Georgia Child Fatality Review Panel summary report calendar years 1999-2004, 2007

GEORGIA CHILD FATALITY REVIEW PANEL
Summary Report Calendar Years 1999-2004
Office of Child Fatality Review 506 Roswell Street, Suite 230
Marietta, Georgia 30060 Phone: (770) 528-3988 | Fax: (770) 528-3989
Website: www.gacfr.dhr.georgia.gov
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Mission
To serve Georgia's children by promoting more accurate identification and reporting of child fatalities, evaluating the prevalence and circumstances of both child abuse cases and child fatality investigations, and monitoring the implementation and impact of the statewide child abuse prevention plan in order to prevent and reduce incidents of child abuse and fatalities in the State.
Acknowledgements
The Georgia Child Fatality Review Panel wishes to acknowledge those whose enormous commitment, dedication and unwavering support to child fatality review have made this report possible. These include:
All the members who serve on each of the county child fatality review committees Emily Kahn, Ph.D., MPH, Nicole Alexander, MPH, Jimmy Clanton, Graphics, Maternal and Child
Health Epidemiology Section, Epidemiology Branch; and Lisa Dawson, MPH, Injury Prevention Section, Environmental Health and Injury Prevention Branch, Georgia Division of Public Health John T. Carter, Ph.D., Epidemiology Department of Emory University, Rollins School of Public Health Richard Wheat, Director of the Office of Vital Statistics All the other public/private agencies that have so willingly collaborated with this office and provided support
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GEORGIA CHILD FATALITY REVIEW PANEL

MEMBERS
Chairperson Edward D. Lukemire Superior Court Judge, Houston Judicial Circuit

DeAlvah Simms Child Advocate for the Protection of Children3
Mary Burns, M.D. Board Chair, Dept. of Human Resources3
Velma Tilley Judge, Bartow County Juvenile Court
Vanita Hullander Coroner, Catoosa County
Kris Sperry, M.D. Chief Medical Examiner, Georgia Bureau of Investigation
Kevin Tanner Chief Deputy Dawson County Sheriff's Office
Nancy N. Fajman, M.D. Child Abuse Prevention Advocate
Gwendolyn Skinner Director, Division of MHDDAD3

Vernon M. Keenan Director, Georgia Bureau of Investigation3
Melvin Everson Member, Georgia House of Representatives2
Stuart Brown, M.D. Director, Division of Public Health3
Mary Dean Harvey Director, Division of Family & Children Services3
Myra Tolbert Board Chair Criminal Justice Coordinating Council3
Gloria Butler Member, Georgia State Senate1
J. David Miller District Attorney, Southern Judicial Circuit
Vacant Child Injury Prevention Advocate

Brenda Jones Administrative Assistant
Rachelle Carnesale Child Death Investigation Team Director

STAFF
Eva Pattillo Executive Director
Tamara Hurst Program Manager

Kecia McDonald Executive Secretary
Arleymah Raheem Program Manager

The Georgia Child Fatality Review Panel is an appointed body of 17 representatives that oversees the county child fatality review process, reports to the governor annually on the incidence of child deaths, and recommends prevention measures based on the data. Two year appointments are made by the governor except as otherwise noted.
1Appointed by the Lieutenant Governor 2Appointed by the speaker of the House of Representatives 3Ex-Officio
3

MESSAGE FROM THE CHAIR
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TABLE OF CONTENTS
Mission ................................................................................................................................... 2
Members ................................................................................................................................. 3
Message from the Chair ........................................................................................................... 4
List of Figures and Tables ........................................................................................................ 6
Preface .................................................................................................................................... 8
Executive Summary ................................................................................................................. 9
Accomplishments and Recommendations ................................................................................. 11
Georgia Child Fatality Investigation Program ............................................................................ 12
Information Sources and Inconsistencies ................................................................................... 13
Child Deaths in Georgia ........................................................................................................... 14 All 1999-2004 Reviewed Deaths ...................................................................................... 16 Preventability .................................................................................................................... 17 ChildAbuse and Neglect ................................................................................................... 18 PriorAgency Involvement ................................................................................................. 21 Sleep-Related Infant Deaths .............................................................................................. 23 Asphyxia .......................................................................................................................... 23 SIDS/SUID ...................................................................................................................... 25 Unintentional Injury-Related Deaths ................................................................................... 28 Motor Vehicle....................................................................................................................29 Drowning .......................................................................................................................... 34 Suffocation ....................................................................................................................... 37 Fire .................................................................................................................................. 39 Intentional Injury-Related Deaths ....................................................................................... 43 Homicide .......................................................................................................................... 43 Suicide ............................................................................................................................. 46 Firearm ............................................................................................................................. 50
Race, Ethnicity and Disproportionate Deaths ............................................................................ 55
History of Child Fatality Review ............................................................................................... 58
Appendices ............................................................................................................................. 59
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List of Figures and Tables
List of Figures 1. Rate of Death to Children 0-17 years old, Adjusted Death Certificate Data, Georgia 1999-2004 2. Deaths to Children Under Age 18, in Georgia, All Causes Based on Adjusted Death Certificate, 1999-2004 3. All Child Death Rates per 100,000 Children, Age 0-17, by Race/Gender Categories, 1999-2004 4. Cause of Death, All Reviewed Infant/Child Deaths, Georgia 1999-2004 5. History of Domestic Violence in the Home of the Caretaker Among Reviewed Cases with Abuse/Neglect
Findings, 1999-2004 6. Causes of Death Among Reviewed Deaths with Abuse/Neglect Findings, Georgia 1999-2004 7. Relationship of Perpetrator to Decedent in Reviewed Cases with Abuse/Neglect Findings,
1999-2004 8. Agency Involvement Among Reviewed Deaths by Abuse/Neglect Status, 1999-2004 9. Reported CPS Involvement Among Deaths with Abuse/Neglect Findings, 1999-2004 10. Reviewed Sleep-Related Asphyxia Deaths, Age <1, by Month of Age, 1999-2004 11. Location at Time of Death for Infants Reported as Sleep-Related Asphyxia, 1999-2004 12. Number of People Sleeping with Infant at Time of Death, 1999-2004 13. Reviewed SIDS/SUID-Related Deaths by Age, 1999-2004 14. Location at Time of Death for Infants who Died of SIDS/SUID, 1999-2004 15. Discovered Sleeping Position of Infants who Died of SIDS/SUID, 1999-2004 16. Reviewed SIDS/SUID Deaths by Month of Occurrence, 1999-2004 17. SIDS Death Rates per 1,000 Live Births, Age <1, Based on Adjusted Death Certificate Data,
Three-Year Moving Average, 1999-2004 18. Reviewed Unintentional Injury-Related Deaths by Cause, 1999-2004 19. Reviewed Motor Vehicle-Related Deaths by Position at Time of Injury Among Occupants of a
Vehicle, 1999-2004 20. Reviewed Motor Vehicle-Related Deaths by Position at Time of Injury Among
Occupants Outside a Vehicle, 1999-2004 21. Reviewed Motor Vehicle-Related Deaths by Restraint Use and Age, 1999-2004 22. Primary Cause of Reviewed Fatal Motor Vehicle Crashes Among Teens Ages 15-17, 1999-2004 23. Reviewed Motor Vehicle-Related Death Rates, per 100,000 children ages 0-17, by Rural vs.
Urban Locale, 1999-2004 24. Motor Vehicle-Related Death Rates per 100,000 Teens Age 15-17, Three-Year Moving Average,
1999-2004, Based on Adjusted Death Certificate Data 25. Numbers, Rates and Locations of Reviewed Deaths Due to Drowning per
100,000 population, 1999-2004 26. Reviewed Deaths Due to Drowning in Pools and Bathtubs by Month of Occurrence, 1999-2004 27. Drowning-Related Death Rates per 100,000 Children Age 0-17, Three-Year Moving Average, 1999-2004,
Based on Adjusted Death Certificate Data 28. Suffocation-Related Deaths by Cause of Asphyxia, 1999-2004 29. Suffocation-Related Death Rates per 100,000 Children Age 0-17,
Three-Year Moving Average, 1999-2004, Based on Adjusted Death Certificate Data 30. Reviewed Deaths Due to Fire by Month of Occurrence, 1999-2004 31. Reviewed Fire-Related Death Rates per 100,000 Children Age 0-17, by Rural vs.
Urban Locale, 1999-2004 32. Fire-Related Death Rates by Race per 100,000 Children Age 0-17, Three-Year
Moving Average, 1999-2004, Based on Adjusted Death Certificate Data 33. Fire-Related Death Rates by Sex per 100,000 Children Age 0-17, Three-Year
Moving Average, 1999-2004, Based on Adjusted Death Certificate Data 34. Reviewed Homicide-Related Deaths by Mechanism of Injury, 1999-2004 35. Relationship of Perpetrator Among Reviewed Homicide Deaths, 1999-2004 36. Homicide-Related Death Rates per 100,000 Teens Age 15-17, Three-Year
Moving Average, 1999-2004, Based on Adjusted Death Certificate Data 37. Reviewed Suicide-Related Deaths by Mechanism of Death, 1999-2004
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List of Figures and Tables (cont)
38. Reviewed Suicide-Related Deaths by Month of Occurrence, 1999-2004 39. Time of Death Among Suicide-Related Deaths, 1999-2004 40. Mechanism of Suicide-Related Deaths by Age Group, 1999-2004 41. Suicide-Related Death Rate per 100,000 Teens, Age 15-17, Three-Year Moving
Average, 1999-2004, Based on Adjusted Death Certificate Data 42. Reviewed Firearm-Related Deaths by Intent, 1999-2004 43. Reviewed Firearm-Related Death Rates per 100,000 Children, Age 0-17, by
Urban vs. Rural Locale, 1999-2004 44. Reviewed Firearm-Related Deaths by Status of Firearm Security, 1999-2004 45. Reviewed Firearm-Related Deaths by Type of Firearm, 1999-2004 46. Firearm-Related Death Rates per 100,000 Teens, Age 15-17, Three-Year Moving
Average, 1999-2004, Based on Adjusted Death Certificate Data 47. Deaths to Children <1 and Percent of Population in Georgia, by Race and Gender,
Based on Adjusted Death Certificate Data, 1999-2004 48. Deaths to Children 1-17 and Percent of Population in Georgia, by Race and
Gender, Based on Adjusted Death Certificate Data, 1999-2004 49. Reviewed Hispanic Deaths by Cause of Death, 1999-2004 50. Deaths to Hispanic Children Under Age 18 in Georgia, All Causes Based on
Adjusted Death Certificate Data, 1999-2004
List of Tables 1. Top 5 Causes of Death by Race and Age Group, 1999-2004 2. Preventability, All Reviewed Infant/Child Deaths, Georgia 1999-2004 3. Demographics of Deaths with Abuse/Neglect Findings, 1999-2004 4. Demographics of Reviewed SIDS/SUID Deaths, 1999-2004 5. Demographics and Other Important Characteristics of Reviewed Motor Vehicle-Related Deaths, 1999-2004 6. Other Important Characteristics of Reviewed Motor Vehicle-Related Deaths, 1999-2004 7. Demographics and Other Important Characteristics of Reviewed Drowning-Related
Deaths, 1999-2004 8. Demographics of Suffocation-Related Deaths, 1999-2004 9. Demographics of Reviewed Fire-Related Deaths, 1999-2004 10. Other Important Characteristics of Reviewed Fire-Related Deaths, 1999-2004 11. Demographics of Reviewed Homicide-Related Deaths, 1999-2004 12. Demographics of Suicide-Related Deaths, 1999-2004 13. Demographics and Other Important Characteristics of Reviewed Firearm-Related
Deaths, 1999-2004 14. Number and Percent of Deaths to Hispanic Children Under Age 18 in Georgia, as a
Percent of the Population, 1999-2004
Appendices A. Criteria For Child Death Reviews B. Child Fatality Review Timeframes and Responsibilities C1. Total Child Fatalities Based on Adjusted Death Certificate C2. Total Reviewed Child Fatalities C3. Reviewed Child Fatalities with Abuse/Neglect Findings C4. Preventability for Reviewed Deaths with Suspected or Confirmed Abuse or Neglect D. Eligible Deaths Reviewed/Eligible Deaths, Georgia, 1999-2004 E. 1999-2004 Child Fatality Reviews, By County, By Age Groups
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Preface

