Child deaths from abuse and neglect
Child deaths from abuse and neglect
In this paper we provide an overview of child deaths due to child abuse and neglect in Australia and set these statistics in an international context.
Child deaths from abuse and neglect are deaths resulting from acts of physical violence or neglect of a child that are perpetrated by a family member or caregiver. In this paper we define a child as being under the age of 18 years.
This paper also includes information, where available in the state/territory child death reports, on deaths of children and young people who had a history of child protection involvement.
What international statistics are available?
The World Health Organization (WHO) has estimated that every year there are 41,000 homicide deaths of children under the age of 15 (WHO, 2014). In their 2006 report, WHO estimated that violence related child deaths were almost twice as high in low-income countries (2.58/100,000) than in high-income countries (1.21/100,000) (WHO, 2006). UNICEF (2003) estimates suggested that of the 27 most economically developed nations, Australia had the 9th lowest rate of child death resulting from maltreatment for children under 15 years of age in the 5-year period from 1994-98. While Australia's rate, 0.8 per 100,000 children, is approximately 4 times the rate of Spain, Greece and Italy, it is below the rates in New Zealand (1.3) and the USA (2.10) (Damashek, Nelson, & Bonner, 2013).
These figures are likely to under-represent the actual numbers of deaths however. Mortality statistics rely on the accurate and complete capture of all deaths within a defined population. In high-income countries with well-developed systems, birth and death registration processes ensure statistics are produced in a routine, systematic manner. In addition to this, death certification relies on doctors or coronial reviews to assign a cause of death. While child death statistics from high-income countries are relatively reliable, death registration processes can limit the accuracy of information about child deaths. For instance, some have argued that the International Classification of Diseases (the system used for coding cause of death in more than 100 countries including Australia) has a lack of suitable codes in relation to maltreatment (Child Welfare Information Gateway, 2015; Frederick, Goddard, & Oxley, 2013; WHO, 2015). Coding rules also dictate that where "intent" is uncertain, the default is "unintentional" (Scott, Tommyr, Fraser, Walker, & McKenzie, 2009). In addition, investigators are unable to go beyond their identification role to considering the factors that led to death, and wrongful cause of death may be recorded because of the difficulties in differentiating accident from intentional injury (Fraser, Sidebotham, Frederick, Covington, & Mitchell, 2014).
In low-income countries registration systems are often not as well developed, with some countries not recording births and/or deaths. In low-income countries where deaths are registered, a doctor may record cause of death if they are present. However, if a doctor is not present at the time of death, certification is reliant on verbal autopsy after the fact. In some cases trained medics or tribal elders may assign cause of death and in some circumstances the death may only be captured during community surveys.
The Global Burden of Disease Project has found that death registration data are available for 83 countries (28% of the global population) and high quality data were only available for 20 countries (Bhalla, Harrison, Shahraza, & Fingerhut, 2010).
Research has consistently found that the youngest children are the most vulnerable to abuse- and neglect-related deaths. For example, a large-scale population-based study conducted in the United Kingdom from 1993-96 determined that abuse was the main cause in 6% of child deaths, and a secondary cause in 6-8% of cases examined (Frederick et al., 2013). Recent data collection found that 73.9% of child deaths from abuse and neglect in the US were in children younger than 3 years of age, with the rate mostly decreasing with age. The rate of children who died under the age of 1 was 18.09 per 100,000 children compared to 6.58 per 100,000 children aged 1 at the time of their death (US Department of Health and Human Services, 2015).
In countries with well-developed death registration systems, child death review systems have evolved to provide the additional information necessary to understand and prevent child deaths.
What information is available in Australia?
In Australia, state and territory Registrars are responsible for registering all deaths in their jurisdiction. Statistics are compiled and reported by the Australian Bureau of Statistics. There is however, no national report on causes of death for all Australian children under the age of 18.
According to the most recent national data from the Australian Institute of Health and Welfare (AIHW), between 2008 and 2010, the leading cause of death among children aged 0-14 years was injury. Of these injuries, the third leading type of injury was assault, following transport-related deaths and accidental drowning. In 2009-10, among children aged 0-14 years, there were 24 deaths due to homicide (0.6/100,000 children) and the rate of homicide was highest among infants less than 1 year old (2.1/100,000 infants or 6 deaths) (AIHW, 2012).
