Child deaths from abuse and neglect
Child deaths from abuse and neglect
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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, 2016). 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). Damashek, Nelson, and Bonner (2013) reported that Australia's rate, 0.8 per 100,000 children, is approximately four times the rates of Spain, Greece and Italy, although it is below the rates in New Zealand (1.3) and the USA (2.10).
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, Tonmyr, 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 autopsy1 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 are 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 74.8% of child deaths from abuse and neglect in the USA 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 20.91 per 100,000 children compared to 6.38 per 100,000 children aged 1 at the time of their death (US Department of Health and Human Services, 2017).
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 recent national data from the Australian Bureau of Statistics (ABS; 2016), in 2015, medical conditions (n = 32) and accidental drownings (n = 32) were the two leading causes of death among children aged 1-14 years. A further 22 children died from assault.
The Australian Institute of Criminology reported that across the period 2010-12, approximately 12% (n = 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 in 2005 with the aim of developing national and international comparable child death statistics, and to better understand and prevent child deaths. In 2015-16, the South Australian Child Death and Serious Injury Review Committee (CDSIRC) was appointed chair of the Review and Prevention Group for a three-year term. This change was met with a renewed commitment by the Committee to focus on the comparative analysis of child deaths (CDSIRC, 2016).
Under-reporting of child death and injury due to maltreatment
Due to the difficulties associated with determining assault or child maltreatment as an underlying cause of death, and because routine data are collected for different reasons (Stone et al., 1999), individual databases are likely to under-represent the true magnitude of child maltreatment fatalities (Palusci, Wirtz, & Covington, 2010; Schnitzer, Gulino, & Yuan, 2013; Sheldon-Sherman, Wilson, & Smith, 2013).
Australian research using hospital morbidity data has shown that almost a third of children admitted to hospital with an unintentional injury2 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, the 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.
Available data on child deaths in Australian states and territories
Recent reports released by state and territory 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 2017, 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 2012 through to 2016. The committee is required to report circumstances where a child or young person, or their sibling, had a child protection report made in the three years prior to their death.
In the period from January 2012 to December 2016, 21 (18.8%) of the 112 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 2016 annual report. From 2012 to 2016, 13 children had contact with both authorities prior to their death. The majority of children were known to police only due to the circumstances surrounding the child's death.
Due to the small number of deaths each year in the ACT, only general information about cause of death is provided in the CYPDRC (2017) annual report. There were no fatal assaults reported during 2012-16. Suicide and intentional self-harm were identified as a concern in the deaths of children and young people in the five-year reporting period.
New South Wales
There are two child death review teams who report on child deaths in NSW. The NSW Child Death Review Team (CDRT) annually reviews 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 2015, there were 504 child deaths in NSW and the families of 101 of these children had a child protection history (CDRT, 2016). Of the children whose families were known to child protection prior to their death, eight deaths were attributed to suicide, injury was the cause of death for four children and four child deaths were related to abuse. Nine children also died while in care.
A further four children without a child protection history died as a result of abuse or alleged abuse. Of the total number (n = 8) of children who died of abuse or alleged abuse in 2015, half were under the age of 2 years and a family member was implicated in the death of all but one child.
In 2015, half (n = 21) of the total deaths caused by sudden and unexpected death in infancy (SUDI)3 were in families with a child protection history, and an unsafe sleeping environment was a factor in 13 of these cases. 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 two-year period from January 2012 to December 2013. Of these deaths:
- fifteen children died from neglect;
- five children died as a result of abuse;
- four children died as a result of suspected abuse; and
- three children died in circumstances suspicious of neglect.
In eight of the nine cases where a child died from known or suspected abuse-related causes the perpetrator was related to the child. Most (n = 5) of the children were less than 5 years of age, and 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 of the 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 (n = 59), almost two thirds were male (n = 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 (n = 40).
The NT Child Death Review and Prevention Committee annual report (2016) provides information on all infant and child deaths registered in the NT during 2015. 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, 38 deaths were registered during this period. Sixty per cent (23) of the deaths were during infancy and three quarters (n = 29) of the 38 children who died in 2015 identified as Aboriginal.
Aggregated data over the period 2011-15 showed that of the 242 child deaths registered, nearly a quarter (62 deaths) of children who died across this time period were known to child protection services within the three-year period prior to their death. A large proportion of those children with a child protection history (88.7%) were Aboriginal.
Eight children were reported to have died while in the care of the Department of Children and Families during 2011-15. There was no evidence that poor quality of care contributed to the deaths of seven of the children. An investigation into the death of the remaining child was underway at the time the 2016 CDRPC annual report was published.
