopsied in the Department of Pathology and Legal Medicine of the Raymond Poincaré Hospital, Garches, France, during the 18-year period from 1991 to 2008. Cases included were analyzed for victims' age and gender, victim-assailant's relation, death cause and scenery, and offender's motivation. For the purposes of the study, victims were divided into four age groups: new born; infants (1-23 months); young children (2-5 years); and children (6-15 years). During the study period, 70 victims of homicide or fatal neglect were identified, which equates to a child homicide prevalence of 0.56 per 100,000 children per year. Slightly more than half of the victims (51.4%) were less than 1 year old. Neonaticide prevalence was 0.12 per 100,000 births with an equal distribution between genders. Neonates were most likely to be killed by their mothers while fathers were the most frequent assailants in both infants and children groups. Stepparents were involved in only one case. Familicide cases where children and spouses are killed were perpetrated only by fathers. The leading cause of death was blunt trauma (especially head trauma). In the neonaticide group, half of the victims died from passive neglect whereas gunshots were predominant in the children groups.

Child maltreatment deaths in the U.S. National Child Death Review Case Reporting System

Comprehensive reviews of child death are increasingly conducted throughout the world, although limited information is available about how this information is systematically used to prevent future deaths. To address this need, we used cases from 2005 to 2009 in the U.S. National Child Death Review Case Reporting System to compare child and offender characteristics and to link that information with actions taken or recommended by review teams. Child, caretaker, and offender characteristics, and outcomes were compared to team responses, and findings were compared to published case series. Among 49,947 child deaths from 23 states entered into the Case Reporting System during the study period, there were 2,285 cases in which child maltreatment caused or contributed to fatality. Over one-half had neglect identified as the maltreatment, and 30% had abusive head trauma. Several child and offender characteristics were associated with specific maltreatment subtypes, and child death review teams recommended and/or planned several activities in their communities. Case characteristics were similar to those published in other reports of child maltreatment deaths. Teams implemented 109 actions or strategies after their review, and we found that aggregating information from child death reviews offers important insights into understanding and preventing future deaths. The National Child Death Review Case Reporting System contains information about a large population which confirms and expands our knowledge about child maltreatment deaths and which can be used by communities for future action.

Fatal child maltreatment: characteristics of deaths from physical abuse versus neglect

This study examined victim, family, and alleged perpetrator characteristics associated with fatal child maltreatment (FCM) in 685 cases identified by child welfare services in the state of Oklahoma over a 21-year period. Analyses also examined differences in child, family, and alleged perpetrator characteristics of deaths from abuse versus neglect. Case information was drawn from child welfare investigation records for all FCM cases identified by the state Department of Human Services. Fatal neglect accounted for the majority (51%) of deaths. Children were primarily younger than age 5, and parents were most frequently the alleged perpetrators. Moreover, most victims had not been the subject of a child welfare report prior to their death. A greater number of children in the home and previous family involvement with child welfare increased children's likelihood of dying from neglect, rather than physical abuse. In addition, alleged perpetrators of neglect were more likely to be female and biologically related to the victim. These results indicate that there are unique family risk factors for death from neglect (versus physical abuse) that may be important to consider when selecting or developing prevention efforts.

The epidemiology of child homicides in South Africa

OBJECTIVE

To describe age- and sex-specific rates of child homicide in South Africa.

METHODS

A cross-sectional mortuary-based study was conducted in a national sample of 38 medicolegal laboratories operating in 2009. These were sampled in inverse proportion to the number that were operational in each of three strata defined by autopsy volume: < 500, 500-1499 or > 1499 annual autopsies. Child homicide data were collected from mortuary files, autopsy reports and police interviews. Cause of death, evidence of abuse and neglect or of sexual assault, perpetrator characteristics and circumstances surrounding the death were investigated.

