Georgia Child Fatality Review Panel Annual Report CALENDAR YEAR 2 0 2 1 Elizabeth Andrews Panel Chair Brian Kemp Governor The Child Fatality Review Panel Members Elizabeth Andrews Panel Chair, CAISC Coordinator, GBI Medical Examiner's Office Vacant Panel Vice-Chair, Vic Reynolds Director, Georgia Bureau of Investigation Mandi Ballinger Member, Georgia House of Representatives Kathleen Bennett Retired Mental Health Specialist Judy Fitzgerald Commissioner, Department of Behavioral Health and Developmental Disabilities Gloria Butler Member, Georgia State Senate Kathleen Toomey Commissioner, Department of Public Health Robertiena Fletcher Board Chair, Department of Human Services Jay Neal Director, Criminal Justice Coordinating Council Candice Broce Commissioner, Division of Family and Children Services Tiffany Sawyer Prevention Director, Georgia Center for Child Advocacy Richard Hawk Coroner, Coweta County Paula Sparks Investigator, Georgia Peace Officer Standards and Training Council Dr. Jonathan Eisenstat Chief Medical Examiner, Georgia Bureau of Investigation Jerry Bruce Director, Office of the Child Advocate Randy McGinley District Attorney, Alcovy Judicial Circuit Amy Jacobs Commissioner, Department of Early Care and Learning Vacant Member, State Board of Education ii Georgia Child Fatality Review Panel Table of Contents The Child Fatality Review Panel Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii Table of Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii Mission. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Letter from the CFR Panel Chair. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Background and History of Child Fatality Review in Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Reported Child Deaths in Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2021 Child Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Trends in Infant/Child Deaths, Georgia 2010-2021. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Child Deaths Review Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Maltreatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Action or Failure to Act that Contributes to a Death. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Supervision and Exposure to Hazards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Summary of Selected Causes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Selected Cause of Death Categories: Prevention Target Populations. . . . . . . . . . . . . . . . . . . . . . . . 17 Unintentional Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Drowning Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Motor Vehicle-Related Deaths. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Intentional Causes (Homicide and Suicide). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Sleep-Related Infant Deaths . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Attachments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Appendix A, Georgia Child Fatality Review Timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Appendix B, 2021 Compliance Map. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Annual Report - Calendar Year 2021 iii Mission The mission of the Georgia Child Fatality Review Panel is to provide the highest quality of child fatality data, training, technical assistance, investigative support services, and resources to any entity dedicated to the well-being and safety of children to prevent and reduce child abuse and fatality in the state. The mission is accomplished by promoting more accurate identification and reporting of child fatalities, evaluating the prevalence and circumstances of both child abuse and child fatalities and developing and monitoring the statewide child injury prevention plan. The Georgia Child Fatality Review Panel, each county-level review committee, their functions and membership requirements are established in Georgia statute (19-15-1 through -6). Acknowledgments The Georgia Child Fatality Review Panel acknowledges the following people and entities whose enormous commitment, dedication, and unwavering support to Child Fatality Review have made this report possible: All the members who serve on each of the County Child Fatality Review Committees J ohn T. Carter, PH.D., M.P.H., Emeritus Assistant Professor, Rollins School of Public Health, Emory University The report was developed and written by the staff members of the Child Fatality Review Unit within the Georgia Bureau of Investigation. 4 Georgia Child Fatality Review Panel Letter from CFR Panel Chair Honorable Governor Brian Kemp and Members of the Georgia General Assembly: We are honored to present the Annual Report of the Georgia Child Fatality Review Panel for child death data composed in calendar year 2021. This data, representing sudden and unexpected child fatalities of Georgia residents, is compiled by 159 local child fatality review committees pursuant to statutory requirements. This report could not be assembled without the continued diligence and contributions of the local child fatality review committees. On behalf of the Panel, I extend my utmost appreciation for every local committee member's participation in the investigation, prosecution, review, and prevention process. At the Panel's annual retreat, the following local teams/members were recognized for their exceptional service: CFR Committee of the Year: Clayton County CFR Community Prevention Efforts of the Year: Macon Judicial Circuit Coroner of the Year: Leon Jones, Bibb County Medical Examiner of the Year: Dr. Karen Sullivan, Fulton County CFR Rookie of the Year: Jeffery Kujawa, Houston County District Attorney Timothy Vaughn with the Oconee Judicial Circuit was also honored, marking 37 years of faithful service. Congratulations to all the awardees for their excellence, commitment, and compliance in collecting child death data and executing prevention efforts throughout our state. Within the past year, great strides have been accomplished in partnering with those involved in child death investigation, review, and prevention. Our partnership with The National Center for Fatality Review and Prevention continues with the launch of the Drowning Death Scene Investigation and Child Death Review (CDR) Project. This initiative collects data from pediatric drownings with the intent to create a standardized death