The Australian Institute of Criminology reported that across the period 2010-12, approximately 12% (61) of all homicides were children and young people under 17 years of age. During the same period, 34 domestic homicides were sub-classified as filicides (death of a child or infant under the age of 1 attributed to a parent or step-parent) (Bryant & Cussen, 2015).
The Australian and New Zealand Child Death Review and Prevention Group (Review and Prevention Group) was established with the aim of developing national and international comparable child death statistics, and to better understand and prevent child deaths. The Review and Prevention Group had their inaugural meeting in 2005. Data prepared for the most recent meeting held in 2012 was reported in the 2013-14 Queensland Child and Family Commission's annual report.
Under-reporting of child death and injury due to maltreatment
Research has demonstrated that because routine data are collected for different reasons (Stone et al., 1999), individual databases are likely to under-represent the numbers of fatal child maltreatment cases (Palusci, Wirtz, & Covington, 2010; Schnitzer, Gulino, & Yuan, 2013; Sheldon-Sherman, Wilson, & Smith, 2013). In order for the cause of death recorded on a death certificate to be attributed to assault or child maltreatment, a doctor or coroner must ascertain either assault or child maltreatment as the underlying cause. If there is any uncertainty about the intent of the cause of death then, according to the requirements of the International Classification of Diseases, the death must be assigned to an "accidental cause". This is likely to result in an underestimation of the true magnitude of child maltreatment fatalities. Australian research using hospital morbidity data has shown that almost a third of children admitted to hospital with an unintentional injury are known to child protection authorities (McKenzie, Scott, Fraser, & Dunne, 2012) suggesting that a number of admissions likely to be associated with maltreatment are not recognised as such. The association between classifications of unintentional death and child maltreatment was the focus of US research that analysed the deaths of children under the age of 5 who died from a fatal injury during 1999-2007. Data analysis revealed that children who were referred to child protection for neglect prior to their death represented 82% of the 247 unintentional fatal injuries reported (Putnam-Hornstein, Cleves, Licht, & Needell, 2013). Under-recognition of maltreatment as a cause of injury is also likely to apply to data on child deaths.
Which states and territories carry out child death reviews?
Detailed information on deaths resulting from child abuse and neglect is not available from all Australian jurisdictions; however, information from jurisdictions that carry out official inquiries into child deaths (also referred to as child death reviews) provides some guidance. Child death review teams report on state and territory level data for the Australian Capital Territory, New South Wales, the Northern Territory, Queensland, South Australia, Victoria and Western Australia.
Child Death Review Teams collate and link data from multiple sources to improve understanding of the circumstances of each child's death. This information is used for the benefit of future prevention and action. In New South Wales, Northern Territory, South Australia, Western Australia and Victoria, Child Death Review Teams are legislated to make recommendations that arise from child death patterns and trends, and to monitor the implementation of these recommendations. They do not aim to determine the culpability of alleged offenders or comment on the individual performance of workers, nor do they investigate the causes of child deaths; that role is left to the police and coroner. In most cases, Child Death Review Teams rely mainly on document and case note analysis, however in some instances teams may conduct interviews or meet with staff or families of the deceased.
Reports released by the child death review teams/committees are described and available data are presented below. For those jurisdictions that do not have a publicly available formal and routine fatal abuse reporting mechanism, a description is provided of any other publicly available review or data on fatal abuse. There is no uniform structure or legislation for child death review team responsibilities. Reporting requirements vary for each state or territory.
Australian Capital Territory
In 2015, the ACT Children and Young People Death Review Committee (CYPDRC) released its fourth annual report providing detailed information regarding child deaths that have occurred from 2010-11 through to 2014-15. The committee is required to report circumstances where a child or young person, or their sibling, had a child protection report made in the 3 years prior to their death.
In the period from July 2010 to June 2015, 23 (20.7%) of the 111 children and young people who died were known to child protection services and/or had a sibling who was known to child protection services. An analysis of children who were known to both police and child protection services when they died was also provided in the 2015 annual report. From 2010-15, 20 children had contact with both authorities prior to their death. The committee was unable to determine any trends of patterns, however, the combined child protection and police data is expected to establish a baseline for future comparisons.
