GAO Says U.S. Child Maltreatment Deaths Are Undercounted

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Officially, the number of children who died of maltreatment in the United States in 2009 was 1,770. That’s the count from the National Child Abuse and Neglect Data System.

But no one knows the real number, a Government Accountability Office official told a congressional subcommittee today, because the states don’t have the same standards or resources for investigating and reporting child deaths.

Kay E. Brown, director of the Education, Workforce and Income Security division of the GAO, told members of the House Ways and Means Subcommittee on Human Resources that the Department of Health and Human Services’ official numbers represent a substantial undercount of such deaths, partly because 24 states reported only the deaths of children who had had contact with child protective services.

These states did nothing to cull numbers from medical examiners, police records or even hospitals, and they and many others failed to determine the underlying circumstances of a child’s death. Not represented in the child maltreatment deaths were many incidents that were ruled as accidental – including parents rolling over on infants who were sharing their bed – and deaths that were ruled as sudden infant deaths that may actually have been intentional suffocations.

Brown’s testimony came in conjunction with the release of a report by her agency that researched the discrepancies in how states report child deaths. She said, for example, that officials in California disagreed over whether to include as maltreatment deaths  children who died of natural causes, but who also showed evidence of neglect or abuse and whose deaths could have been prevented with proper medical attention.

Michigan officials told GAO investigators that they have difficulty getting medical records from children who are taken across the state line for treatment.

Patricia Covington, head of the federally funded Center for the Review and Prevention of Child Deaths  said in testimony prepared for delivery that although most states have child death review committees, many rely only on child protection services for information.

In Michigan in an average year, Covington said, CPS recorded 40 maltreatment deaths, police reported 26 and vital records reported 16 child abuse deaths – but few of those deaths were reported in more than one place. An extensive investigation revealed that the true child abuse death toll in Michigan for the year was 100 children. Similar lapses in reporting are suspected in about half the states.

In 2009, Florida reported 192 child deaths and Texas reported 280 – a total of 26.6 percent of the child abuse deaths from the entire country. But the two states represent only 16 percent of the country’s population.  Do Florida and Texas simply do a better job at investigating child deaths?

“The 1,700 yearly child maltreatment deaths reported by the National Child Abuse and Neglect Data System are just the tip of the iceberg,” said Dr. Carole Jenny, pediatrics professor at Brown University and head of the Child Protection Program at Hasbro Children’s Hospital in Providence, R.I.

She told the committee that there need to be improved ways of counting maltreatment deaths, but also improved methods of discerning and recognizing child abuse and neglect deaths.

The full GAO report, entitled, “Child Maltreatment: Strengthening National Data on Child Fatalities Could Aid in Prevention,” is here.