Challenges in Determining Child Maltreatment Fatalities: What Do We Really Know?

Emily M. Douglas, Kerry A. Lee

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


The challenges associated with determining causes of fatal child maltreatment have been documented by multiple professional fields and by the US government. This study explored these challenges, as well as the relative lethality of determinations of general neglect, medical neglect and physical abuse. Existing sources of information were used for this study: (1) data from the US National Child Abuse and Neglect Data System (NCANDS) data set extracted from annual Child Maltreatment reports published by the US Department of Health and Human Services; and (2) information published in recent state-level child death review team (CDRT) reports. Results from the NCANDS data set indicated that more children died from general neglect (x̅ = 70.9%) than abuse (x̅ = 44.8%) or medical neglect (x̅ = 8.2%). Children who experienced medical neglect died at the highest rate (6.82 per 1000 medical neglect victims), making it the most lethal, followed by physical abuse and general neglect. The findings from CDRT reports were inconsistent, with some states indicating that more children died from abuse than neglect, which is in direct contrast to national statistics. The inconsistent and confusing use of language and constructs from CDRTs has important implications for multiple child-serving fields. Key Practitioner Messages: Professional child-serving fields struggle with making accurate determinations of abuse or neglect-related fatalities. Most child maltreatment fatalities are related to neglect. In terms of lethality, medical neglect appears to be most lethal, followed by physical abuse, and then general neglect. US-state CDRT reports are not consistent in their use of terms and confuse constructs such as ‘neglect’ and ‘accident’. This makes it challenging to use their reviews as reliable sources of information. We recommend the adoption of consistency in the use and understanding of terms related to child maltreatment deaths, at a minimum across all jurisdictions in the USA, if not across all nations.

Original languageEnglish
Pages (from-to)505-517
Number of pages13
JournalChild Abuse Review
Issue number6
StatePublished - 1 Nov 2020


  • child abuse
  • child maltreatment fatalities
  • child neglect


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