Due to the small number of deaths that occur each year in the ACT, only general information about cause of death is provided in the CYPDRC (2015) annual report. There were no fatal assaults reported during 2010-15. Self-harm was identified as a concern in the deaths of children and young people in the 5-year reporting period.
An analysis into the deaths of children since 2004 was also provided in the committee's annual report (2015). Findings showed that with the exception of medical causes or prematurity, the main cause of death was transport accidents and intentional self-harm.
New South Wales
There are two child death review teams who report on child deaths in NSW. The Child Death Review Team (CDRT) provides a review of the causes and patterns of deaths of all NSW children 17 years of age or younger. The NSW Ombudsman provides a biennial review of the causes and patterns of deaths of the subgroup of children who died of abuse, neglect, and/or circumstances suspicious of abuse and neglect and children who died while in care or detention.
In 2014, there were 485 child deaths in NSW and the families of 101 children had a child protection history (CDRT, 2015). Of the children whose families were known to child protection prior to their death, 7 deaths were attributed to suicide, drowning was the cause of death for 6 children, and 3 child deaths were related to abuse. A further 6 children without a child protection history died as a result of abuse or alleged abuse.
In 2014, 37.8% (17) of the total deaths caused by sudden and unexpected death in infancy (SUDI) had families with a child protection history and an unsafe sleeping environment was a factor in the majority of these cases (12). As in previous years, infants with a child protection history were over-represented in SUDI.
The NSW Ombudsman's (2015) biennial report of reviewable child deaths reviewed 41 deaths in the 2-year period from January 2012 to December 2013. Of these deaths, 5 children died as a result of abuse, 4 children died as a result of suspected abuse, 15 children died from neglect, and another 3 children died in circumstances suspicious of neglect. Most of the children (5) who died of abuse-related causes were less than 5 years of age, and in 8 of the 9 cases the perpetrator was related to the child. The families of five children who died from abuse related circumstances had a child protection history. Twelve children who died as a result of neglect were less than 5 years of age and 13 families had a child protection history.
Of these 41 deaths, 14 children died while in out-of-home care between 2012 and 2013 (NSW Ombudsman, 2015).
In addition to the biennial reporting requirements, the Ombudsman analysed familial abuse-related deaths that occurred from 2004-2013 (NSW Ombudsman, 2015). During this period, 83 children from 75 families died in abuse-related circumstances; three quarters of children were under 5 (59), almost two thirds were male (52), and 15 children identified as Aboriginal or Torres Strait Islander. Over half the families of children who died as a result of abuse were known to child protection services (40).
The NT Child Death Review and Prevention Committee Annual Report (2015) provides information on all infant and child deaths registered in the NT in 2014-15. Information on whether children were known to child protection services is provided in this report, but this does not imply the deaths were child protection related. Overall, 40 deaths were registered during this period. Fifteen deaths occurred during infancy and more than half (27) of the 40 children who died in 2014-15 identified as Aboriginal.
Aggregated data over the period 2010-14 showed that of the 239 child deaths registered, nearly a quarter (56 deaths) of children who died across this time period were known to child protection services within 3 years before their death. A large proportion of those children with a child protection history (85.7%) were Aboriginal.
Responsibility for the review of child deaths in Queensland has recently been revised. As of 1 July 2014, responsibility for detailed analysis of all child deaths in Queensland was transferred from the former Commission for Children and Young People and Child Guardian (CCYPCG) to the Queensland Family and Child Commission (QFCC).
In the 2014-15 financial year there were 445 child deaths registered in Queensland (QFCC, 2015). Suicide was the leading external cause of death for children and young people (28 deaths) in 2014-15. Drowning was the cause of death for 16 children and fatal assault and neglect was the reason for 14 child deaths. The high number of deaths attributed to fatal assault or neglect in 2014-15 was in part due to one incident that involved multiple fatalities. Nine children were victims of domestic homicide, four children died as a result of fatal abuse and neonaticide was the cause of death for one child.
Approximately 52 children who died in 2014-15 were known to child protection services in the 3 years before the child's death. The majority of these children (31) died from external causes. Fatal assault or neglect was the cause of death for 3 children and 15 children or young people died as a result of suicide. A further 8 children died from sudden and unexpected death in infancy.