The Queensland Family and Child Commission (QFCC) is responsible for the detailed analysis of all child deaths in Queensland. In the 2015-16 financial year there were 390 child deaths registered in Queensland (QFCC, 2016). Suicide (n = 20) and transport (n = 18) were the leading external causes4 of death for children and young people.Drowning was the cause of death for eight children and fatal assault and neglect was the reason for nine child deaths. Of the fatal assault and neglect deaths, five children were victims of domestic homicide, and one child died due to an assault caused by a family member. Overall, however, the number of child deaths that resulted from drowning, suicide, and fatal assault and neglect was lower in 2015-16 than in previous years.
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 three years of the department's last involvement with the child. From 1 July 2014, a Child Death Case Review Panel began reviewing the deaths of any child known to the child protection system within the year before their death.
In 2015-16, 46 children who died were known to child protection services in the year before the child's death. Seventeen of these children died from external causes. Confirmed or alleged fatal assault or neglect was the cause of death for four children, five children or young people died as a result of suicide, two children drowned and four children died from unintentional injuries.5 Eleven children died from sudden and unexpected death in infancy.6
At the time the QFCC annual report (2016) was published, the causes of death for 12 children known to child protection services were still pending.
In a special review of 16 child deaths attributed to fatal assault or neglect between 2004-06, the Commission 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 three 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. During the 2014-15 period, 182 children died in South Australia (CDSIRC, 2016). Twenty-six of these deaths were Aboriginal children and 52 children who died in 2014-15 had contact with Families South Australia7 in the three years prior to their death.
The CDSIRC annual report (2016) also covered data for a period of 10 years from 2005-15, during which 27% (n = 322) of children who died were known to child protection. Of the children known to child protection, 13 child deaths were attributed to a deliberate act, 20 deaths were attributed to suicide and 19 children died while under the Guardianship of the Minister. From 2005-15 there were 161 deaths caused by sudden and unexpected death in infancy (SUDI).8 In 43% of SUDI cases the child was known to Families SA at the time of his or her death. The rate of all SUDI-related deaths declined from 2005-15, except in the most disadvantaged areas where rates have remained unchanged.
In addition, a quarter (25.9%) of the 266 children with disabilities who died between 2005-15 had contact with Families SA prior to their death. Aboriginal children whose families had contact with Families SA in the three years before their death were 11 times more likely to die than non-Aboriginal children in 2014-15.
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 factors in the deaths 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.
In Tasmania, the Council of Obstetric and Paediatric Mortality and Morbidity conducts bimonthly reviews of statewide paediatric deaths. The Council was established under the Obstetric and Paediatric Mortality and Morbidity Act 1994 with the aim of investigating the deaths of Tasmanian children between the ages of 29 days to 17 years.
The most recent information about child deaths in Tasmania is from 2015 (Council of Obstetric and Paediatric Mortality and Morbidity, 2015). According to preliminary findings released by the council, 12 children died in 2015. Of these, two were unexplained infant deaths, with one related to an unsafe sleeping environment, and three child deaths were associated with suspected suicide. The review of 2016 cases is due to be finalised soon.
Additional maltreatment fatality data was made available by the Tasmanian Child Death Review Committee for the period 2005-06. During this 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 two cases, child deaths resulted from Sudden Infant Death Syndrome;
- in three cases, child deaths were classified as resulting from suspected abuse or neglect; 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 2015-16 the Department of Health and Human Services referred 38 cases of children (an increase of 59% from the previous year) who had died and were known to child protection up to 12 months before their death to the commission for inquiry (CCYP, 2016). Fifty-five per cent of these children (21) were involved with child protection at the time of their death.
Of the 38 cases referred, six children died from non-accidental trauma, four children died as a result of self-harm, drowning was the cause of death for two children, and one child died from sudden and unexpected death in infancy (SUDI).9 In addition, 11% of children were Aboriginal.
In 2015-16, the CCYP finalised reports for 50 cases that were in scope for a child death inquiry. Eighteen per cent of these children died in 2015-16. Of the total finalised reports, twenty of the deaths were attributed to external causes including eight deaths related to suicide and one case of drowning. Sixty-six per cent of the cases finalised in 2015-16 involved children who had active child protection cases at the time of their deaths.
Since 30 June 2009, the Ombudsman Western Australia has had responsibility for reviewing and investigating certain child deaths in Western Australia. In particular, the Ombudsman reviews the circumstances in which 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, 2016).
Investigable deaths are defined in the Ombudsman's legislation, the Parliamentary Commissioner Act 1971 (s 19A(3)) and cover when a child dies in any of the following circumstances:
- In the two 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 2015-16, a total of 84 child death notifications were received (Ombudsman Western Australia, 2016). Of these, 41 deaths were investigable. Of the 84 child death notifications, 55 children were male, 21 children identified as Aboriginal, and 37 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 infant10 (30), motor vehicle accident (15), suicide (14), drowning (4) and alleged homicide (6).
In addition, children aged under one year and those aged between 13 and 17 years were over represented in the number of children that died in 2015-16. Forty-three per cent (36) of deaths were of children under the age of one, while 26 of children were in the 13-17 age group.