How well are we protecting our children? Child protection has long been an issue that has generated discussion among those in child-focused organizations, legislators, and city, county, and state governments. However, it is often only the most egregious, heinous circumstances that garner media attention and support of resources. While these should not be ignored, these events are considerably less frequent than the more common, foreseeable, and preventable injuries which often occur in the home every day, and often lead to death. Child protection must encompass a broader range of thinking if we are truly committed to protecting children. We must take the necessary steps to eliminate practices contributing to child deaths, and employ measures proven to reduce injury and death. Listed below are some identified gaps in preventing child deaths.
Motor Vehicles Currently, Georgia law exempts pickup trucks from
the mandated child restraint requirements. In 2005, the federal government offered grants to states with a comprehensive child restraint law. After several attempts to legislate this simple safety measure, the bill to remove the exemption for pickup trucks was not passed (HB 18). Georgia's children remain at risk of being killed in a pickup truck crash while unrestrained. Current Georgia ATV regulations do not require the completion of a driver safety course, use of helmets for child operators, the restriction of children as passengers, or the restrictions on the speeds at which children can drive. Although requiring these driver safety measures for ATVs is recommended by the ATV manufacturers and CDC, Georgia legislators did not approve this measure in 2006 (HB 1004), which continues to place children at high risk of being fatally injured in a crash. Swimming Pools Georgia does not have any statewide regulations to ensure the safety of private or semi-private swimming pools. Pool fencing that isolates the pool is the safest, most convenient layer of protection against the dangers that swimming pools can pose to toddlers. Adequate pool fencing prevents a child from having access to a swimming pool if a responsible adult is not present and has been promoted as a method to prevent drowning. Firearms Though seventeen states currently have Child Access Prevention legislation (CAP) to regulate child access and usage of firearms (including Florida and Virginia), Georgia does not have a CAP law, negligent owner law, or a minimum age for possession of rifles or shotguns. The Georgia legislature has failed twice to pass a CAP law (SB 72 in 1995, and SB 190 in 1997), which leaves children poorly protected from careless gun owners. Florida's CAP law has been shown to

reduce youth gun deaths by 51% from 1989 to 2000, probably due in large part to its stiff penalties and statewide marketing (Pediatrics, 2000). Smoke Alarms Although smoke detectors are proven to protect children and families in the event of a residential fire, Georgia does not require landlords to install or maintain smoke alarms in all sleeping areas. A significant number of fires occur in rental properties; therefore, mandating installation and maintenance of working smoke alarms in rental homes would certainly save a number of young lives lost.
In addition to the need for improvement in the aforementioned areas, there are other measures that should be addressed. Child protection encompasses not only the child's physical home environment and the neighborhoods where they live and play, but also the child's family who cares for them each day and night.
Child Abuse and Neglect Unwanted pregnancies can result in needless tragedy when newborns are disposed of after birth. In Georgia, despite the enactment of a law designed to avert such travesties, substantial barriers remain to protecting these unwanted children. The current law is insufficient. The Safe Place for Newborns Act of 2002 grants
amnesty from child abuse or abandonment prosecution to mothers who relinquish custody of their unwanted newborns. This is a good starting point to protect newborn infants from injury or harm, but does not address the primary issues that lead to abandonment of unwanted children. This poorly-publicized law does not permit mothers to relinquish children at fire stations or police stations, which are often more accessible than birthing centers and hospitals, nor can they remain anonymous. These provisions therefore discourage drop-offs and have resulted in only two officially recorded infant drop-offs in the four years since the legislation passed. Child protection and safety should not be delegated to any one agency, but should include all organizations responsible for the well-being of children. Unfortunately, agencies responsible for children often have competing visions and expectations. We must structure linkages between agencies if we are to succeed in protecting children. There must also be a community response and responsibility for children. Successful prevention efforts require planning, forethought, and commitment, resulting in the institutionalization of safeguards that seek to prevent injury of any kind. There are many well-researched, proven protection strategies that we have failed to implement, and further avoidance will only lead to more deaths of children. If we are committed to helping our children grow up to be healthy, educated and employable, we must work together to make their childhood environment safe.

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Executive Summary

The Georgia Child Fatality Review Panel (Panel) publishes an annual report chronicling the tragic, preventable deaths of children in Georgia. Child deaths are identified through death certificate data provided by the Vital Statistics Unit of Public Health. Local child fatality review committees review only those deaths that are sudden, unexpected, or unexplained ("eligible"), and complete a standardized form detailing the circumstances of the deaths. That information is compiled and used in the Panel's report. The Panel is charged with tracking the numbers and causes of child deaths as well as identifying and recommending prevention strategies that could reduce the number of child deaths.
This year, the Panel is providing a summary report detailing the circumstances of child deaths from 1999 2004. The good news is that we have seen a decline in the rate of child deaths from 1999 (79.9/ 100,000) to 2004 (75.6/100,000) and a decline in the number of deaths eligible for review (based on adjusted death certificate data) from 34.8% in 1999 to 33.7% in 2004. Considering aggregated child death data over a period of time is useful in revealing recurring patterns and for indicating prevention gaps and opportunities. We encourage parents, communities, organizations, and policymakers to use these data to make life-saving decisions for children.