scene investigation (DSI) form utilized by first responders in their response to such fatalities. Support and involvement in events surrounding safe sleep and suicide awareness as well as fire, motor vehicle, and gun safety marked a record year for prevention initiatives. The work of the Panel has just begun; we must continue our mission to increase the effectiveness of county-based child death reviews and improve state and community response with increased coordination among agencies. Let us proactively utilize this report to facilitate community education and prevention in efforts to reduce child fatalities. The Panel commends Director Register, the Child Fatality Review Managers, Agents, and medical examiner office personnel at the Georgia Bureau of Investigation for their commitment to our most vulnerable residents, our children. We thank Governor Kemp and Members of the Georgia General Assembly for their attention to the Panel's Annual Report. Together, we shall continue our mission to reduce and prevent child fatality in Georgia. Sincerely, Elizabeth Andrews Chair, Child Fatality Review Panel Annual Report - Calendar Year 2021 5 Background and History The child fatality review process was initiated in Georgia in 1990 as an amendment to an existing statute for child abuse protocol committees. The legislation provided that each county child abuse protocol committee establish a subcommittee to systematically in collaboratively review child deaths that were sudden, unexpected, and/or unexplained, among children younger than 18 years of age. The Child Fatality Review committees became a statewide, multidisciplinary, multi-agency effort to prevent child deaths. Georgia code section 19-15-1 through 6 has been amended over the years, adding even more structure, definition, and members to the process. Members now form a stand-alone committee instead of a subcommittee, which has added emphasis to the importance of the function. Through the State Panel and the work of the local committees, we have the opportunity to learn from tragedy, prevent deaths, and give a new generation hope. Agencies and organizations working together at the state and local level offer the greatest potential for effective prevention and intervention strategies. The purpose of these reviews is to describe trends and patterns of child deaths in Georgia and to identify prevention strategies. As mandated in statute, this report identifies specific policy recommendations to reduce child deaths in Georgia. The product of the review process is a description of trends and risk factors for child deaths in Georgia. The CFR local teams and the Georgia CFR Panel use the review information to identify prevention strategies. The Georgia CFR Panel includes experts in the fields of child abuse prevention, mental health, family law, death investigation, and injury prevention. The variety of disciplines involved, and the depth of expertise provided by the Panel allow an in-depth analysis of both contributory and preventative factors for child deaths. This report identifies specific policy recommendations to reduce child deaths in Georgia. 6 Georgia Child Fatality Review Panel Introduction 2021 Infant and Child Deaths There were 1,440 reported deaths of infants and children in Georgia during calendar year 2021. The count by age group may be an undercount due to an (anecdotally reported) issue with medical examiner staffing and delays in autopsy completion and reporting. There were 48 infant deaths reported as cause of death "unknown" (ICD10 code R99). These deaths are classified as "sleep-related" and are counted as "reviewable" for Child Fatality Review (CFR) purposes. Table A. 2021 Georgia Infant and Child Deaths Age in Years DC_Cause Infant 1 to 4 5 to 9 10 to 14 15 to 17 Totals MVA 8 Other Unintentional 7 19 17 26 46 116 30 15 19 32 103 Homicide Suicide 11 24 9 13 50 107 1 29 56 86 Sleep-Related 182 182 Medical 562 86 47 72 55 822 Unknown Intent 2 1 1 1 1 6 Unknown (>1 Yr) 8 1 5 4 18 Total 772 168 91 165 244 1,440 The impact of the COVID-19 pandemic on number of reported child deaths is probably also underestimated. The 2021 death certificates only reported 21 COVID-19 deaths among children less than 18 years of age (an increase from six in 2020). However, there are issues with case definition (COVID-19 not identified as associated with the death) and indirect effects of pandemic-associated stress. The decrease in number of infant deaths (2019 to 2020) reported last year continued into 2021 (772 deaths). The infant mortality rate (deaths per 100,000 births) had decreased to 6.3 in 2020 and continued to decrease slightly to 6.2 in 2021. Most of the reduction in infant deaths was due to the decrease (from 298 to 214) in number of infants dying of medical causes at birth (within the first day of life). (See Attachments, Table A for age and race/ethnicity detail.) Annual Report - Calendar Year 2021 7 Figure 1. Average Infant Annual Deaths, by Age in Days An examination of the race distributions showed that most of the "1 day" decrease was in the Black Non-Hispanic population. (Appendix, Table B.) The total decrease was 39.1% compared to 11.7% for the White Non-Hispanic infants. The decrease was consistent across major categories for cause of death. Figure 2. % Decrease in Black Non-Hispanic Infant Deaths, Age < 1 Day The number of deaths of youth ages 10 through 17 increased during the two pandemic years from 304 in 2019 to 409 in 2021. This increase is associated with specific cause of death categories primarily intentional (homicide and suicide). 