FINDINGS

An estimated 1018 (95% confidence interval, CI: 843-1187) child homicides occurred in 2009, for a rate of 5.5 (95% CI: 4.6-6.4) homicides per 100 000 children younger than 18 years. The homicide rate was much higher in boys (6.9 per 100 000; 95% CI: 5.6-8.3) than in girls (3.9 per 100 000; 95% CI: 3.2-4.7). Child abuse and neglect had preceded nearly half (44.5%) of all homicides, but three times more often among girls than among boys. In children aged 15 to 17 years, the homicide rate among boys (21.7 per 100 000; 95% CI: 14.2-29.2) was nearly five times higher than the homicide rate among girls (4.6 per 100 000; 95% CI: 2.4-6.8).

CONCLUSION

South Africa's child homicide rate is more than twice the global estimate. Since a background of child abuse and neglect is common, improvement of parenting skills should be part of primary prevention efforts.

Fatal child maltreatment in England, 2005-2009

OBJECTIVE

This paper presents comprehensive and up-to-date data covering 4 years of Serious Case Reviews into fatal child maltreatment in England.

METHODS

Information on all notified cases of fatal maltreatment between April 2005 and March 2009 was examined to obtain case characteristics related to a systemic classification of 5 broad groups of maltreatment deaths (severe physical assaults; covert homicide/infanticide; overt homicide; extreme neglect/deprivational abuse; deaths related to but not directly caused by maltreatment).

RESULTS

A total of 276 cases were recorded giving an incidence of 0.63 cases per 100,000 children (0-17) per year. 246 cases could be classified based on the data available. Of these the commonest specific group was those children who died as a result of severe physical assaults. Apparently deliberate overt and covert homicide was less common, while deaths as a direct consequence of neglect were rare. In contrast, some evidence of neglect was found in at least 40% of all cases, though not the direct cause of death.

CONCLUSIONS

Class characteristics differ between the different categories of death and may suggest the need for different strategies for prevention.

The epidemiology of nonaccidental trauma in children

BACKGROUND

Abuse of children is abhorrent in Western society and, yet, is not uncommon. Nonaccidental trauma (NAT) is the result of a complex sociopathology. Not all of the causative factors of NAT are known, many are incompletely described, not all function in each case, and many are secondary to preexisting pathology in other areas.

QUESTIONS/PURPOSES

We therefore addressed the following questions in this review: (1) what is the general incidence of NAT; (2) what factors are intrinsic to the abused child, family, and society; and (3) what orthopaedic injuries are common in NAT?

METHODS

We searched Medline, Medline In Process & Other Non-Indexed Citations, and Embase using OVID. Only one article fit our inclusion criteria; therefore, this is a descriptive generalized review of the epidemiology of NAT.

RESULTS

The general incidence of NAT ranges from 0.47 per 100,000 to 2000 per 100,000. Younger children are at greater risk of NAT than older children. Parents are often the perpetrators of the abuse. Rib fractures are highly indicative of NAT in young children.

CONCLUSIONS

It is important to consider child, family, and societal factors when confronted with suspicions of child abuse. Our review demonstrates the currently limited information on the true incidence of NAT. To determine a much more accurate incidence of NAT, there needs to be a population-based surveillance program conducted through primary care providers.

Characteristics of child abuse homicides in the state of Kansas from 1994 to 2007

OBJECTIVE

This study described the epidemiology of child abuse homicides in the state of Kansas from 1994 to 2007. It focused on obtaining significant details on all recorded child abuse homicides in Kansas during this time frame to provide critical information that can be used for future preventive measures.

METHODS

A retrospective case review was conducted on data gathered by the Kansas State Child Death Review Board for all cases of "child abuse homicides" that occurred from 1994 to 2007.