Deaths per 100,000 Children 0-17

Figure 1: Rate of Death to Children 0-17 years old, Adjusted Death Certificate Data, Georgia
1999-2004

90.0 79.9
80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0
0.0 1999

81.2 2000

80.7

79.2

2001

2002

Year

78.4 2003

75.6 2004

Key Findings From 1999 2004, 10,620 children died in Georgia. Based on adjusted death certificate data, 3,577 deaths were eligible for review. Child fatality review committees reviewed 2,943 (82%) of those deaths; however, the cause of death listed on death certificates and the cause of death determined by child fatality

review committees sometimes differed due to cause of death coding standards for the death certificate data. The percent of reviewed deaths greatly improved over the time period from 75.9% in 1999 to 98.6% in 2004. Vital Records has begun to use child fatality review data, which is believed to be more reliable, to adjust death certificate data in the state.
FATAL CHILD ABUSE/NEGLECT
Department of Family and Children Services reported that 355 children in Georgia died as a result of substantiated abuse or neglect. Those deaths were investigated by DFCS, and did not include deaths handled by law enforcement and the courts without DFCS involvement. One hundred eighty-seven (53%) of the 355 child abuse/neglect related deaths were children who were previously known to DFCS.
Child fatality review committees determined that 709 child deaths resulted from both confirmed and suspected abuse/neglect (390 confirmed and 319 suspected). Perpetrators were identified in 437 of the 709 abuse/ neglect related deaths, as well as relationship of the perpetrator to the child. More than 1 perpetrator was identified in 40 child abuse/neglect deaths. Sixty percent (60%) of those perpetrators were natural parents. Homicide was the cause of 195 confirmed abuse deaths, and children under the age of 5 accounted for 78% (153) of those homicides.
NATURAL
Adjusted death certificate data indicated a total of 7,837 children under the age of 18 died of natural causes. Infants accounted for the vast majority (6,402) of those deaths. There were 787 SIDS deaths a 22% increase over the time period from 1999 2004. The leading causes of infant deaths continued to be congenital anomalies, low birth weight, and prematurity.
Child fatality review committees reviewed 1,210 deaths from natural causes. Six hundred ninety-two (692) of those deaths were SIDS and SUID. (SUID Sudden Unexplained Infant Death - is a term used for a death that appears to be SIDS, but has other factors that could have contributed to the death.) Committees are required to review all SIDS deaths and medical deaths that are unexpected or unattended by a physician.

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INJURIES
Adjusted death certificate data listed 2,783 deaths resulting from known injuries, but 34 of those deaths listed an unknown intent. An additional 120 deaths listed an unknown cause.
Unintentional Injuries
Adjusted death certificate data indicated that 62% (2,363) of deaths in children ages 1 17 resulted from injuries (infant deaths [6,822] were mostly due to natural causes [6,402]). Seventy-seven percent (77%) of all injuries in the 1 17 year age group resulting in death were unintentional (excludes unknown intent and unknown cause). The 3 leading single causes of unintentional injury related deaths in all age groups were:
1,181 motor vehicle incidents 264 drowning incidents 196 suffocation incidents
There was a 9% decline in the number of all deaths caused by unintentional injuries from 366 in 1999 to 333 in 2004. The most marked increase in unintentional deaths over this time period was fire-related deaths, from 13 in 1999 to 38 in 2004.
Child fatality review committees reviewed 1,617 deaths attributed to unintentional injuries. Child fatality review data agreed with adjusted death certificate data on the 3 leading causes of death related to unintentional injury as seen below:
961 motor vehicle incidents 205 drowning incidents 166 suffocation incidents
Intentional Injuries
Adjusted death certificate data indicated 601 children died from injuries intentionally inflicted by themselves or by others. From 1999 to 2004, there were 429 homicides (a 9% decline over this time period), and 172 suicides (a 7% decline over this time period).

Child fatality review committees reviewed 533 deaths from intentional causes 378 homicides and 155 suicides.
FIREARM DEATHS
Adjusted death certificate data indicated firearms were used in 280 child deaths. One hundred fifty-nine (159) of those deaths were ruled homicides, 83 were suicides, 33 were unintentional, 4 were unknown intent and 1 death was classified as unknown cause.
Child fatality review committees reviewed 268 firearm related deaths. Eighty-seven percent (87%) were intentional (159 homicides and 73 suicides). The type of firearm was identified in 254 of the 268 reviewed firearm related deaths. Handguns were most frequently used (188 of the 254 deaths where type of firearm was identified).
PREVENTABILITY
A primary function of the child fatality review process is to identify those deaths believed to be preventable. The issue of preventability was addressed in 3,413 (99%) of the 3,461 child deaths reviewed. Child fatality review committees determined that 72% (2,463) of the 3,413 reviewed child deaths with preventability data were definitely or possibly preventable. Ninety-six percent (676) of the 706 reviewed child abuse/neglect related deaths with preventability data were determined to be definitely or possibly preventable.
AGENCY INVOLVEMENT
Child fatality review committees reported that in 479 (68%) of the 709 child abuse/neglect related deaths, the child and/or family had prior involvement with at least one state or local agency. Committees identified 72 deaths for which they concluded an agency intervention could have prevented the death. Forty-three of those 72 deaths (60%) had abuse/neglect findings.

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Accomplishments and Recommendations

Accomplishments

1. Realized a 30% increase in county committees' 3. Require fences and gates that isolate public and

compliance for reviewing eligible child deaths

private swimming pools statewide

over the 6 year period (from 76% in 1999 to

4. Require an autopsy, including toxicology

99% in 2004)

studies, for every death of a child under the age

2. Formed a number of partnerships to provide

of seven with the exception of children who are

training to committees and assistance with local

known to have died of a disease process while

prevention efforts. Partnerships included the

attended by a physician. Further, require

Georgia SIDS Project, Georgia Traffic Injury

complete skeletal x-ray (following established

Prevention Institute, Public Health, GBI, and DFCS pediatric and radiological protocol), of the

3. Distributed one thousand gun locks to county

bodies of children who died before their

committees for local distribution

second birthday

4. In 2004, initiated annual recognition of county

5. Expand funding for mental health services for

efforts through the "CFR Coroner of the Year"

children, especially those identified as "at risk"

and "CFR County Committee of the Year"

awards

On-going Agency Recommendations

5. Established and supported child fatality

investigation teams with a multi-disciplinary

1. DFCS: The Panel recommends that when a

approach in a total of 20 judicial circuits

child dies due to parent(s) or caretaker(s)

6. Implemented an on-line reporting system for

neglect or aggression, efforts be made to visit

completion of child fatality and coroner reports

the surviving children in the home on an on-

by local committees

going basis for a minimum of three months to

7. Published and distributed a "Child Fatality

assess their safety and well-being, and enable

Review Policy and Procedures" manual

referrals to appropriate services

8. Published and distributed a "Statewide Model

2. Public Health: Implement a statewide

Child Abuse Protocol" manual in collaboration

campaign that promotes safe infant sleep

with the Office of Child Advocate, DFCS, and

environments and explicitly describes dangers

GBI

posed to infants in bed-sharing and other

9. Co-sponsored an annual conference with

unsafe sleep environments

DFCS, Office of Child Advocate, and GBI on

3. Coroner's and Medical Examiner's

serious injury and child fatality

Offices: Conduct a death scene investigation

for any child death that is suspicious,

On-going Legislative Recommendations

unexpected, and/or unexplained

1. Provide sufficient funding to the Georgia Child Fatality Review Panel to fulfill statutory requirements
2. Fund expansion of home-based family support models that promote and enable appropriate parenting skills for prevention of child abuse and neglect

On-going Goal
1. Collaborate with relevant organizations to develop a statewide child abuse/child injury prevention plan

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Georgia Child Fatality Investigation Program

The Child Fatality Investigation Program was created to develop and support multi-disciplinary child death investigation teams in communities around the state. The program is administered through the Child Fatality Review Panel, through collaboration with the Georgia Bureau of Investigation and the Division of Family and Children Services. Unlike the approach to adult homicides in which each discipline becomes involved separately in time and allocation of effort, this team approach maximizes the information-gathering and decision-making capabilities of authorities. Child death investigation teams recognize the value of employing the specific expertise and resources each involved agency brings to the investigation. These teams utilize highly trained representatives from their own district attorney's offices, local law enforcement agencies, coroners and/or medical examiners, and the Department of Family and Children Services. These teams immediately respond and share information from the point of the child's death, thereby encouraging better investigations with more obtainable evidence. Regional specialists from the Georgia Bureau of Investigation are available to assist teams as well. This is an investigative trend that Georgia has begun to embrace statewide.
Numerous jurisdictions around Georgia have agreed to participate in the Child Fatality Investigation Program and have received assistance and training upon request and without any cost. The program is available for consultation and review of both new and old cases and many jurisdictions have availed themselves of the opportunity to put a "fresh eye" on cases by referring them to the program. Model protocols are available as well as initial and follow-up trainings and case consultations. Resource notebooks designed for teams to utilize at death scenes are offered to participating teams as well. Several members of the program have requested and received assistance interviewing and preparing expert medical witnesses for trial. A continued goal of the program is to assist the legal and investigative communities in understanding the evolving medical testimony in shaking and shaken/impact cases, now more often referred to as acceleration/deceleration deaths. Recent attacks on the accepted science in this area have resulted in some confusion amongst practitioners in law enforcement and prosecution; however, this is simply a training issue which the program can readily address.
The original jurisdictions involved in the pilot program include: Lookout Mountain Judicial Circuit, Middle