8 Georgia Child Fatality Review Panel Figure 3. Number of Child Deaths, GA, 2019-2021, by Age Category Trends in Cause of Death for Georgia Infants and Youth (< 18 years of age) The recent changes in infant and child deaths represent a discontinuity in the longer-term trends (last ten years). The number of infant deaths (and the mortality rate) have been decreasing since 2015, but the rate in 2020 was lowest in 10 years and represented the largest one-year change. A preliminary review of the literature does not reveal an explanation of the decrease in the infant mortality rate. The Georgia low birthweight and premature birth rates have not decreased over the past two years, and they are strong risk factors for infant mortality. Figure 4. GA Infant and Child Deaths, Ages < 18 Annual Report - Calendar Year 2021 9 The ten-year trend data shows an increase in 2021 in intentional deaths (homicide and suicide) and sleep-related deaths of infants. Forty-four of the "Unknown" cause of death infants were reviewed and 22 were determined to be sleep-related. The 22 non-sleep-related deaths would account for most of the observed increase in the death certificate data. (19 unknown infant deaths in 2020 and 48 in 2021.) Figure 5. GA Infant and Child Deaths, 2012-2021 10 Georgia Child Fatality Review Panel 2021 Georgia Child Death Review Process The Child Death Review (CDR) is the multidisciplinary review of individual child deaths to help communities understand why children die and equip them to effectively prevent future fatalities. The COVID-19 pandemic continued to adversely affect the CFR (Child Fatality Review) process in 2021. The proportion of reviewable deaths reviewed dropped an additional 3 percentage points (83.8 to 80.9) after an eight-percentage point decrease between 2019 and 2020. The review rates and changes were consistent across cause categories. (Deaths with a "Medical" cause are not defined as "Reviewable", although a review team may decide that a specific death should be reviewed. In 2021, 100 "medical" deaths were reviewed perhaps because the death was unexpected or did not occur while the decedent was in the care of a physician.) Table B. Proportion of Reviewable Deaths Reviewed, 2021 Reviewed? Death Certificate Cause No Yes % Reviewed Medical (non-reviewable) 722 100 12.2 MVC 19 Other Unintentional 24 97 83.6 79 76.7 Sleep-Related 36 146 80.2 Homicide Suicide 22 85 79.4 12 74 86.0 Unknown Intent 1 Unknown (Age > 0) 4 5 83.3 14 77.8 Reviewable Total 118 500 80.9 Reviewable deaths (based on death certificate non-medical deaths) in 2021 were distributed across 121 Georgia counties. Thirty-eight counties had no reported reviewable deaths, and 84 counties with a total of 366 reviewable deaths reviewed all deaths. Attachment Table C provides individual county review data. Annual Report - Calendar Year 2021 11 Table C. Review Summary, 2021 Georgia Child Fatality Review Category Description #Counties #Deaths 1 All Reviewable Deaths Reviewed 84 366 2 Some Reviewable Deaths Reviewed 20 214 3 No Reviewable Deaths Reviewed 17 38 4 No Reviewable Deaths 38 Not Reviewed 80 38 12 Georgia Child Fatality Review Panel Maltreatment Action or Failure to Act that Contributes to a Death Fortunately, an overt act that directly causes a child's death is a rare event. Thirty Infants and toddlers were killed in 2021 by parents and other caregivers; and abuse was identified as the cause for 15 of those 30 deaths. Abuse was reported as the cause for only 22 deaths (all ages under 18) in 2021. The CFR form has questions addressing the role (if any) of maltreatment in causing or contributing to a death. Other questions address any history of maltreatment for the decedent and whether poor supervision or exposure to hazards may have contributed to the death. These various maltreatment questions were used to define a summary maltreatment variable that assigns a single maltreatment-related value to each death. (The "de-duplication" works from the top down. For example, if abuse and neglect were both identified as causing the death, that death is reported as "Cause, Abuse". Twenty deaths had neglect identified as a cause, but one of those deaths also had abuse identified. That single death is not counted in the Total for the "Cause, Neglect" entry.) Table D. Maltreatment Summary, 2021 Reviewed Deaths Cause or Contribute History Cause/ History Cause Category Abuse Neglect Abuse Neglect Supervision Exposure to Hazard None Proportion Motor Vehicle Crash 5 11 12 17 Other Unintentional 0 3 8 9 21 Homicide 18 3 11 14 13 Suicide 13 4 3 SleepRelated 1 4 13 13 26 Medical 1 2 11 16 Undetermined 2 2 1 2 38 23 26.4 20 19 25.0 14 15 52.3 22 34 22.4 82 9 20.9 1 65 31.3 4 8 26.3 Total 22 19 68 68 82 Duplicated Totals 22 20 85 119 109 181 173 28.9 280 Annual Report - Calendar Year 2021 13 About 29% of all reviewed deaths had maltreatment identified as causing or contributing to the death or had a reported history of maltreatment. That proportion has increased slightly over the last ten years (from 26.6% for 2012-2016 to 28.9, 2017-2021). The five-year comparison shows a doubling in the number of deaths with neglect reported as causing or contributing to the death and 150% increase in deaths with reported exposure to hazard. We do not know how much of these increases is associated with increased sensitivity to these risks by the review teams. Table E. Reported Maltreatment, Five-Year Comparison Cause or Contribute Abuse Neglect Abuse Neglect 2012-2016 25 11 66 37 Average 2017-2021 27 24 76 37 History Poor Supervision 57 73 Exposure to Hazard 56 146 None 274 184 Percent Cause/History 26.6 28.9 Any 48.1 67.6 14 Georgia Child Fatality Review Panel Supervision and Exposure to Hazards These two topics (supervision and exposure to hazards) were introduced in the preceding section on maltreatment because they indicate possible "lack of action" that may have contributed to a child's death. These three parameters (variables/risk factors) are not independent, but they can be used to examine prevention opportunities for specific cause of death / age populations. A subsequent report section on selected causes of death illustrates this "prevention planning" approach. Supervision: The CDR form addresses supervision of the decedent in three sections. In Section D (Supervisor Information), the initial question is: "Did child have supervision at time of the incident leading to death?"; and valid responses are: 1. No, not needed given developmental age or circumstances 2. No, but needed 3. Yes 4. Unable to determine Eighty-one (81) of the 613 reviewed deaths (13.2%) reported "No but needed". The two supervision measures show similar age distributions, but the second measure addresses deaths where poor supervision is a contributing factor. Figure 6. Percent Reviewed Deaths with Supervision Issues, GA 2021 The possible contribution of poor supervision to the death is captured by three variables. The "Circumstances" section has a question: "Child abuse or neglect, poor supervision or exposure to hazards cause or contribute to death?". If the answer is "Yes", then "Poor/absent supervision" is one of the possible responses to describe the action. In Section J (Person Responsible), the first question is: "Did person(s) cause/contribute to death?". There are follow-up questions for up to two persons to identify the type of action, and "Poor/absent supervision" is one of the responses. Poor supervision is indicated if it is selected in one or more of these three variables. The CFR teams determined that poor supervision was involved in 109 of the 613 reviewed deaths (17.8%). Annual Report - Calendar Year 2021 15 Exposure to Hazards is defined using the same variables as Poor Supervision, with a value for Hazard (4) replacing the Poor Supervision value (3). A total of 280 reviewed deaths had "Hazard" checked for at least one of the three variables. Infants accounted for half of the indicated presence of a hazard. Approximately one-third of the child (ages 1 17) deaths had "Hazard" reported. Table F. Reviewed Deaths with Hazard Indicated Hazard Reported Age Category Yes No Infant 141 58 1 - 4 29 68 5 - 9 18 31 10 - 14 32 65 15 - 17 60 111 Total, < 18 280 333 Percent 70.9 29.9 36.7 33.0 35.1 45.7 The CDR form has a follow-up question regarding the type of hazard. There was a response for 260 of the 280 deaths that indicated a hazard. The "Sleep environment" response explains the large number of infants exposed to a hazard. Figure 7. Identified Hazards, GA CDR 2021 16 Georgia Child Fatality Review Panel Summary of Selected Causes Selected Cause of Death Categories: Prevention Target Populations The county Child Fatality Review (CFR) teams determined that 80% or more of reviewed deaths could probably have been prevented. The central mission of the CFR process is to reduce the number of infant/child deaths; and the intent of the following "cause-specific" discussion is to provide information for use by GA legislators, the CFR Panel, Panel subcommittees, and concerned agencies/organizations. Figure 8. 2021 Reviewed Deaths, % Preventable (# Preventable) Unintentional Injuries There were 186 reviewed unintentional deaths in Georgia in 2021, with motor vehicle-related events (including pedestrians and bicyclists) accounting for 57 percent (106) of the deaths. Drowning the second-leading cause accounted for 24 deaths (13%). Table G. Reviewed 2021 Unintentional Injury Deaths, GA Cause Asphyxia Drowning Fall/Crush Fire MVC Other Cause Poison Weapon Totals Infant 2 2 8 4 16 1 to 4 4 11 7 19 2 1 2 46 Age in Years 5 to 9 10 to 14 1 3 3 1 1 5 1 15 24 1 1 3 25 34 15 to 17 5 1 40 2 14 3 65 Totals 7 24 2 14 106 8 16 9 186 Annual Report - Calendar Year 2021 17 The white toddlers are 2.2 times more likely to drown than a black toddler; but the black 5- to 17-year-old is 3.8 times more likely to 1d8rown than a white child. Georgia Child Fatality Review Panel Drowning An average of 35 GA children die each year due to drowning. There has not been any consistent trend over time in drowning deaths (although the average number of annual deaths has dropped to 31 for the past four years, compared to 37 for the preceding six years), so the following discussion addresses the total deaths over the 10-year period. This aggregation of years provides a sufficient sample to look for age and race differences. There were 346 reported deaths of youth under the age of 18 in GA between 2012 and 2021. County CFR teams reviewed 285 of those deaths (82.4%). (Appendix Table E) The age and race/ethnicity data indicate two distinct populations toddlers ages one through four, and children/teens ages five through 17. Figure 9. GA Drowning Deaths, Ages 1 to 17, 2012-2021 Figure 10. Drowning Mortality Rates by Age Group and Race Annual Report - Calendar Year 2021 19 The fatality reviews provide information regarding the circumstances of the death and risk factors. Supervision is a factor described under the Responsibility section questions "Did person(s) cause/contribute to death?" and "What act caused/contributed to death?" "Poor supervision" is one of the options for the second question, and it was reported for 84% of the reviewed toddler (ages 1 to 4) deaths and 43% of the youth (ages 5 to 17) deaths. An ability to swim is important for all children, and a racial disparity was noted in reviewed drowning deaths. The higher drowning risk for Black/African American youth (referenced in the discussion of death certificate data) may be partially explained by a racial disparity in swimming skills. Over 70% of the Black youth drowning victims were reported as unable to swim, compared to less than 40% of the White youth. Table H. Racial Disparity in Swimming Skills Child able to swim? (DROchswim) Race (Non-Hispanic) Yes No Unknown % Non-Swimmer* White 16 10 9 38.5 Black 15 40 28 72.7 * Excludes "Unknown" The prevention section of the CDR form provides an opportunity for team recommendations. The 10-year data shows a decrease in the responses to the question: "Recommendations and/or initiatives that could be implemented to prevent future deaths". Figure 11. Proportion of Drowning Reviews with Recommendation 20 Georgia Child Fatality Review Panel Motor Vehicle Incidents Reported deaths (ages < 18) associated with MV incidents vary from year to year, but the average number is approximately 100 per year. There has been an increase in Black/African American deaths during the first two years of the COVID19 pandemic. The White deaths stayed at about 4 per 100,000, but Black deaths increased to over 6/100,000 in 2021. Figure 12. Georgia Motor Vehicle Mortality Rate, Ages < 18 Child Fatality Review (CFR) teams reviewed 106 motor vehicle related deaths in 2021. The majority of the 106 incidents in 2021 were related to cars, vans, SUVs, or trucks, accounting for 58% (61) of these deaths. The 15-17 age group has largest number of deaths in this category with 27, accounting for 44%. Table I. Reviewed 2021 Motor Vehicle Deaths, by Involved Vehicle Child's Vehicle ATV Infant 1 to 4 1 Age in Years 5 to 9 10 to 14 4 3 15 to 17 4 Bicycle Car, van, SUV, truck (driver) Car, van, SUV, truck (passenger) 7 Motorcycle Pedestrian 1 Other/Unknown Totals 8 2 17 10 10 7 10 1 6 1 6 3 2 6 5 19 15 24 40 Totals 12 2 17 44 1 17 13 106 Annual Report - Calendar Year 2021 21 Assuming no significant trends over time, the 10-year set of reviewed data was used to describe the MVC victim population and examine