At the time the QFCC annual report (2015) was published the cause of death for 11 children known to child protection services was still pending.
Between 1 August 2004 and 30 June 2014, the Department of Communities, Child Safety and Disability Services was required to conduct a review of its involvement in each case where a child known to the child protection system died within 3 years of the department's last involvement with the child. From 1 July 2014, a Child Death Case Review Panel will conduct reviews of the deaths of any child known to the child protection system within the year before their death.
In a special review of 16 child deaths attributed to fatal assault or neglect that occurred between 2004-06, the Commissioner for Children and Young People and Child Guardian (2013) found that all but one child death was characterised by at least one reported vulnerability characteristic present in the child's family. These characteristics mainly included: a child's family having a history of child protection involvement; the child being known to child protection in the 3 years prior to their death; at least one of the children's parents having a criminal history; a family history of domestic violence; or at least one parent having a history of drug and/or alcohol abuse.
In South Australia, the Child Death and Serious Injury Review Committee (CDSIRC) reviews circumstances and causes of deaths and serious injuries to children and young people. During the 2013-14 period, 203 children died in South Australia (CDSIRC, 2015). Thirty-four of these deaths were of Aboriginal children and 49 children who died in 2013-14 had contact with Families South Australia1 in the 3 years prior to their death.
In 2014, in the 26 cases where the child or their family had had some form of contact with Families SA, domestic violence, homelessness or transience, and financial problems were the issues that most frequently generated concerns about parental capacity to care for children. Families with multiple and complex needs, including the concerns identified by the review team, have been identified as the primary client group of modern child protection services (Bromfield, Lamont, Parker, & Horsfall, 2010).
The CDSIRC annual report (2015) also covered data for a period of 10 years from 2005-14, during which 26% (290) of children who died were known to child protection. Of the children known to child protection, 11 child deaths were attributed to a deliberate act, 5 deaths were attributed to neglect, and 18 deaths were attributed to suicide. From 2005-14 there were 152 deaths caused by sudden and unexpected death in infancy (SUDI). In 43% of SUDI cases the child was known to Families SA at the time of his or her death. In addition, nearly a quarter (24.9%) of the 249 children with disabilities who died between 2005-14 had contact with Families SA prior to their death. Aboriginal children whose families had contact with Families SA in the 3 years before their death had a higher rate of death than non-Aboriginal children.
Findings from an in-depth review into the deaths of Aboriginal children between 2005-14 were provided in the 2015 CDSIRC annual report. The review concluded that from 2005-14 Aboriginal children died at a rate 3.6 times higher than non-Aboriginal children. Trauma, multiple forms of abuse, and unsafe sleeping environments were found to be a factor in the death of the children highlighted in three case studies. Common family characteristics identified in the three cases included disadvantage, intergenerational poverty, domestic violence, and mental health issues.
The most recent maltreatment fatality data in Tasmania is from 2005-06. During this time period there were 10 child deaths of children known to the child protection system (Department of Health and Human Services, 2006).
Of these 10 deaths:
- in two cases, the child protection system was only alerted to the child after his or her death;
- in three cases, child deaths were classified as resulting from suspected abuse or neglect;
- in two cases, child deaths resulted from Sudden Infant Death Syndrome; and
- in three cases, child deaths were attributed to natural causes or as a consequence of disability that was unrelated to the child protection system.
The Commission for Children and Young People Act 2012 requires that the Commission for Children and Young People (CCYP) conduct an inquiry in relation to a child who has died and who was a Child Protection client at the time of their death or within 12 months before their death.
In 2014-15 the Department of Health and Human Services referred 24 cases of children who had died and were known to child protection up to 12 months before their death to the Commission for inquiry (CCYP, 2014). Of the 24 cases referred, 4 children died as a result of suicide or self-harm, one child died from non-accidental trauma, and one child died from sudden and unexpected death in infancy (SUDI). In addition, 17% of children identified as Aboriginal.
In 2014-15, the CCYP reviewed 43 cases. Seventeen of the deaths were attributed to external causes including 3 accidents, 2 cases of drowning, 1 fire-related death, and 1 child whose death was caused by choking. Seven children died from SUDI and in 6 of these cases there was a history of unsafe sleeping environments. Sixty per cent of the cases reviewed in 2014-15 involved children who had active child protection cases at the time of their deaths.