Judicial Circuit, Douglas Judicial Circuit, Dougherty Judicial Circuit, Stone Mountain Judicial Circuit, Eastern Judicial Circuit, Rome Judicial Circuit, Northeastern Judicial Circuit, Alcovy Judicial Circuit, Southern Judicial Circuit, and Tifton Judicial Circuit. The following jurisdictions enrolled in the program in 2004: Blue Ridge Judicial Circuit, Bell-Forsyth Judicial Circuit, Clarke Judicial Circuit, Rockdale Judicial Circuit, and Gwinnett Judicial Circuit. In 2005, the Flint, Cobb, Clayton and Macon Circuits joined the program and the Douglas Circuit re-established their team. In 2006, the focus of the program was to work with new and existing teams to enhance their teamwork and investigative skills. The Brunswick Judicial Circuit also joined the program in 2006.
The goal of the Program is to ensure that proper scene investigation is performed in all appropriate cases, and that involved agencies work in concert with one another from the inception of the investigation pursuant to their protocols, sharing valuable information and facilitating better decision-making. In 2004, 569 cases of child death were considered eligible for review by CFR teams. Forty-two of those deaths were deemed to be homicides. Therefore, given that nearly one child a week is a victim of homicide in Georgia, the need for the best quality in investigations is apparent.
Utilizing 2004 CFR data from two jurisdictions - one employing a team approach and one employing the traditional approach - participation in scene investigation was reviewed. An interview with the jurisdiction utilizing a team approach was also conducted. CFR data combined with interviews revealed that in the team-based jurisdiction where only drowning, possible SIDS/SUID and potential asphyxia cases were reported, the team activated and reported to the scene in 100% of the cases. Criminal charges were lodged in 50% of the potential asphyxia cases. In the jurisdiction employing the traditional approach, as expected, law enforcement reported to the scene 85% of the time and the local coroner reported to the scene 46% of the time. By including the district attorney in their early investigations, the team-based jurisdictions can benefit from expert legal advice as well as practical information on securing a conviction beyond making an arrest. By including a DFCS investigator, teams can benefit from the family histories already available with the agency from prior contact in many cases. The jurisdiction employing a team approach reports that communication does cut down on conflicting action by the involved agencies and results in better decision making by all parties.

12

Information Sources and Inconsistencies

This summary report on Georgia's 1999 - 2004 infant and child fatalities uses two related but independent sources of data death certificate (DC) data collected by the Vital Statistics Unit and prepared by the Office of Health Information and Policy (OHIP), and the child fatality review (CFR) data collected by the Office of Child Fatality Review. These two data sources do not always agree on the cause or manner of death; however, the cause and manner of death are consistent between the two sources for a majority of deaths. The CFR process brings together people and information that may not be available when the DC is completed. Access to additional information by CFR committees sometimes results in a different conclusion regarding the cause and/or manner of death.
There are two major differences between the prior annual CFR reports (1999 through 2004) and this summary report. The cause of death for the death certificate has been "corrected" to agree with the

conclusion of the county CFR team if there were differences between the two sources. One example is a car crash that lands in a lake resulting in a drowning death. The DC may report this as a drowning death while the CFR team concludes it was a motor vehiclerelated death. Both are reasonable conclusions; however, for consistency, we have used the CFR cause throughout this report. Corrected DC data in this summary report is labeled "Adjusted Death Certificate" data.
The prior annual CFR reports have generally included data from all child fatality reviews submitted by the county review teams. Every year there are a few reviewed deaths for which we cannot identify a Georgia death certificate. There were a total of 84 unlinked reviews over the six-year period. These may be out-ofstate deaths of GA residents that are not reported back to Georgia Vital Records. These 84 reviews are not included in the results presented in this report.

13

Child Deaths in Georgia

All Child Deaths

The rate of child deaths in Georgia has shown a slight decline from 1999 through 2004 the six year period covered in this report. A total of 10,620 children died during this time period due to medical causes, intentional and unintentional injuries. The vast majority of those deaths were due to medical causes (7,043). However, the main focus of this report will be on injury-related child deaths and SIDS/SUID which accounted for the remaining 3,577 deaths. Aside from medical deaths, motor vehicle-related incidents continued to be the leading cause of death in children less than 18 years of age, while Sudden Infant Death Syndrome (SIDS) was the leading cause of death in infants.
Existing research indicates that injury-related deaths are predictable, therefore preventable. If we hold to this premise, 2,783 children died unnecessary deaths.

County committees have gradually embraced the assertion that injury-related deaths are preventable as evidenced in their findings (see "Preventability"). Each year during this time period, committees have determined a higher percentage of deaths to be definitely or possibly preventable.
The following sections illustrate cause and topicspecific data. Cause of death is further subdivided by factors such as gender, age and race to show greater detail and highlight areas for possible prevention. Each section also addresses findings, and recommendations resulting from adjusted death certificate data and CFR reports as indicated.
Medical deaths in this report do not include those attributed to SIDS.

Findings: Two-thirds (66%) of all child
deaths are due to medical causes. Examples include deaths due to diseases such as leukemia, complications of prematurity and low birthweight, and deaths due to birth defects The second leading cause of death overall was motor vehicle crashes SIDS, the third leading cause of death, accounted for 787 deaths, or 7.4% of all child deaths

Figure 2: Deaths to Children Under Age 18 in Georgia All Causes Based on Adjusted Death Certificate, 1999-2004 (N=10,620)

Cause of Death

Medical 66.3%

MVC 11.1%

1181

SIDS 7.4%

787

Homicide 4.0%

429

Drowning 2.5%

264

Suffocation 1.8% 196

Suicide 1.6% 172

Fire 1.4% 152

Other Injury 1.3% 133

Unknown 1.1% 120

Poison 0.5% 53

Unknown Intent 0.3% 34

Firearm 0.3% 33

Fall 0.2% 16

Other SIDS 0.1% 7

0

1000

2000

3000

4000

5000

Number of Deaths

6000

7043

7000

8000

Findings: Child deaths disproportionately
occur among African-Americans. The rate for AfricanAmericans is 1.7 times higher than for Whites among both males and females Males are more likely to die than are females. Within each racial category, the rate for males is higher than the rate for females

Rate per 100,000 Children 0-17

Figure 3: All Child Death Rates per 100,000 Children Age 0-17 by Race/Gender Categories, 1999-2004 (N=10,620)

140

130

125.1

120

110

100 92.7
90

80

75.3

70

60

54.8

50

40

30

38.9 33.1

20

10

0
# of Deaths Rate

White Male 3176 75.3

White Female 2176 54.8

A-A Male 2930 125.1

A-A Female 2118 92.7

Other Male 122 38.9

Other Female 98 33.1

14

Table 1: Top 5 Causes of Death by Rank and Age Group, 1999-2004 (N=10,620)

Rank
1 2 3 4 5

<1 6822 (64.2%)
Medical 5608 (82.0%)
SIDS 787 (11.5%) Suffocation 131 (1.9%)
Unknown 82 (1.2%)
Homicide 80 (1.1%)

1-4 1066 (10.0%)
Medical 504 (47.2%)
MVC 161 (15.1%)
Homicide 114 (10.7%)
Drowning 106 (9.9%)
Fire 70 (6.6%)

Age Group in Years

5-9

10-14

612 (5.8%)

840 (7.9%)

Medical 279 (45.6%)

Medical 361 (43.0%)

MVC 168 (24.5%)
Drowning 42 (6.9%)

MVC 229 (27.3%)
Homicide 56 (6.7%)

Homicide 37 (6.0%)
Fire 32 (5.2%)

Drowning/Suicide 47 (5.6%)

15-17 1280 (12.1%)
MVC 568 (44.4%)
Medical 291 (22.7%)
Homicide 142 (11.1%)
Suicide 124 (9.7%)
Drowning 57 (4.5%)

All Deaths <18 10620 (100%)
Medical 7043 (66.3%)
MVC 1181 (11.1%)
SIDS 787 (7.4%)
Homicide 429 (4%)
Drowning 264 (2.5%)