risk factors. Passengers (of car, van, SUV, or truck) comprised the largest population by position (424 out of 938) 45%. Figure 13. Position of MVC Decedent by Age, GA 2012-2021 A primary prevention objective for passengers is availability and use of appropriate restraint systems. Over half of reviewed fatalities for children <18 who were passengers in a car, van, SUV, or truck were either not restrained or improperly restrained. Black children accounted for almost 80% of the unrestrained/improperly restrained infants, while they were 57% and 51% of the 1- to 4-year-olds and the 5-to-17-year-olds respectively. Figure 14. C hildren who were Passengers in a Car, Van, SUV or Truck and were Unrestrained or Improperly Restrained (Percent and Number) 22 Georgia Child Fatality Review Panel The teenage drivers are a second target population for prevention. There were 145 reviews of deaths of teen drivers from 2012 to 2021. Ninety percent of the time the teen driver was determined to be at fault in the motor vehicle incident. Males were involved in single vehicle accidents twice as often as females (66% of the time versus 32%). Speed, lack of seatbelt use, recklessness and inexperience were top contributing factors to motor vehicle incidents involving teen drivers. Figure 15. C ontributing Factors in Reviewed Fatal Crashes Involving Teen (15 to 17) Drivers, GA, 2012-2021 Pedestrian deaths are distributed across all age groups and represent a prevention challenge. For the 15 to 17 age group, 85% of reviewed pedestrian deaths were male, and 75% of the 10 to 14 age group were male. The toddlers represent a supervision issue, and the older children/youth need education in awareness of their environment. Figure 16. N umber of Reviewed Pedestrian Deaths by Race/Ethnicity, Sex and Age Group, 2012-2021 Annual Report - Calendar Year 2021 23 Intentional Injuries Homicides continued an increase that started in 2020, and suicides (death certificate reports) increased from an average of 59 per year over the previous five years to 86 in 2021. The homicide increase has been associated with an increase within the Black/A-A population ages 15 to 17. The number doubled starting in 2015, and there has been another 50% increase over the past two years. Figure 17. Average Annual Homicides, GA, Ages 15-17 The child death review data shows that 65% of the homicides involved firearms, and firearms were used for 58% of the suicides. 24 Georgia Child Fatality Review Panel Table J. Reviewed Intentional Deaths by Mechanism, GA Residents, 2021 Age Category (yrs.) Mechanism Homicide Blunt Force Trauma Firearm Hanging Heat Knife Maltreatment Motor Vehicle Poison Suffocation Total Suicide Firearm Hanging Poison Total Infant 5 1 1 1 8 1 - 4 9 3 1 1 2 1 5 22 5 - 9 10 - 14 15 - 17 1 2 10 42 1 1 1 4 11 43 13 31 1 13 14 2 2 1 28 47 Total 15 57 1 1 2 4 1 6 1 88 44 28 4 76 The 10-year review data provides information on risk factors associated with deaths among defined (cause of death, age, race/ethnicity, and mechanism of death) populations. Appendix, Table F has the aggregate homicide and suicide breakout for the period for all four variables. The following table shows some of the disparities in homicide and suicide deaths for ages < 18. Toddlers account for 38% of the Black, non-Hispanic homicides compared to 56% for White, NH. This difference is a result of the large racial disparity in teen homicides. Many of the toddler homicides (approximately 60% for Black and White, NH) are attributed to blunt force trauma. The teen homicides are firearm-related (93% for Black, NH and 76% for White, NH), and over 80% of the firearm homicide victims were male. Annual Report - Calendar Year 2021 25 Table K. Age and Race/Ethnicity Distributions, GA Intentional Injuries, 2012 - 2021 Age Distribution (Count) Homicide Suicide Years NH Black 1 to 4 Toddler 179 5 to 14 Child 73 59 15 to 17 Teen 222 69 NH White 1 to 4 Toddler 71 5 to 14 Child 22 90 15 to 17 Teen 34 195 Racial Distribution (Percent) Homicide Suicide Non-Hispanic Black 68.6 25.8 White 18.4 57.5 Other 4.5 5.8 Hispanic All Races 8.5 10.9 The described age, race, and mechanism distributions highlight areas for additional risk factor investigation. The toddler homicides raise questions regarding the child's supervision and status of caregivers responsible person(s). The firearm deaths (including accidental deaths) highlight questions regarding access to firearms. The New York Times reported (12/15/2022) that: "Guns are now the No. 1 cause of deaths among American children and teens, ahead of car crashes, other injuries and congenital disease." Access to firearms and firearm safety are major challenges for public health prevention. Further analysis of CFR firearm-related data will be a priority for future work. A biological parent or the mother's partner was identified as the person responsible for the death for over 80% of the toddler homicides. The most common mechanism was "blunt force trauma" (59% of the homicides). Table L. R elationship of Person Responsible for Toddler Homicides Description Homicide BFT Missing 30 10 Biological mother 97 43 Biological father 63 45 Mother's partner 52 49 All Other 50 26 Total 292 173 % Biological Parent or 80.9 84.0 Partner 26 Georgia Child Fatality Review Panel There are a series of questions regarding the firearm used in the deaths, but there are many "Missing" responses. Only 17 out of 152 suicides with a Yes/No response indicated the weapon was locked. Figure 18. " Was the weapon locked?" Access to firearms is a serious concern related to suicides, but the mental health of the young person is a major contributing factor. Bullying in school has always been a problem, but the expanded use of social media means that a child is never out of reach of a bully. Younger teen and female suicide victims are more likely to have been bullied (including cyber bullying) than older teens or males. Thirty-two percent of females ages 10 to14 were reported to have been bullied. Figure 19. R eviewed Suicide Deaths with Reported Bullying, GA, 2012-2021 Of reviewed deaths of children who died by suicide, 29 percent had some form of abuse or neglect at some point in their lives and 56% communicated suicidal thoughts or intentions or talked about suicide. Annual Report - Calendar Year 2021 27 Sleep-related deaths (Sudden Unexpected