RESULTS

A total of 170 child abuse homicide cases in Kansas between 1994 and 2007 were identified. The majority of these cases (63.5%) were considered fatal child physical abuse. There was a predominance of female victims (55.9%). The vast majority of victims were White (78.8%), followed by Black (17.1%). One to 2-year-olds accounted for the largest age group of children who were victimized (33.5%). For cases with known prenatal care status, 74% of mothers received adequate prenatal care. The largest percentage of victims was children of single mothers (40.6%), with no prior history of child abuse (60%). The majority of deaths occurred in the victim's residence (81.8%). The greatest number of deaths occurred secondary to abusive head trauma (42.9%), followed by asphyxia (21.8%). When a trigger was known, 44.2% involved inconsolable crying. The most common perpetrator was the victim's biological father (26.6%), followed by the victim's biological mother (24.9%), then the victim's mother's male paramour (19.8%).

CONCLUSIONS

Familiarity with characteristics involved in child abuse homicide allows for opportunities to enlist important preventive measures. Most child abuse homicides occurred at the hands of the victim's biological parents and in the victim's own residence. Prevention should be focused on parent education and coping mechanisms for the frustrating features of crying in normal infants that lead to shaking or abuse.

Child homicide on the territory of Belgrade

OBJECTIVE

This study examines the incidence and other epidemiological and medico-legal characteristics of child homicide in the territory of Belgrade, Republic of Serbia.

METHODS

We performed a retrospective analysis of all autopsies carried out at the Institute of Forensic Medicine in Belgrade during a 15 year period between 1991 and 2005, focusing on homicide cases of victims aged 0-14 years. These were then analyzed in terms of number of deaths, mortality rates, age, and sex of the victim, relation to the perpetrator, and cause of death and injury.

RESULTS

Forty-six homicides were identified where the victims were aged 0-14 years. These included 24 girls and 22 boys. In 32 cases (69.6%) the perpetrator was one of the child's birth parents, more frequently the mother. Blunt head trauma was the most frequent cause of death, followed by exsanguination. In 9 cases (19.5%) there was evidence of physical abuse; 16 children died in the setting of multiple homicide and/or murder/suicide. In 4 cases (8.7%) there was evidence of neglect which contributed to the fatal outcome. There were 10 cases of neonaticide within the 46 homicides. There were, however, 49 further cases where bodies of newborn infants were discovered after having been disposed of in suspicious circumstances.

CONCLUSIONS

Proportionally, the largest number of victims fell within the 1-4 years age group, with a slight preponderance of females, most of them killed at home by a close family member, usually the mother. Blunt head trauma was the single most frequent cause of death. Injury patterns consistent with child abuse were identified among 20% of the study group.

Characteristics of infant homicides: findings from a U.S. multisite reporting system

OBJECTIVE

The purpose of this study was to describe homicides of infants (children <2 years of age) in the U.S.

METHODS

Cases were derived from the National Violent Injury Statistics System; 71 incidents involving 72 infant homicides were in the data set. Type 1 involved beating/shaking injuries inflicted by a caretaker; type 2 involved all other homicides (including neonaticide, intimate partner problem-related homicide, crime-related death, and other types).

RESULTS

Seventy-five percent of the incidents were type 1 incidents, perpetrated mainly by men (83%; typically the infant's father or the boyfriend of the infant's mother). In 85% of the type 1 incidents, the infant was transported to the hospital, usually at the initiative of the perpetrator or another household member. In almost one half of the type 1 incidents, a false story was offered initially to explain the injuries. In contrast, the type 2 incidents (16 cases) were perpetrated mainly by women (11 of 16 cases) and involved methods such as poisoning, drowning, sharp instruments, or withdrawal of food and water; most infants were not taken to the hospital. Although 93% of incidents were perpetrated by caretakers, the large differences between the 2 incident types suggest different avenues for prevention.

CONCLUSIONS

The circumstances involved in the type 1 homicides (beatings by caretakers) suggested that those attacks occurred impulsively, death was unintended, and emergency care was summoned, often with a false story. Previous abuse was suspected in more than one half of those incidents.

