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The term of the Commission to Eliminate Child Abuse and Neglect Fatalities expired on March 18, 2016.

Why Do We Study Near Fatalities?

Filed in Commissioner’s Blog By on March 10, 2015

Dr. David SandersBy David Sanders, Chairman

March 10, 2015

We all agree that it is important to study fatal events of child abuse and neglect in order to improve our ability to prevent future deaths. But new research suggests that studying near-fatal events of child abuse also may be very important. This is because near fatalities are similar to fatalities in almost every way that we can measure them. For example: children who suffer from a near fatality are almost identical in age to those who die from child abuse. Their family risks factors are similar (including domestic violence and substance abuse), and the relationships between perpetrators and victims are the same.

In fact, one of the only differences between a near fatality and a fatality is, often, simply the difference in medical care received and the timing of that medical care. In other words, the only reason one child survives and another dies from the same abuse may be the fact that the first child lives close to a hospital that offers advanced medical care and is staffed by doctors trained to treat life-threatening events. It is important to keep in mind that the children who survive these near-fatal events are often left with severe, lifelong disabilities.

Right now, studying near fatalities is difficult because there is no clear definition of such events. The Child Abuse Prevention and Treatment Act (CAPTA), which establishes minimum definitions for states, defines a near fatality as “an act that, as certified by a physician, places the child in serious or critical condition.” Many states have their own definitions of what it means for a child to be in “serious” or “critical” condition. In California for example, a near fatality is “a severe injury or condition caused by abuse or neglect and requires that the child have received critical care for at least 24 hours following the child’s admission to an intensive care unit.” In New Jersey, the definition is “a serious or critical condition certified by a physician, in which a child suffers permanent mental or physical impairment, a life threatening injury or a condition that creates the probability of death within the foreseeable future.” Because of the lack of a standardized definition, the same event might be considered a near fatality in one state, but not in another.

As a result of this lack of standardization, and because states are not required to review or report on near-fatality cases in the same way they review or report fatalities, we don’t know exactly how many children suffer near fatalities from abuse or neglect every year. Several researchers have used data from children who are hospitalized with serious injuries to try and calculate this number. Their research suggests that, for every child who dies as a result of abuse, more than 10 children are hospitalized with severe abuse- or neglect-related injuries. Given that an estimated 3,000 or more children die annually from child abuse or neglect, these data suggest that tens of thousands of children are suffering from near fatalities each year.

The Commission to Eliminate Child Abuse and Neglect Fatalities (CECANF) is studying near fatalities closely. We are evaluating how continued research related to near fatalities could help us better understand these events and thereby prevent both fatalities and near fatalities; how clarifying definitions can help us better understand the number and type of near fatalities that occur in the United States each year; and how policies and practices within the agencies that interact with children could contribute to eliminating near fatalities among our children.

Please help us by submitting your thoughts via this website. We look forward to hearing from you.



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