Infants Infants (children less than 1-year old) accounted
for 64% of all child deaths Eighty-two percent of infant deaths were due to
medical causes, primarily complications of prematurity and low birthweight and birth defects The second leading cause, accounting for another 12% of infant deaths, was SIDS The third leading cause of death among infants, accounting for 2% of infant deaths was suffocation
Ages 1-4 (Early Childhood) Ten percent of all child deaths occurred to children
between the ages of 1 and 4 years The largest group of deaths were due to medical
causes, including: birth defects, respiratory diseases, cardiovascular diseases and cancer The leading cause of non-medical deaths in this age group, and every age group beyond infancy was motor vehicle crashes. These deaths are largely preventable The third most common cause of death, and the second leading cause of non-medical deaths, was homicide. These deaths are preventable Drowning and fire were the next 2 most common causes of death, respectively. These causes remain on the list throughout childhood. These deaths are also preventable
Ages 5-9 (Middle Childhood) The fewest child deaths (6%) occurred in this age
group Motor vehicle crashes were the most common
cause of non-medical deaths Drownings were the third leading cause of death Homicide and fire were the fourth and fifth most
common causes of death in this age group

Ages 10-14 (Early Adolescence) Eight percent of child deaths occurred among
children between the ages of 10 and 14 Motor vehicle crashes were the second leading
cause of death; however in this age group, they accounted for a larger percentage of non-medical deaths than in younger ages. Twenty-seven percent of child deaths in this age group were caused by motor vehicle crashes, compared with 25% for 5 to 9-year-olds and 15% for 1 to 4-yearolds Homicide was the third leading cause of death in this age group, accounting for 56 deaths, or 7% of the total Suicide emerged as one of the 5 leading causes of death in this age group, accounting for 6% of deaths. The same number of deaths in this age group was due to fire
Ages 15-17 (Middle Adolescence) Twelve percent of child deaths occurred among
teens between the ages of 15 and 17 In this age group, motor vehicle crashes surpassed
medical causes of death to become the leading cause of death overall. Motor vehicle crashes accounted for 44% of deaths to teens between the ages of 15 and 17 Homicide was the second leading cause of nonmedical deaths, accounting for 11% of deaths Suicide was the third leading cause of non-medical deaths, accounting for another 10% of deaths Drowning was the fourth leading cause of nonmedical deaths. Between 1999 and 2004, there were 264 drowning deaths in this age group, accounting for 3% of deaths among 15 to 17-year-olds

15

All 1999 - 2004 Reviewed Deaths
Cause of Death

All 1999 - 2004 Reviewed Deaths

In this 6-year retrospective review period, child fatality review committees reported on 3,461 infants and children who died from suspicious, unexpected or unexplained circumstances. A child's death is eligible for review when not under the care of a physician, or not in a hospice, as a result of injury or without expectation. Child medical deaths are recommended for review if unattended by a physician (such as unexpected heart failure, complications from asthma, or similar circumstances). CFR committees reviewed 82.2% (2,943) of all child deaths reported by death certificate data as either an injury or infant sleeprelated death. An additional 518 medical deaths were also reviewed by committees, leading to a total number of 3,461 reviewed child deaths. Complete data on reviewed child deaths can be found in Appendix C.2.
Why review child deaths? The purpose of the child fatality review process is to analyze all circumstances of each child's untimely death. The mission of child fatality review in Georgia and throughout the country is to prevent child deaths by understanding those factors that put children at risk. There may be critical factors which contributed to the death and one or more of those factors could have been eliminated. Reducing risk factors and promoting

protective factors in families and in the built environment can save lives. Understanding the events which surround a child's death through investigation and reporting can help families, communities and policymakers learn from the tragedy and work to protect other children from the same outcome.
A large percentage of child deaths in Georgia occur in those counties with the largest percentage of the child population. The ten counties with the most reviewable child deaths (1,418 total) were Bibb, Chatham, Cherokee, Clayton, Cobb, DeKalb, Fulton, Gwinnett, Muscogee, and Richmond. These ten counties held 40% of the total of eligible child deaths statewide, and reviewed 89% of their reviewable deaths (1,256), which is higher than the state overall average. There were 30 counties that had from 1 to 5 reviewable child deaths (100 total), and 68% were reviewed (68), which is lower than the state average.
All charts, graphs and findings in the following sections include only those eligible deaths which were reviewed by committees. Medical causes of deaths, and those with unknown data, are not included unless otherwise noted.

Findings: Motor vehicle incidents were
the leading cause of injuryrelated deaths to children (28%) SIDS and SUID together are the second leading cause of child death (20.0%). The number of infants who died during sleep (692) is higher than the number of all children who died from drowning, suffocation, suicide, fire, and falls combined (678) Medical circumstances were the third leading cause of deaths to children (15.0%), which includes such causes as asthma, congenital abnormalities, heart-related illness, and prematurity

Figure 4: Cause of Death, All Reviewed Infant/Child Deaths, Georgia, 1999-2004 (N=3,461)

Motor Vehicle Crash 27.8%

961

SIDS/SUID 20.0%

692

Medical 15.0%

518

Homicide 10.9%

378

Drowning 5.9%

205

Suffocation 4.8%

166

Suicide 4.5%

155

Fire 4.0%

137

Unknown 1.9%

67

Other Injury 1.7%

59

Poison 1.2%

43

Unknown Intent 1.0%

34

Firearm(Unintentional) 0.9%

31

Fall 0.4%

15

0

100

200

300

400

500

600

700

800

900

1000

Reviewed Deaths

16

Preventability

Preventability

A preventable death is defined by Georgia Child Fatality Review as one in which, with retrospective analysis, it is determined that a reasonable intervention (e.g., medical, educational, social, psychological, legal, or technological) could have prevented the death. In other words, a child's death is preventable if the community or an individual could reasonably have done something that would have changed the circumstances that led to the death. We often think that injury events are random "accidents". However, most injuries to children are predictable, understandable, and therefore, preventable. Many perinatal and infant deaths could be prevented if attention is paid to factors relating to maternal health in the prenatal period, and sleeping environment in the first year of life. Many medical deaths could be prevented by compliance with medical treatment regimens. Motor vehicle deaths could be prevented by supervising small children in driveways and parking lots, improving driver training, and enforcement of driving regulations. Not all risk factors can be addressed in the short-term. Some identifiable, but complicated risk factors can be

modified over time, with changes in the social environment and acceptability of certain behaviors.
Committees are expected to determine which child deaths could have been prevented. A death is generally determined to be "definitely preventable" when the risk factors had been identified and were well-known in the community. A death is generally determined to be "possibly preventable" when the risk factors may have been identified but may not have been well-known in the community. A death is generally determined to be "not preventable" when there were no identifiable risk factors, or the circumstances were entirely unpredictable.

Table 2: Preventability, All Reviewed Infant/Child Deaths, Georgia 1999-2004 (N=3,461))

Definitely Preventable Possibly Preventable Not Preventable Missing Information

N 1305 1338
770 48

% 37.7% 38.7% 22.2%
1.4%

CFR Committee Prevention Recommendations
Restrict access to neighborhood ponds and lakes. Neighborhoods and homeowner associations should be responsible for restricting access to all natural bodies of water or pools found in their community
Create legislation for ice cream trucks and all other service vehicles that attract children requiring that the vehicles be equipped with large mirrors to prevent injury to child pedestrians
Develop parenting/safety classes with sliding scale fee structures based on income. Parents express interest in taking classes but many times are unable to pay the fee
Require more intensive follow-up for juveniles with severe depression or suicidal ideation. Create an oversight committee that reviews the actions of mental health facilities when children die while in their care
Require all drivers to have driver education classes

that are specific to the types of roads on which they typically drive. This is especially needed for vehicle operators who drive on rural dirt roads Initiate legislation to require anyone who operates a boat to take boating safety classes through DNR Create a database that DFCS can use to check for restraining orders and TPOs on parents or parents' significant others Create safety measures to assure that referrals for services are made when a family moves to another state Develop parenting classes that focus on the common symptoms of infant illnesses such as jaundice Create legislation requiring young mothers to participate in parenting classes Generate better coordination of services with bordering states to enhance referrals to committees in the event of a child fatality State should take initiative to push local jurisdiction to pass ordinances for fencing-in of private pools

17

Child Abuse and Neglect

Child Abuse and Neglect

There are generally 4 recognized forms of child maltreatment: neglect, physical abuse, sexual abuse, and psychological or emotional maltreatment. Most victims of maltreatment are very young, with almost threefourths being younger than 5 years old. The child rescue orientation is reflected in a long-standing tendency to see child maltreatment as arising from poverty and parental irresponsibility, and so emphasizes the removal of children from their homes to protect them. The family support approach, by contrast, focuses on ameliorating the social and environmental factors that contribute to parental stress and child maltreatment (Future of Children).
How does GA compare to the U.S.? From 1999 to 2004, 73% of child abuse and neglect deaths in Georgia occurred to children younger than 5 years old. Of these deaths, 53% are infants younger than 1 year. National statistics show that children under 6 years of age account for 86% of all maltreatment deaths and infants account for 43% of these deaths.