The Ombudsman's (2016) annual report also included analyses of child deaths reported during the period 2010-16. During the six-year reporting period, investigable child deaths accounted for 14% of suicides, 33% of sudden, unexpected death of an infant, 6% of drownings and 4% of alleged homicides. Overall, there was a higher proportion of investigable deaths caused by accident other than motor vehicle, alleged homicide and suicide compared to non-investigable deaths.
In 2010-16 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.
- ACT Children and Young People Death Review Committee. (2017). Annual report 2016. Canberra: ACT Government. Retrieved from <www.childdeathcommittee.act.gov.au/Publications.html>
- Australian Bureau of Statistics. (2016). Causes of Death, Australia, 'Table 1.3. Cause of death and ICD-10 code', time series spreadsheet, cat. no. 3303.0. Retrieved from <www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3303.02015?OpenDocument>
- Bhalla, K., Harrison, J. E., Shahraza, S., & Fingerhut, L. A., on behalf of the Global Burden of Disease Injury Expert Group. (2010). Availability and quality of cause-of-death data for estimating the global burden of injuries. Bulletin of the World Health Organization, 88, 831-838. Retrieved from <www.who.int/bulletin/volumes/88/11/09-068809/en/>
- Bryant, W., & Cussen, T. (2015). Homicide in Australia: 2010-2011 to 2011-2012 National Homicide Monitoring Program report (Monitoring Report 23). Canberra: Australian Institute of Criminology. Retrieved from <aic.gov.au/publications/current%20series/mr/21-40.html>
- Child Death and Serious Injury Review Committee. (2016). Annual report 2015-16. Adelaide: Government of South Australia. Retrieved from <www.decd.sa.gov.au/department/about-department/minister-education-and-child-development-decd/child-death-and-serious-injury-review-committee
- Child Welfare Information Gateway. (2015). Child abuse and neglect fatalities 2013: Statistics and interventions. Washington, DC: US Department of Health and Human Services, Children's Bureau. Retrieved from <www.childwelfare.gov/pubs/factsheets/fatality/>.
- Commission for Children and Young People. (2016). Annual report 2015-16. Melbourne: Commission for Children and Young People. Retrieved from <www.ccyp.vic.gov.au/publications/index.htm>
- Commission for Children and Young People and Child Guardian. (2013). Fatal assault and neglect of Queensland young people report. Brisbane: Commission for Children and Young People and Child Guardian. Retrieved from <nla.gov.au/nla.arc-14014>
- Council of Obstetric and Paediatric Mortality and Morbidity. (2015). Preliminary Paediatric Mortality and Morbidity Report for 2015. Tasmania: Department of Health and Human Services. Retrieved from <www.dhhs.tas.gov.au/about_the_department/partnerships/registration_boards/copmm/document_list3>
- Damashek, A., Nelson, M. M., & Bonner, B. (2013). Fatal child maltreatment: characteristics of deaths from physical abuse versus neglect. Child Abuse and Neglect, 37(10), 735-744.
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- Fraser, J., Sidebotham, P., Frederick, J., Covington, T., & Mitchell, E. (2014). Learning from child death review in the USA, England, Australia, and New Zealand. The Lancet, 384(9946), 894-903.
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- Putnam-Hornstein, E., Cleves, M., Licht, R., & Needell, B. (2013). Risk of fatal injury in young children following abuse allegations: Evidence from a prospective, population-based study. American Journal of Public Health, 103(10), e39-e44.
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1 Verbal autopsy refers to an interview process with a child’s next of kin or relative to establish cause of death (WHO, 2012).
2 The accidental death of an individual that is caused by external factors such as transport, fire, poison or drowning-related incidents.
3 Sudden and unexpected death in infancy is an umbrella term that is used to describe the unexpected death of an infant where there is no immediate or apparent cause of death.
4 Deaths associated with an external cause (or injury) refers to the unintentional or intentional death of a child caused by transport, fire, suicide or fatal-assault related incidents, or other non-natural causes of death.
5 The accidental death of an individual that is caused by external factors such as transport, fire, poison or drowning related incidents.
6 Sudden and unexpected death in infancy is an umbrella term that is used to describe the unexpected death of an infant where there is no immediate or apparent cause of death.
7 Contact with Families SA may relate to services such as financial assistance and does not necessarily indicate child protection issues.
8 Sudden and unexpected death in infancy is an umbrella term that is used to describe the unexpected death of an infant where there is no immediate or apparent cause of death.
9 Sudden and unexpected death in infancy is an umbrella term that is used to describe the unexpected death of an infant where there is no immediate or apparent cause of death.
10 Sudden and unexpected death in infancy is an umbrella term that is used to describe the unexpected death of an infant where there is no immediate or apparent cause of death.
This paper was updated by Kathryn Goldsworthy, Senior 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.