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

Abstract

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.

Introduction

In 2006, the national child mortality rate was 64.7 per 100,000 (National MCH Center for Child Death Review, 2006a). The Kansas child mortality rate was similar at 68.4 per 100,000. The rate for unintentional injury in Kansas was 17.1 per 100,000; for homicides, 2.8; and for suicides, 2.1 (National MCH Center for Child Death Review, 2006b). To understand how and why children die, several states have established a comprehensive, multidisciplinary child death review board. Their findings can be used to improve the safety of children and to propose strategies for prevention of death.

The Kansas State Child Death Review Board (SCDRB) was created in 1992 as a multi-disciplinary, multi-agency panel to review child deaths in Kansas (Kansas Child Death Review Board, 2009). The SCDRB has the statutory obligation to review the death of every child under the age of 18 who was a Kansas resident or died in the State of Kansas. The SCDRB is alerted of a death when they receive birth/death certificates from the Kansas Department of Health and Environment Vital Statistics Department. All records provided to the Board remain confidential. When all information has been obtained, a case is assigned to an SCDRB member who is responsible for reviewing the information and reporting the findings to the entire Board during the monthly meeting. A determination of true cause and preventability is made. From 1994 through 2007, 6,982 child deaths have been reviewed. All homicides of children from birth until the 18th birthday totaled 303 (Kansas Child Death Review Board, 2009).

In the United States, homicide was the fourth leading cause of death in children aged 1–14 years in the year 2005 (Heron & Betzaida, 2009). In 2007, an estimated 1,760 children died nationally from abuse or neglect (Child Maltreatment, 2007). The rate was 2.35 per 100,000 children, but child fatalities from abuse or neglect may be underreported. As many as 50–60% of child deaths resulting from abuse or neglect are not recorded as such on death certificates (Crume, DiGuiseppi, Byers, Sirotnak, & Garrett, 2002). The degree of underascertainment affects the national estimates of child maltreatment fatality in the US (Herman-Giddens et al., 1999).

Child maltreatment is a complex problem that stems from a variety of factors, including stress, poverty, substance abuse, and mental illness. The SCDRB defined Child Abuse Homicide as the result of abuse from caretakers (inflicting injury with malicious intent, usually as a form of discipline or punishment) or neglect (failing to provide shelter, safety, reasonable supervision, and nutritional needs; Kansas Child Death Review Board, 2009). Risk factors associated with child abuse homicide include maternal risk factors (e.g., young age, less than 12 years of education, and being unmarried) and household risk factors (e.g., male not related to the child living in the home, prior substantiation of child abuse and neglect, substance abuse, and low socioeconomic status).

Three-fourths of child abuse homicide victims nationally were younger than 4 years of age (Child Maltreatment, 2007). Nearly 13% were between the ages of 4 and 7 years, thus indicating that the majority who died from child abuse or neglect are young children. Infant boys (younger than 1 year) had a fatality rate of 18.85 per 100,000 boys of the same age. Infant girls (younger than 1 year) had a fatality rate of 15.39 per 100,000 girls of the same age. Nearly one-half (41.1%) of all fatalities were White children. More than one-quarter (26.1%) were Black children, and nearly one-fifth (16.9%) were Hispanic children. In Jefferson County, Alabama, the majority of deaths occurred among children younger than age 2, with a high proportion of fatalities among Black children of unmarried mothers (Lyman et al., 2003).

Environmental risk factors included children who were already known to Child Protective Services (CPS) agencies (Child Maltreatment, 2007). Children whose families had received family preservation services in the past 5 years accounted for 11.9% of child fatalities. More than 2% of the child fatalities had been in foster care and were reunited with their families in the past 5 years. In Missouri, children residing within households with adults unrelated to them had nearly 6 times the risk of dying from maltreatment-related unintentional injury (Schnitzer & Ewigman, 2008). Children residing with step or foster parents and those living with other, related adults were also at increased risk of maltreatment death. The cases were also more likely to reside in households with siblings under age 5 and have a prior report of child abuse or neglect concerning themselves and others in the household.

The perpetrator was usually known to the victim (Child Maltreatment, 2007). Nearly 70% of child abuse fatalities were caused by 1 or more parents. More than one-quarter of fatalities were perpetrated by the mother acting alone. Child abuse fatalities with undetermined perpetrators accounted for 16.4%.

The purpose of this study was to describe the epidemiology of child abuse homicides in the state of Kansas from 1994 to 2007. Data were obtained from the Kansas State Child Death Review Board. The results of the study identified risk factors for child abuse fatalities and should contribute to preventive endeavors.