Fatal abuse is interrelated with poverty, domestic violence and substance abuse. Fathers and mothers' boyfriends are most often the perpetrators in the abuse deaths; mothers are more often at fault in the neglect fatalities.
Domestic Violence and Child Abuse The concurrent incidence of domestic violence and child abuse within the same families is well documented. In a national survey of over 6,000 families, researchers found that 50% of the men who frequently assaulted their wives also frequently assaulted their children (Family Violence Prevention Fund). In fact, the U.S. Advisory Board on Child Abuse and Neglect suggests that domestic violence may be the single major precursor to child abuse and neglect fatalities in this country (1995). Babies whose mothers are victims of domestic violence during pregnancy are more than twice as likely to die in the first weeks of life (Amer. Journal of Public Health, 2006).

Finding: Among the 371 child abuse/
neglect deaths with information on history of domestic violence, 111 (30%) indicated a history of domestic violence in the home of the caretaker

Figure 5: History of Domestic Violence in the Home of the Caretaker Among Reviewed Cases with Abuse/Neglect Findings,
1999-2004 (N=709)
History of Domestic Violence 111 (16%)

Facts: Domestic violence perpetrators
sometimes intentionally injure children in an effort to intimidate and control their adult partners. Children may also be injured - either intentionally or accidentally - during attacks on their mothers Children whose mothers are abused sometimes suffer at the hands of their mothers as well. One study found that the rate of child abuse by mothers who were beaten is at least double that of mothers whose husbands did not assault them (Family Violence Prevention Fund)

Unknown 338 (47%)

No History of Domestic Violence
260 (37%)

Opportunity for Prevention: Provide and support effective child abuse and family violence prevention
programming to include public education campaigns aimed at changing the social norms that ignore and support abuse, and mobilizing individuals to take actions that protect women and children. Provide support to new families, such as home visitation or family support programs

18

Findings:
More than two-thirds of the deaths with abuse/neglect findings are due to nonhomicide, non-suicide injuries
Among non-homicide, nonsuicide deaths, motor-vehicle incidents were the leading cause of death to children (22.5%), followed by sleeprelated infant deaths (18.9%) and drowning (16.6%)

Figure 6: Causes of Death Among Reviewed Deaths with Abuse/ Neglect Findings, Georgia 1999-2004 (N=709)
Firearm (Unintentional) 5

Homicide 216

Fall 6 Poison 8 Suicide 10 Other Injury 14 Unknown Intent 15 Unknown 26 Fire 37 Medical 39 Suffocation 47
Drowning 82
SIDS/SUID 93

Facts:
Neglect cases can result from intentional or grossly negligent failure to adequately supervise a child, resulting in bathtub drowning, suffocations, poisonings and other types of fatal incidents
Most fatal injuries resulting from abuse are much more subtle than poisoning, beating, bludgeoning, shooting, or strangulation. Suffocation, for example, often leaves no medical sign of the cause of death. Most infant deaths with

Non-Homicide 493

MVC 111

abuse/neglect findings are related to head injuries, some of which leave no external sign of trauma
Opportunity for Prevention: Recognize and reduce risk factors for child maltreatment. Certain risk
factors can be easily identified, such as: children under the age of 5, parents or caregivers who are under the age of 30, low income, singleparent families experiencing major stresses, children left with male caregivers who lack emotional attachment to the child, substance abuse among caregivers, parents and caregivers with unrealistic expectations of child development and behavior, children with emotional and health problems, and lack of suitable childcare

Findings:

Figure 7: Relationship of Perpetrator to Decedent in Reviewed

More than half of all perpetra-

Cases with Abuse/Neglect Findings, 1999-2004

tors were the natural parents.

Natural Mother 30.4%

Mothers accounted for 30.4%,

Natural Father 26.2% Mother's Significant Other 9.3%

43

and fathers accounted for

Friend 6.7%

31

26.2% of abuse or neglect-

Acquaintance 4.6%

21

Stranger 4.3%

20

related deaths to children

Other Non-Relative 3.7%

17

The mother's significant other

Babysitter/Child Care Worker 2.6% Other Relative 2.6%

12 12

was involved in 43 deaths (9%),

Self 2.2%

10

while friends (31) and acquain-

Sibling 2.0%

9

Stepfather 1.5%

7

tances (21) were the perpetra-

Grandmother 1.5%

7

tors in 52 abuse or neglect-

Stepmother 0.9%

4

Father's Significant Other 0.4%

2

related deaths (11.3%)

Grandfather 0.4% 2

Foster Father 0.2% 1

140 121

Fact:

Adoptive Mother 0.2% 1 Adoptive Father 0.2% 1

Research findings show that among children ages 0-3 years,

0

20

40

60

80

100

120

140

160

Reviewed Deaths

the majority of child abuse

Opportunity for Prevention:

homicide cases occurred within Promote the less visible but critically important resources for child protec-

the family. After age 12,

tion such as the contributions made by worship communities, extended

perpetrators are primarily extra- families, friends and neighbors, youth groups, and other community re-

familial (outside the family)

sources that support families and guide parents in the proper care and

nurturance of their children

19

Findings: Infants have the highest rates
of abuse/neglect related deaths among all age groups, at 35.2 per 100,000 population, but the risk of child abuse/neglectrelated deaths decreases as the child gets older Seventy-three percent of all deaths with findings of child abuse/neglect occurred among pre-school aged children Males are more likely to have deaths associated with abuse and neglect than are females. Overall, males are 41% more likely than females to have abuse and neglect findings African-American males and females have the highest rates of abuse/neglect related deaths among all race/gender groups, at 10.0 and 6.3 per 100,000 population, respectively

Table 3: Demographics of Deaths with Abuse/Neglect Findings, 19992004 (N=709)

Demographic

Category

Age

Infant

1 to 4

5 to 14

15 to 17

Number
274 243 147
45

%

Rate Per 100,000

Children Age 0 - 17

38.6%

35.2

34.3%

8.1

20.7%

2.0

6.3%

2.1

Race

White Black Other

316

44.6%

3.9

379

53.5%

8.2

14

2.0%

2.3

Gender

Male Female

423

59.7%

6.2

286

40.3%

4.4

Race/Gender

White Male

184

26.0%

4.4

White Female

132

18.6%

3.3

A-A Male

234

33.0%

10.0

A-A Female

145

20.5%

6.3

Other Male

5

0.7%

*

Other Female

9

1.3%

3.0

Fact: One study of the social support and social network relationships of
neglecting and non-neglecting, low-income, single, African-American mothers found key differences in the mothers' perceptions of their relationships and interactions. The study found that the relationships of neglecting mothers were characterized by conflict, distrust, and lack of mutuality, while non-neglecting mothers experienced satisfying supportive relationships which emphasized a sense of mutuality and fairness (Family Violence Prevention Fund)

Prevention Gap:

Child welfare and family violence advocates do not

responses to families; instituting family court models

operate under the same guidelines and with the

that address overlapping domestic violence and child

same mandates. These two groups often operate in

abuse cases; cross training domestic violence and

their own silo, never coming to understand that

child welfare advocates; and creating domestic

violence in the family is a complex issue that

violence units in child welfare agencies

requires collaboration and cooperation among

Child maltreatment prevention should be a multi-

outside organizations to understand each side of the

year effort, not an attempt at a "quick fix." It will

issue, and work together in finding answers to end

take several years to develop and implement a

violence in the home

multifaceted approach to prevention through a

Statewide Opportunities for Prevention: Examples of promising practice approaches include:
co-locating domestic violence advocates in child welfare offices for case consultation and supportive services; developing cross-system protocols and partnerships to ensure coordinated services and

collaborative effort among multiple groups both on a local and national level. In order to create broad public support for prevention efforts, a longitudinal evaluation of the project's impact on families will also be necessary. Clearly, these important strategies will take a considerable investment of time and resources

20

Prior Agency Involvement

Prior Agency Involvement

Figure 8a. Agency Involvement for Reviewed Deaths with No Abuse / Neglect Finding

No Agency Public Health
DFCS/CPS DFCS/Public Assistance
Court Other Other or Missing
DJJ