Infant Death SUID): Sleep-related deaths continue to resist efforts to address recognized risk factors. Safe sleep campaigns have promoted "back-to-sleep" positioning for infants and avoidance of soft bedding and other items in the crib, but the annual number of deaths has remained steady. The GA death certificates reported an average of 162 sleep-related deaths each year from 2014 through 2020. (The increase in 2021 to 182 is suspected to be a reporting anomaly.) Table M. Reviewed SUID Deaths, GA Residents, 2021 SUID Category Asphyxia Undetermined Race/Ethnicity Male Female Male Female White 7 6 23 10 Black 15 6 41 27 Hispanic 1 1 1 3 Multi-Race 1 2 1 3 Total 24 15 66 43 Total 46 89 6 7 148 Estimated mortality rates show that Black, non-Hispanic infants were about 2.5 times more likely to die from a sleep-related event than White, NH infants. ("Estimated" rate because not all deaths are reviewed yielding an underestimate for the mortality rate.) Male infants are also at a slightly higher risk and comprise 61% of SUID deaths. Fatality review teams determined that 148 reviewed deaths in 2021 were sleep-related. The review process for sleep-related deaths yields four categories for the deaths of infants in a sleep environment. If soft bedding is involved and suffocation is suspected, the cause is considered SUID-Asphyxia (suffocation). The three other SUID categories (SIDS, SUIDMedical, and Undetermined) are combined in "Undetermined" in the following graphic. SUID-Medical indicates that there was some underlying medical condition, but the condition was not determined to be the cause of death. There is some year-to-year fluctuation in SUID, but the count has averaged 153 per year. Figure 20. R eviewed GA SUID Deaths, by Category, 2012-2021 The risk factors of concern include sleeping position (on back is recommended), sleeping surface (adult bed, crib, other surface), sleeping alone, and soft surfaces/objects on the surface. Over 55% of decedents were reported as sleeping in an adult bed, and the proportion did not vary significantly by race/ethnicity. The presence of a crib in the home (of an infant reported sleeping in an adult bed) was reported for 67% of the Black, NH deaths and 80% of the White, NH deaths. Figure 21. P roportion of Decedents in Adult Bed, by Race/Ethnicity: Reviewed Deaths Annual Report - Calendar Year 2021 29 Co-sleeping is a recognized risk factor for sleep-related death a roll-over, or even a large arm, can block an airway or constrict an infant's chest and compromise breathing. The 10-year review data indicated 74% of the deaths on an adult bed and 57% on other surfaces had a co-sleeping adult. Only 38% of decedents were reported as sleeping alone. Sleeping on their back has been aggressively promoted for over a generation, but over 60% of decedents were found on their stomach or side. (Fifty-eight percent of decedents were reported as having been put to sleep on their back.) Over 50% of all infants had unsafe sleep surface/bedding reported for each of the three listed variables. Twenty-nine percent were reported with all three of the unsafe conditions. 30 Georgia Child Fatality Review Panel Summary There has been a change in the age and cause of death distributions for Georgia infants and youth (<18 years of age) associated with the COVID19 pandemic. The infant mortality rate dropped by 10% from 2019 to 2020, and the rate remained at that low level (6.2 deaths per 1,000 births) in 2021. Most of that decrease was due to a drop in reported deaths in the first day of life for Black / African American newborns. The child (ages 1 through 17) deaths increased during the past two years from 562 in 2019 to 668 in 2021. The number of deaths defined as "Reviewable" (for Child Fatality Review {CFR}) increased from 480 (2018-2019) to 600 (2020-2021). (All non-medical deaths are considered reviewable.) Table N. Possible Pandemic-Associated Changes in Number of GA Infant/Child Deaths Cause of Death Age Category 2018 2019 Year of Death 2020 2021 Medical Infant 711 702 587 562 Motor Vehicle 15 to 17 41 33 52 46 Intentional Homicide 10 to 14 4 6 18 13 Homicide 15 to 17 37 32 44 50 Suicide 15 to 17 38 41 31 56 Sleep-Related SIDS Infant 104 104 107 101 Suffocation in Bed Infant 27 33 31 31 Unknown Infant 22 26 19 48 The medical infant deaths are not generally subject to review, but the CFR teams are charged with the review of all other deaths. Eighty-one percent of reviewable 2021 deaths were reviewed by CFR teams, with 84 teams reviewing all reviewable deaths in their county. The multi-year CFR data base was used to describe the pandemic associated changes noted and to examine risk factors for age, race/ethnicity, and sex for selected cause of death categories. The following provides highlights from those descriptive analyses: Drowning: The drowning deaths did not show any trends over time, but the multi-year data distinguished two populations with different risk factors and racial distributions. The white toddlers are 2.2 times more likely to drown than black toddlers; but the black 5- to 17-year-old is 3.8 times more likely to drown than a white child. Access to pools and ability to swim may explain some of the observed racial differences. Annual Report - Calendar Year 2021 31 Motor vehicle incidents: There has been an increase in Black/African American deaths during the first two years of the COVID19 pandemic. The White deaths stayed at about 4 per 100,000, but Black deaths increased to over 6/100,000 in 2021. There are (at least) three distinct prevention target populations: 1. Appropriate restraint use is an issue for passengers of all ages. Over half of passenger decedents in a car, van, SUV, or truck were either not restrained or improperly restrained. 2. S peed, lack of seatbelt use, recklessness and inexperience were top contributing factors to motor vehicle incidents involving teen drivers (about two-thirds male). 