Samsun’da Cinayet Kurbanı Çocuklar 1998-2007

Küresel bir halk sağlığı sorunu olan şiddetin tüm türleri, dünyanın her yerinde görülmektedir. Kendi kendini yaralama, kişilerarası ya da toplu şiddet sonucu, her yıl bir milyondan fazla kişi ölmekte ve çok daha fazlası da yaralanmaktadır. Yaşanan şiddetten çocuklar ve gençler de etkilenmekte olup 2000 yılı verilerine göre, dünyada 199.000 (Yüzbinde 9.2) genç cinayeti olduğu, şiddet sonucu günde ortalama 10-29 yaş arası 565 çocuk, adölesan ve genç erişkinin öldüğü bildirilmektedir. Bu çalışmada, Samsun İl merkezinde meydana gelen 0-18 yaş grubu cinayet olguları değerlendirilerek, çocukluk çağı cinayetlerine yönelik bazı çıkarımlarda bulunmak amaçlanmıştır. Samsun Adliyesi’ndeki kayıtlar retrospektif olarak incelenerek; 10 yıllık (1998-2007) sürede Samsun Ağır Ceza Merkezi bölgesinde gerçekleştirilen 0-18 yaş grubu 18 cinayet olgusuna ait veriler değerlendirilmiştir. Olguların %77,8 (14 olgu)’i erkektir ve en fazla olgu (11 olgu) 16-18 yaş grubundadır. İki olguda sanık belirlenememiş olup, 2’sinde annesi, l’inde babası, 8’inde arkadaşı, akrabası ya da komşusu, 5 olguda ise tanımadığı bir kişidir. Sadece 2 olguda ölüme neden olan olay evde meydana gelmiştir. Olguların çoğunda (12 olgu) ateşli silah ya da kesici-delici alet kullanılmıştır. Cinayet öncesi sanıkla aralarmda tartışma olduğu bildirilen olgu sayısı 11’dir. Çocuğun yaşama ve sağlıklı olarak yaşamını sürdürme hakkının korunması için birey ve toplum olarak gerekli önlemleri almamız ve toplumsal şiddetin azaltılmasına yönelik çalışmalar yapmamız gerekmektedir.Anahtar kelimeler: Çocukluk çağı, cinayet

The murder of children by fathers in the context of child abuse

OBJECTIVE

This study examined the backgrounds of fathers who fatally abuse their children and the contexts within which these homicides occur. The type of relationship between victim, perpetrator, and the victim's mother was a particular interest.

METHODS

Data were gathered from 26 cases of fatal child abuse perpetrated by fathers derived from the wider Murder in Britain study. Quantitative and qualitative data were collected from extensive prison case files of men serving life sentences for child murder.

RESULTS

This was a group of undereducated, underemployed men with significant criminal histories. All except one victim had been subjected to previous violence by the offender, almost three-quarter of whom had also perpetrated violence against their intimate partners (the child's birth mother). Many men had unreasonable expectations and low tolerance levels of normal childhood behaviors, and many appeared jealous and resentful of these young children. All 26 victims were under 4 years of age. Sixty-two percent of the offenders were stepfathers and in only four cases was the perpetrator a birth father married to the birth mother. Stepfathers had more disrupted and disadvantaged backgrounds and experiences than birth fathers.

CONCLUSIONS

Findings suggest that fathers who perpetrate fatal child abuse have a propensity to use violence against children in their care and intimate partners, raising questions about the gender dynamics and generational boundaries operating in these families. The nature and type of intimate relationship (whether married or cohabiting) and fathering relationship (whether birth or de facto) were important differentiating factors in these homicides as well as characteristics of the offender.

PRACTICE IMPLICATIONS

Professionals working in child protection strive to provide effective services to children and families, ever vigilant to the possibility of the death of a child as a consequence of an assault. By and large, fathers (either biological or de facto) as the perpetrators of such assaults have received minimal attention in both policy and practice. Findings from this study suggest that practitioners need to be cognizant of men's attitudes towards and expectations of fathering (particularly stepfathering) which may present increased levels of risk to both children and intimate partners.