401 364 287 254 184 94

1307 955

0 200 400 600 800 1000 1200 1400
Number of Deaths

Figure 8b. Agency Involvement for Reviewed Deaths with Abuse / Neglect Finding

No Agency

230

Public Health

272

DFCS/CPS

228

DFCS/Public Assistance

132

Court

122

Other

86

Other or Missing

48

DJJ 16

0 50 100 150 200 250 300
Number of Deaths

Approximately fifty-five percent (1,924) of all reviewed child deaths had personal (direct) or familial (indirect) involvement with one or more county agencies. Agency involvement did not always occur immediately before the child death, but may have occurred at any period prior to the death, and with any member of the child's family. Families may have had interaction with more than one county agency, and the service encounter may have been only once or for ongoing services.
Findings: Sixty-eight percent of children with abuse/neglect
findings had had prior agency contact. Of children without abuse/neglect findings, 53% had had prior contact with governmental agencies For children both with and without abuse/neglect findings, public health was the most common point of contact (38% and 35% respectively) One-third (32%) of children with abuse/neglect findings had prior involvement with Child Protective Services, as did 15% of children without abuse/ neglect findings Seventeen percent of children with abuse/neglect findings had had previous contact with the courts, compared with 10% of children without abuse/ neglect findings
Opportunity for Prevention: Provide ongoing support services to child protec-
tive services staff through continued education and training, caseload numbers reflective of the Child Welfare League recommended average, and emotional support assistance

DFCS (Public Assistance) was involved in 18.6% of child deaths when abuse or neglect was reported, and 13.2% of child deaths without evidence of abuse or neglect

Fact: Professionals who work with governmental and
other public agencies are mandated to report suspected child abuse or neglect, yet often receive little or no formal training in identification of risk factors or signs associated with abuse

Opportunity for Prevention: Specific project strategies including training, should
be created through a dynamic partnership between local public agencies and service providers, including CPS, domestic violence agencies, home visitation programs, fatherhood programs, early childhood development and daycare programs, the schools, the police, healthcare providers, after school youth programs, and economic development programs, to name a few. Ideally, the policies and practices of each of the partnership agencies would be reviewed and changed to integrate a strong prevention focus into services and programs

Figure 9: Reported CPS Involvement Among

Deaths with Abuse/Neglect Findings, 1999-2004

(N=228)

Decedent

49

Decedent and Other Child in Family

41

Other Child in Family, Not Decedent

49

Decedent, Other Child in Family and Caretaker

28

Caretaker

17

Other Child in Family and Caretaker

7

Decedent and Caretaker

15

Unknown

22

21

Sleep-Related Infant Deaths
Age in Months

Sleep-Related Infant Deaths

Sleep-related deaths include all deaths to infants that occur while sleeping, but have no obvious medical or environmental cause. They are the leading cause of death for children from birth to 1 year of age. According to the Centers for Disease Control and Prevention, more than 4,500 infants die each year with no obvious explanation. Many of these deaths are caused by Sudden Infant Death Syndrome (the sudden death of an infant less than 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history). Others appear to be SIDS, but have other factors present that could have contributed to the deaths (Sudden Unexplained Infant Death SUID). Also included in sleep-related deaths are those

resulting from sleep-related asphyxia (extreme decrease of oxygen in the body accompanied by an increase of carbon dioxide). Examples of sleep-related asphyxia include unintentional overlay by a caregiver, sleeping with head or face covered, or wedging.
Although many risk factors have been identified in association with SIDS, no main cause has been determined. Research is suggesting that there may be a complex combination of predisposing factors and environmental stressors that contribute to SIDS. Even though there has been a significant decrease in the number of deaths attributed to SIDS since the "Back to Sleep" campaign began in 1992, SIDS and other sleeprelated factors continue to contribute to a major number of infant deaths.

Asphyxia

Findings: Eighty-three percent of infants
were 6 months of age or younger when they died Fifty-two percent (58) of the children who died were 3 months old or younger The most frequent ages at death were 1 month (n=20), 2 months (n=19) and 3 months (n=18)
Fact: Sixty percent of infant suffo-
cation occurs in the sleeping environment (SafeKids, 2005). Infants in particular are at greater risk for suffocation because of their inability to lift their heads or remove themselves from tight places

Figure 10: Reviewed Sleep-Related Asphyxia Deaths, Age <1, By Month of Age, 1999-2004 (N=111)

11 10
9 8 7 6 5 4 3 2 1 0 Unknown

2 3
2
1 1

6 5
7

13 14

18 19 20

0

5

10

15

20

25

Number of Deaths

Opportunity for Prevention: Always place infants to sleep on a flat, firm sleeping environment. Adult
beds do not meet federal safety standards for infants and can cause accidental entrapment or suffocation

22

Findings: Thirty-nine infants (35%)
were found in a bed Thirty-two infants (29%)
were found in a crib Fifteen infants (14%) were
found on a couch or chair
Fact: No studies have found
protective effects of bedsharing with respect to SIDS; however, some studies have found a decreased risk factor of SIDS among infants who sleep in the same room as their parents (Arch. of Pediatric Adolescent Medicine, 2003)

Figure 11: Location at Time of Death for Infants Reported as

Sleep-Related Asphyxia Deaths, 1999-2004 (N=111)

On floor 6 (5%)

In infant car seat 2 (2%)
Being held 4 (4%)

Other 12 (11%)
Unknown 1 (1%)

On couch/chair 15 (14%)

In crib 32 (29%)

In bed 39 (34%)
Opportunity for Prevention: In-home use of car seats has resulted in suffocation deaths when the seat
overturned onto a soft surface. Never leave an infant unattended in a car seat

Findings: Seventy-two infants (65%)
were sleeping alone when they were discovered Thirty-nine infants (35%) were sleeping with others at the time of death. Of these, more than half (n=24) were sleeping with one other person. Nine infants were sleeping with 2 other people, and 6 infants were sleeping with 3 or more people
Facts: Bed-sharing is particularly
dangerous when the caregiver is overweight or under the influence of anything that might hamper a normal arousal response Infants exposed to tobacco smoke may have a diminished arousal response. The risk for SIDS increases when infants bed-share with mothers who smoke

Figure 12: Number of People Sleeping with Infant at Time of Death, 1999-2004 (N=111)

S leeping A lo ne 72 (65% )

S leeping with O the rs
39 (35% )

1 person 24 (22% )
2 peo ple 9 (8% )
3 peo ple 5 (5% )
>3 peo ple 1 (1% )

Opportunity for Prevention: Never let an infant sleep with anyone as it increases the risk for entrap-
ment or suffocation from overlay
Family was visiting with grandparents. The baby was bed-sharing with the parents when the father awoke and found the baby unresponsive.

23

SIDS/SUID Age in Months

SIDS/SUID

Findings: The most common age for
SIDS /SUID was two months (n=166 [24%]) Sixty-six percent of all SIDS and SUID deaths occur in children younger than 4 months Only 7% of all SIDS/SUID deaths occurred in infants older than 6 months
Fact: Generally, most babies
who die from SIDS/SUID are between 2 and 6 months old. The risk of death declines dramatically after 6 months of age

Figure 13: Reviewed SIDS/SUID Deaths By Age, 1999-2004 (N=692)

12 2

11 3

10 3

99

8 11

7

21

6

32

5

47

4

3

2

1

<1

35

Unknown 1

104 140 166
118

0

20

40

60

80

100

120

140

160

180

Number of Deaths

Opportunity for Prevention:
Health care providers should consistently provide parents with prevention materials promoting the "Back to Sleep" message and safe sleep environments during the first months of a child's life

Findings:
The most common location for SIDS/SUID deaths was a bed (n=308 [45%])
Over one-quarter (27%) of SIDS/SUID deaths occurred while the infant was in a crib
An additional 7% of infants with SIDS/SUID deaths were found on couches
Facts: No studies have found protec-
tive effects of bedsharing with respect to SIDS; however, some studies have found a decreased risk factor of SIDS among infants who sleep in the same room as their parents (Arch. of Pediatric Adolescent Medicine, 2003) The risk of SUID for infants sleeping on a couch or cushioned chair has dramatic

Figure 14: Location at Time of Death for Infants who Died of SIDS/SUID, 1999-2004 (N=692)

Unknown Other 51 (7%) 54 (8%)
Floor 21 (3%)
Couch 47 (7%)

Crib 187 (27%)

Playpen 24 (3%)

Bed 308 (45%)
adverse consequences that are almost 20 times greater than using recommended cribs and bedding
Opportunity for Prevention: Community agencies should participate in free or reduced-cost crib
programs to support low income families who may not be able to afford a separate safe sleep space for their infant

24

Findings:
Sleeping position was unknown for 24% of infants who died of SIDS and SUID
Forty-one percent of SIDS/ SUID infants were found on their stomachs; an additional 11% of SIDS/SUID infants were found on their sides
Less than one quarter of infants (24%) were sleeping on their back the recommended position to reduce risk of SIDS

Figure 15: Discovery Sleeping Position of Infants who Died of SIDS/SUID, 1999-2004 (N=692)

On stomach, face position unknown
71 (10%)
On stomach, face to side 66 (10%)

On back 170 (24%)

On stomach, face down 145 (21%)

On side 74 (11%)

Facts:
Perceived infant comfort is a main reason caregivers place babies in a prone position for sleep despite the "Back to Sleep" message (Arch. of Pediatric Adolescent Medicine, 1999)
Infants who normally sleep in the supine position have a decreased ability to escape suffocation when placed in the prone position (Pediatrics, 2004)