3. P edestrian deaths are distributed across all age groups, with 69% male and 47% Black/African American. Prevention priorities need to be appropriate supervision for the toddlers and awareness of their environment for older youth. Intentional Injuries: The increase in homicides among Black, 15- to 17-year-old males has been documented. The average number has increased from 14 to 42 per year since 2014. Reduced access to firearms needs to be a prevention priority, but other social/behavioral interventions must be implemented. Infants and toddlers are a different prevention population with biological parents (or caretaker) responsible and blunt force trauma as the mechanism. Prevention approaches include improvement of social support systems, access to parenting training, and more communication among agencies with contact with the infant/toddler. Black and White youth suicides have displayed similar trends an increase in 2015, a plateau through 2020, and another increase in 2021. Whites have a higher suicide rate, but the racial difference has narrowed. Prevention needs to address increased sensitivity to warning signs (56% of victims had communicated suicidal thoughts/plans), access to firearms (17 of 152 guns were locked), and use of social media (bullying). 32 Georgia Child Fatality Review Panel Table O. Average Number of Youth (< 18) Suicides, 2012 - 2021 (GA Death Certificate) 2012 - 2014 2015 - 2020 2021 Non-Hispanic Black 7.7 15.7 25.0 White 24.0 32.8 48.0 White/Black Ratio 3.1 2.1 1.9 Sleep-Related Deaths: Sudden unexpected infant deaths (SUID) have remained relatively steady over the 10-year period. (The increase in the "Unknown" category in 2021 is suspected to be a reporting anomaly.) Data from the reviewed deaths indicates a high prevalence of recognized risk factors: Table P. Prevalence of Risk Factors for Sleep-Related Deaths Stomach or Side Sleep Position Percent 61.1 Sleeping on Adult Bed 56.5 Co-sleeping with Adult 53.1 Soft bedding* 56.0 All 3 29.0 * Pillow and/or Comforter Maltreatment: Child maltreatment - identified as abuse or neglect causing or contributing to the death, or a reported history of maltreatment was identified in 29% of the reviewed deaths. The five-year comparison shows a doubling in the number of deaths with neglect reported as causing or contributing to the death and 150% increase in deaths with reported exposure to hazard. We do not know how much of these increases is associated with increased sensitivity to these risks by the review teams. The frequency of a history of maltreatment again highlights the importance of communication among involved agencies. The large increase in reported exposure to hazards (and poor supervision) indicates the need for parent/caregiver education. Annual Report - Calendar Year 2021 33 Resources Prevent Child Abuse America (www.preventchildabuse.org) Georgia Center for Child Advocacy (georgiacenterforchildadvocacy.org) Child Abuse and Neglect Prevention Plan (CANPP) https://abuse.publichealth.gsu.edu/canpp/ Department of Behavioral Health and Developmental Disabilities Suicide Prevention https://dbhdd.georgia.gov/bh-prevention/suicide-prevention Georgia Crisis and Access line (GCAL) 1-800-715-4225 available 24/7 The Trevor Project (LGBTQ) Trevor Lifeline 1-866-488-7386, 24/7, 365 or text 678-678US Department of Transportation, Federal Highway Administration (www.fhwa.dot.gov) National Highway Traffic Safety Administration (www.nhtsa.gov) Georgia Governor's Office of Highway Safety (www.gohs.state.ga.us) American Red Cross (www.redcross.org) United States Consumer Product Safety Commission (www.cpsc.gov) American Academy of Pediatrics (www.aap.org) Centers for Disease Control and Prevention, Injury Prevention & Control: Division of Violence Prevention (www.cdc.gov/violenceprevention) Georgia Department of Public Health, Youth Risk Behavior Surveillance System (www.dph.georgia.gov/YRBS) Georgia General Assembly (www.legis.ga.) 34 Georgia Child Fatality Review Panel Attachments Table A. Age and Race/Ethnicity Distribution, GA Deaths Ages < 18, 2019 - 2021 2019 2020 2021 Age (Yrs) Infant 1 to 4 5 to 9 10 to 14 15 to 17 Infant 1 to 4 5 to 9 10 to 14 15 to 17 Infant 1 to 4 5 to 9 10 to 14 15 to 17 2021 Totals Hispanic 100 24 8 15 26 76 22 14 23 21 81 20 13 16 34 164 Black 470 76 42 63 68 406 74 47 74 85 400 84 44 81 123 732 Non-Hispanic White Other 286 32 58 8 35 7 50 2 73 7 269 20 54 4 24 3 54 7 78 3 257 34 51 13 33 1 59 9 84 3 484 60 Total 888 166 92 130 174 771 154 88 158 187 772 168 91 165 244 1,440 2019 2020 2021 Age (Days) 0 1 to 6 7 to 27 28 to 365 0 1 to 6 7 to 27 28 to 365 0 1 to 6 7 to 27 28 to 365 Hispanic 40 20 10 30 23 12 11 30 30 17 9 25 Infant Deaths Non-Hispanic Black White 156 92 86 60 60 43 168 91 111 77 87 49 51 40 157 103 111 68 51 51 58 40 180 98 Other 10 6 3 13 9 5 2 4 5 7 7 15 Total 298 172 116 302 220 153 104 294 214 126 114 318 Annual Report - Calendar Year 2021 35 Table B. Infant Mortality Decrease, Age < 1 Day, 2018/'9 to 2020/'1 PregProb IUG Resp Cong Other Totals % Decrease PregProb IUG Resp Cong Other Totals % Decrease Black Non-Hispanic 2018-2019 2020-2021 74 37 191 120 39 25 43 29 16 10 363 221 39.1 Other Non-Hispanic 2018-2019 2020-2021 4 1 8 7 1 4 2 13 14 White Non-Hispanic 2018-2019 2020-2021 22 20 69 48 19 20 47 48 6 8 163 144 11.7 Hispanic 2018-2019 2020-2021 12 7 32 25 5 5 13 10 3 6 65 53 18.5 Cause Category Definitions Label ICD10 Range PregProb P00 - P04 IUG P05 - P08 Resp P20 - P29 Cong Other Q00 - Q99 Description Maternal factors and complications of pregnancy, labor, and delivery Disorders related to length of gestation and fetal growth Respiratory and cardiovascular disorders of the perinatal period Congenital malformations All other medical causes 36 Georgia Child Fatality Review Panel Table C. Counties with Un-Reviewed Deaths, 2021 Reviewable Not Reviewable County All Not Not Reviewable Reviewed Reviewed Reviewed Reviewed Fulton 58 28 30 4 72 DeKalb 49 43 6 7 50 Cobb 22 15 7 1 46 Chatham 19 11 8 1 22 Glynn 11 1 10 3 Troup 7 6 1 8 Bulloch 6 5 1 3 Camden 5 3 2 3 Floyd 5 2 3 5 Douglas 4 3 1 2 12 Habersham 4 3 1 2 Pike 4 3 1 Burke 3 2 1 1 Decatur 3 2 1 2 2 Tift 3 1 2 1 5 Walker 3 2 1 1 4 Catoosa 2 1 1 1 6 Chattooga 2 1 1 1 Murray 2 1 1 5 Sumter 2 1 1 1 Liberty 7 0 7 9 Fayette 5 0 5 7 Baldwin 4 0 4 1 2 Greene 4 0 4 1 Bryan 3 0 3 Grady 2 0 2 1 Morgan 2 0 2 Putnam 2 0 2 Baker 1 0 1 Coffee 1 0 1 5 Evans 1 0 1 3 Jasper 1 0 1 Long 1 0 1 2 McIntosh 1 0 1 Mitchell 1 0 1 1 Towns 1 0 1 Wayne 1 0 1 2 Label* = All Reviewable / Reviewable Reviewed CoFIPS 13121 13089 13067 13051 13127 13285 13031 13039 13115 13097 13137 13231 13033 13087 13277 13295 13047 13055 13213 13261 13179 13113 13009 13133 13029 13131 13211 13237 13007 13069 13109 13159 13183 13191 13205 13281 13305 Label* 58/28 