Since 30 June 2009, the Ombudsman Western Australia has had the responsibility for reviewing and investigating certain child deaths in Western Australia. In particular, the Ombudsman reviews the circumstances in which and why child deaths occur, identifies patterns and trends arising from child deaths, and seeks to improve public administration to prevent or reduce child deaths. In addition, the Ombudsman can review the death of a child where it appears that the actions of other State Government agencies may have been relevant to the life of the child (Ombudsman Western Australia, 2015).
Investigable deaths are defined in the Ombudsman's legislation, the Parliamentary Commissioner Act 1971 (s 19A(3)),and occur when a child dies in any of the following circumstances.
- In the 2 years before the date of the child's death:
- the Chief Executive Officer (CEO) of the Department for Child Protection and Family Support had received information that raised concerns about the wellbeing of the child or a child relative of the child;
- under section 32(1) of the Children and Community Services Act 2004, the CEO had determined that action should be taken to safeguard or promote the wellbeing of the child or a child relative of the child; and
- any of the actions listed in section 32(1) of the Children and Community Services Act 2004 was done in respect of the child or a child relative of the child.
- The child or a child relative of the child is in the CEO's care or protection proceedings are pending in respect of the child or a child relative of the child.
During 2014-15, a total of 84 child death notifications were received (Ombudsman Western Australia, 2015). Of these, 33 deaths were investigable. Of the 84 child death notifications, 53 children were male, 20 children identified as Aboriginal, and 42 were children from regional or remote areas of Western Australia. The circumstances of death in the 84 child deaths in 2014-15 included: sudden, unexpected death of an infant (28), motor vehicle accident (20), suicide (13), and drowning (3).
The Ombudsman's (2015) annual report also included analyses of child deaths reported during the period 2009-2015. During the 6-year reporting period, investigable child deaths accounted for 20% of suicides, 33.4% of sudden, unexpected death of an infant, 3% of drownings and 5% of alleged homicides. Overall, there was a higher proportion of investigable deaths caused by alleged homicide and suicide compared to non-investigable deaths.
In 2009-15 the families of children who had investigable deaths were characterised by family and domestic violence, drug or substance use, alcohol use, homelessness, and parental mental health issues.
Age appears to be a significant factor in child deaths in all jurisdictions with infants accounting for a large proportion of all registered child deaths. Previous contact with child protection services, often with an intergenerational family history, also feature as a common denominator in child deaths across Australia. As trends in the relationship between child deaths and previous contact with child protection services have emerged, a number of states and territories have commenced further research and analysis to look for risk factors. These include deaths in infants attributed to SUDI or other unexplained factors and suicide in young people.
The co-occurrence of multiple social and environmental factors in a substantial number of child death incidents in all jurisdictions is noteworthy. These factors include family and domestic violence, alcohol and drug use, and financial disadvantage, especially family homelessness and poverty. See the CFCA Resource Sheet, Who Abuses Children, for a more detailed discussion about the perpetrators of child abuse and fatal child abuse.
Despite significant efforts at state/territory level to understand deaths associated with maltreatment there is no national collection or compilation of information on all child deaths, including those associated with maltreatment.
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1 Contact with Families SA may relate to services such as financial assistance and does not necessarily indicate child protection issues.
Authors and Acknowledgements
This paper was updated by Kathryn Goldsworthy, Research Officer with the Child Family Community Australia information exchange.
Previous editions have been compiled by Deborah Scott, Veronica Meredtih, Alister Lamont, Mel Irenyi, Briony Horsfall, Katie Kovacs, and Nick Richardson. Previous editions have been compiled by Alister Lamont, Mel Irenyi, Briony Horsfall, Katie Kovacs and Nick Richardson.
An overview of conceptual definitions of abusive and neglectful behaviours, and legislative definitions of "a child in need of protection"
A snapshot of child protection activity in Australia during 2015-16
An overview of the current evidence on who is likely to be a perpetrator of child abuse and neglect
Only when institutions hear from children directly, take their views seriously and act on what they say will they become safer places.