This fact sheet initiates new public service from Prevent Child Abuse America that has been made possible through a grant from the Sigma Delta Tau Sorority. Fact sheets will be issued periodically on a variety of subjects as needs arise. Fact sheets may be reproduced without notice to NCPCA; however, we request that the author, if any, and Prevent Child Abuse America be credited as the source if reproduced in part or in whole in other publications or products.

How much a society values its children can be measured by how well their children are treated. The fact that more than three children a day die from physical abuse or chronic neglect in the United States calls into question America's commitment to its young, especially as many of these deaths are preventable. The fact sheet provides information on child maltreatment fatalities including: 1) national statistics regarding the scope of the problem, 2) the relationship between fatalities and child abuse reports, 3) the underlying causes of child abuse fatalities, and 4) strategies for child welfare agencies and others to prevent future deaths.

How many children died in 1995 as a result of maltreatment?
According to information from 34 states representing 67.3% of the U.S. population under the age of 18, an estimated 1,215 child maltreatment deaths were confirmed by child protective service (CPS) agencies in 1995.¹ This figure undercounts the actual number of maltreatment fatalities, however, as some number of accidental deaths, child homicides, SIDS cases and deaths attributed to undetermined causes should be labeled child maltreatment fatalities.² According to a 1993 study by McClain et al., an estimated 85% of deaths due to parental maltreatment were coded as due to some other cause on the child's death certificate.³

Is the number of child fatalities increasing?
Over 3 children died each day last year as a result of parental maltreatment.⁴ A national survey conducted by Prevent Child Abuse America early in 1995 suggests that the number of confirmed child abuse fatalities increased 39% over the last 10 years. This trend is not surprising given the increase in poverty, substance abuse, and violence experienced by many communities.⁵

Is there a corresponding increase in child abuse reports?
Based on reporting data collected from 37 states and the District of Columbia, a little over 3 million children were reported for child abuse in 1995, approximately 2% more than had been reported in 1994. Overall, child abuse reporting rates have risen by an average of 4% each year between 1990 and 1995. The total number of reports has increased nationwide by 49% since 1986.⁶

What children are most likely to die from maltreatment?
Young children are at the highest risk. Research indicates that between 1993 and 1995, 85% of fatalities occurred to children under the age of five, with 45% to children under the age of one.⁷ Other studies have found that child abuse ranks as the second leading cause of death, after accidents, for children between one and five years old.⁸

How and why do these fatalities occur?
It is difficult to pinpoint one main cause for all fatalities attributed to child maltreatment. Between 1993 and 1995, 37% of all fatalities were the result of neglect, 48% from abuse, and 15% as a result of both forms of maltreatment.⁹ As a result, a few factors related to these fatalities seem to present themselves year after year. According to a 1995 report by Prevent Child Abuse America, states reported that substance abuse, by the abuser, was involved in anywhere from 4% to 65% of all substantiated cases.¹⁰ Additionally, 46% of children who died between 1993 and 1995 had prior or recent contact with CPS agencies.¹¹ This may signify that these are the only deaths that are investigated by many states. As a result, we can expect that a high percentage of reported deaths involve such children. Also, however, there is much difficulty in providing sufficient services to all victims which may also contribute to child maltreatment fatalities.

How can more child abuse fatalities be prevented?
Improving the ability of child protective service agencies to assist their clients by reducing caseloads, expanding training of caseworkers, and funding more treatment services for victims will help reduce fatalities. Child protective services, however, cannot prevent all fatalities single-handedly. Other formal institutions such as schools and hospitals as well as informal, personal networks should play an active role in identifying and assessing families at risk of abusive or neglectful behavior. Finally, alcohol and drug treatment services need to be expanded and made more accessible to pregnant and parenting women.

One of the most promising prevention strategies for reducing early childhood injuries is the provision of comprehensive home health visitors to all expectant and new mothers, or at the very least, to mothers in high risk neighborhoods.¹² In 1991, Prevent Child Abuse America introduced Healthy Families America, a comprehensive home visiting initiative. Such services offer instruction and support regarding prenatal care, parenting skills, household management, and coping with environmental dangers. As a 1996 report on Hawaii's Healthy Start home visitation program concluded, home visiting produces measurable benefits for participants in the areas of parental attitudes toward children, parent-child interaction patterns, and type and quantity of child maltreatment.¹³ Evaluations of other home visitation programs also are underway, specifically evaluations of Healthy Families America sites. This form of primary prevention demonstrates not only a social commitment to a child's well-being from the point of birth, but also a strong commitment to the welfare of society.