49/43 22/15 19/11 11/1 7/6 6/5 5/3 5/2 4/3 4/3 4/3 3/2 3/2 3/1 3/2 2/1 2/1 2/1 2/1 7/0 5/0 4/0 4/0 3/0 2/0 2/0 2/0 1/0 1/0 1/0 1/0 1/0 1/0 1/0 1/0 1/0 Category 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Annual Report - Calendar Year 2021 37 Table D. C hild Fatality Review Team Determination of Preventability: 2021 Reviewed Deaths Could the death have been prevented? Cause of Death Missing No, Yes, probably not probably Undetermined %Preventable Unintentional Motor Vehicle Crash Drowning Other Unintentional 9 87 10 90.6 1 23 95.8 7 39 10 84.8 Intentional Homicide 1 8 73 6 90.1 Suicide 8 52 16 86.7 Sleep-Related 1 15 102 30 87.2 Medical Undetermined 63 9 24 12.5 2 10 7 81.8 Total 113 395 77.8 38 Georgia Child Fatality Review Panel Table E. GA Resident Drowning Deaths, Ages 0 17, 2012 2021 White, Non-Hispanic Black, Non-Hispanic Other Non-Hispanic Hispanic Age Group Male Female Male Female Male Female Male Female Totals No Review Infant 1 1 1 3 1 - 4 15 4 3 2 1 1 26 5 - 9 1 1 6 3 1 2 14 10 - 14 1 4 2 3 10 15 - 17 1 1 4 1 1 8 Total 17 8 17 9 3 5 2 61 Reviewed Infant 4 1 2 1 1 9 1 - 4 60 35 23 13 2 10 3 146 5 - 9 10 5 23 7 2 1 4 52 10 - 14 5 3 21 7 1 2 39 15 - 17 9 18 1 11 39 Total 88 44 87 28 6 24 8 285 % Reviewed 83.8 84.6 83.7 75.7 82.8 82.4 Table F. Reviewed Motor Vehicle Crash Deaths (Ages < 18), GA Residents, 2021 White, Non-Hispanic Black, Non-Hispanic Hispanic & Other Race Male Female Male Female Male Female Total %Male Infant 1 2 3 1 1 8 1 - 4 4 3 5 4 2 1 19 57.9 5 - 9 8 5 1 1 15 93.3 10 - 14 5 6 6 4 2 1 24 54.2 15 - 17 9 6 11 6 6 2 40 65.0 Total 27 15 29 18 12 5 106 64.2 Annual Report - Calendar Year 2021 39 Table G. R eviewed GA Intentional Injury Deaths, 2012 - 2021: by Race/Ethnicity, Age Category, and Mechanism Mechanism Homicide Blunt Force Trauma Black, Non-Hispanic Toddler Child Teen 107 10 3 White, Non-Hispanic Toddler Child Teen 44 3 1 Burns 1 1 Drowning 3 2 2 1 Fire 1 Firearm 14 54 206 5 15 26 Hanging 2 1 Heat 1 Knife 7 4 8 2 4 Maltreatment 13 2 1 1 Medical Neglect 1 1 Motor Vehicle 2 1 Other 2 Poison 10 6 Strangulation 10 2 4 1 1 Suffocation 1 1 2 Undetermined 7 1 2 1 Total 179 73 222 71 22 34 Suicide Fall 1 1 6 Fire 1 Firearm Hanging Poison Total 19 46 34 19 5 3 59 69 47 107 40 68 3 13 90 195 40 Georgia Child Fatality Review Panel 12 Appendix A Child Fatality Review Committee Timeframes and Responsibilities If child is hre(s4i0d4en)t2o0f6t-h6e0c4o3unty, medical examiner or coroner will notify chairperson of child fatality review committee in the child's county of residence within 48 hours of receiving report of child death (Code Section 19-15-3). Medical examiner or coroner reviews the findings regarding cause of death. If child is not resident of county, medical examiner or coroner of the county of death will notify the medical examiner or coroner in the county of the child's residence within 48 hours of the death. Within 7 days, coroner/medical examiner in county of death will send coroner/medical examiner in county of residence a copy of Form 1 along with any other available documentation regarding the death. Upon receipt, coroner/medical examiner in county of residence will follow outlined procedures If cause of death meets the criteria for review pursuant Code Section 45-16-24, medical examiner or coroner will complete Form 1 and forward to the chair of the child fatality review committee for review within 7 days of child's death. Committee meets to review report and conduct investigation into the child death within 30 days of receiving the report. Committee will complete its investigation within 20 days after the first meeting following the receipt of the medical examiner or coroner's report. Committee transmits a copy of its report within 15 days of completion to the Office of Child Fatality Review. If cause of death does not meet the criteria for review pursuant to Code Section 45-16-24, the medical examiner/coroner will complete Sections A, B, and J of Form 1 and forward to the chair of the child fatality review committee within 7 days. If chair believes death meets the criteria for review, chair will call committee together. If chair of committee agrees that death does not meet criteria for review, then chairperson signs Section J of Form 1 and forward to the Office of Child Fatality Review. Send copy of the report within 15 days to district attorney of the county in which the committee was created if the report concludes that the death was a result of: SIDS without confirmed autopsy report; accidental death when death could have been prevented through intervention or supervision; STD; medical cause which could have been prevented through intervention by agency involvement or by seeking medical treatment; suicide of a child under the custody of DHR or when suicide is suspicious; suspected or confirmed child abuse; trauma to the head or body; or homicide. Annual Report - Calendar Year 2021 41 Appendix B - 2020 Compliance Map 42 Georgia Child Fatality Review Panel Conclusion We are committed to preventing child deaths in Georgia. The preventable death of a child is an unimaginable tragedy for a family. While there is no way to predict most child deaths, we can identify some groups of children who are at greater risk of death. Identifying trends require analysis of the causes of fatalities, which begins with accurate vital statistics/data provided by local CFR teams. This report summarizes the data collected regarding the circumstances related to each child death. It is intended to be a vehicle to share the findings with the community to engage others in concerns about these and other risks. We encourage partners and local resources to assist in developing recommendations and implement policies, programs, and practices that can have a positive impact in reducing the risks and improving the lives of Georgia's children. It is our hope that you will utilize the information in this annual report and share it with others who can influence changes for the betterment of children. For more information on this report or the Child Fatality Review Unit, please contact: Georgia Bureau of Investigation Child Fatality Review Unit 3121 Panthersville Rd Decatur, GA 30034 Phone: (404) 270-8715 | ChildFatalityReview@gbi.ga.gov Annual Report - Calendar Year 2021 43 Georgia Child Fatality Review Panel Annual Report CALENDAR YEAR 2 0 2 1