Unknown 166 (24%)
Opportunities for Prevention: Train nurses to model SIDS risk-reduction techniques to ensure that
families know how to reduce SIDS risk. The most critical period during which nurses can influence parents' behavior is during the 24 to 48 hours following delivery (Maternal and Child Health Bureau) Childbirth educators, lactation consultants, trainers for babysitter courses, WIC agencies and pediatricians should distribute information related to infant safe sleep environments to all child caregivers

Finding: There are no clear temporal
patterns associated with SIDS/SUID deaths; however, the months with the greatest number of SIDS deaths are December (n=73) and January (n=74)
Fact: Research has a long history
documenting the seasonality of SIDS showing an increased risk during the winter months
Opportunity for Prevention: Increase public awareness
that infant overbundling and overheating are risk factors for SIDS

Number of Deaths

Figure 16: Reviewed SIDS/SUID Deaths by Month of Occurrence, 1999-2004 (N=692)

80

74

73

70

65

60

55

50

58

57

56

55

51

51

50

47

40

30

20

10

0

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Month of Occurrence

25

Findings:
SIDS and SUID have consistently been highest for AfricanAmerican infants; both AfricanAmerican males and AfricanAmerican females have higher rates than their White counterparts
Males have higher SIDS/SUID rates than do females
The SIDS rates for AfricanAmerican males has remained steady since 1999
The SIDS rates for AfricanAmerican females, White females and White males have increased from 1999 to 2004

Rate (per 1,000 live births)

Figure 17: SIDS Death Rates per 1,000 Live Births: Age<1 (Based on Adjusted Death Certificate Data),
Three Year Moving Average, 1999-2004

2.20

White Male

White Female

2.00

AA Male

AA Female

1.80

1.60

1.40

1.20

1.00

0.80

0.60

0.40

0.20

0.00 99-01

00-02

01-03

02-04

3 Year Periods

Table 4: Demographics Reviewed SIDS/SUID Deaths,

Findings: Males have higher SIDS/SUID
rates than do females

Cha ra cte ristic

1999-2004 (N=692)

Ca te gory

Num be r (%)

Ra te pe r 1,000 Live Births

The rate for African-American Race/Gender

W hite Male

207 29.9%

0.8

males (highest) is 3 times higher

W hite Female

132 19.1%

0.5

than the rate for White females (lowest)

A-A Male A-A Female Other Male

201 29.0%

1.5

141 20.4%

1.1

7

1.0%

0.5

Facts:

Other Female

4

0.6%

*

According to recent SIDS research, both African-American and White mothers were likely to follow advice of medical person-

Data from the Center for Health Statistics show that nationally the SIDS rate among African-American infants remains more than twice the rate of White infants

nel; however, fewer AfricanAmerican mothers were advised about proper infant sleep position (Pediatrics, 2002)

Opportunity for Prevention: Begin a community-wide distribution program of the "Back to Sleep
Resource Kit African American Outreach" as developed by the National Institute of Child Health and Human Development

Statewide Opportunities for Prevention:



The American Academy of Pediatrics recommends

offering an infant a pacifier at nap time and bedtime

because research shows a strong association

between pacifier use and the reduction of SIDS Breastfeeding infants should be introduced to using

a pacifier after they turn 1 month old. The pacifier

should be used when placing an infant down for

sleep and should not be reinserted once the infant

falls asleep

26

Educate caregivers in the community about the dangers of exposing infants to tobacco smoke. Maternal smoking during pregnancy is associated with a significantly increased risk of SIDS (Amer. Journal of Public Health, 2006)
Excessive bed clothes, overheating, prone sleeping, soft bedding, bed sharing, low birth weight and passive smoke are all risk factors for SIDS (Pediatrics, 2001). Share information within communities about the risk factors for SIDS and the steps caregivers can take to lessen the danger for infants

Unintentional Injury-Related Deaths

Unintentional Injury-Related Deaths

Unintentional injuries are a leading cause of death for all children over the age of 1, regardless of gender, race, or economic status. Many deaths occur during summer months when children are less likely to be supervised. Children younger than 4, poor children and minority children are disproportionately represented in these statistics.

How does GA compare with the U.S. average? The crude rate for unintentional injury-related deaths from 1999 - 2003 among Georgia's children ages 0-17 was 1.3 times higher (15.88 per 100,000) than the national average of 12.19 per 100,000.

Cause of Death

Figure 18: Reviewed Unintentional Injury-Related Deaths By Cause, 1999-2004 (N=1,617)

Motor Vehicle Crash 59.4%

961

Drowning 12.7%

205

Suffocation 10.3%

166

Fire 8.5%

137

Other Injury 3.6%

59

Poison 2.7%

43

Firearm 1.9% 31

Fall 0.9% 15

0

100 200 300 400 500 600 700 800 900 1000

Reviewed Deaths

Findings: Motor vehicle-related deaths represent nearly 60%
of all child fatalities from unintentional injuries and have been the leading cause of unintentional injuryrelated death every year from 1999 through 2004 Drowning consistently ranks in the top 3 causes of death from unintentional injuries The number of deaths from suffocation averages 27 per year and ranged from a low of 21 to a high of 40 during this time period Twenty-two of the 43 deaths from poisoning were caused by children ingesting prescription medicines

Facts: Among youth ages 1-19, unintentional injuries are
responsible for more deaths than homicides, suicides, congenital anomalies, cancer, heart disease, respiratory illness and HIV combined (CDC, 1997) Children are highly unlikely to die from injuries sustained from a fall. During any year, approximately 2.5 million children nationally under the age of 14 will be treated in a hospital emergency room for injuries from a fall, but only 100 children will die from their injuries

27

Motor Vehicle-Related Deaths

Motor Vehicle-Related Deaths

From 1999-2004, motor vehicle incidents claimed the lives of 721 of Georgia's children. Most deaths are caused by risky behavior and can be prevented. Since MV crash victims are a diverse group, prevention efforts need to target specific populations. Lack of appropriate restraint use, such as child safety seats and booster seats, contributes significantly to deaths and injuries among infants and young children. Older adolescents between the ages of 15 and 17 have the highest

risk for motor vehicle crashes with the primary cause of death being driver error.
How does GA compare with the U.S. average? From 1999-2003, Georgia's unintentional motor vehicle crash fatality rate for children 0-17 years of age was 9.70 per 100,000. This rate is 1.3 times higher than the national average of 7.32 per 100,000 for the same time period.

Findings:
Children who died in motor vehicle crashes were equally likely to be back seat passengers (n=256), or the operators of the vehicle (n=255)
Of the 255 children operating vehicles, 33 (13%) were 14 years old or younger
One hundred and eighty-seven (26%) were passengers in the front seat of the vehicle. One quarter of these front seat passengers (n=44) were 9 years old or younger

. Figure 19: Reviewed Motor Vehicle-Related Deaths by Position at Time of Injury Among Occupants of a Vehicle, 1999-2004 (N=721)
Unknown 23 (3% )

Back Seat Passenger 256 (36%)

O p e ra to r 255 (35% )

Facts:
Children ages 12 and under should ride in the back seat of the vehicle whether or not the child has outgrown the use of a booster seat
Back seat placement must be accompanied by proper restraint use
Age-appropriate restraints and rear seat positioning are particularly important for children riding in

Front Seat Passenger 187 (26% )
SUV's since these vehicles have a higher tendency to be involved in deadly rollover crashes (Pediatrics, 2006)

Figure 20: Reviewed Motor Vehicle-Related

Deaths by Position at Time of Injury Among

Occupants Outside a Vehicle, 1999-2004

Bicyclist 31 (14%)

(N=229)
Unknown 35 (16%)

Boat 1 (<1%)
Motorized dirt bike 1 (<1%)
Scooter 1 (<1%) In Trailer
2 (1%) Motorcycle
2 (1%)

Other 25 (11%)

Not specified 3 (1%)
ATV 7 (3%)

On or near outside of vehicle 8 (3%)

Findings:
Pedestrians accounted for 60% of the motor vehicle-related deaths of children outside a vehicle. Pedestrians include children crossing streets, walking through parking lots and standing at bus stops
Seven fatalities were attributed to children who were passengers on ATV's. (There are no childsized ATV's designed to carry passengers.)
In 11 incidents, there was no reported information on the child's position, either inside or outside the vehicle

Pedestrian 138 (61%)
A 10-month-old baby was left unattended in a car seat in the driveway. The parents were pre-occupied. A van proceeded to exit the driveway after checking mirrors and visually inspecting the driveway. The van ran over the baby and the car seat.

Prevention Opportunity:
Start a "Spot the Tot" program in the community. This program was started by SafeKids Worldwide in September 2006 to prevent injuries to children who are playing in driveways or in parking lots. "Spot the Tot" recommends that the driver walk completely around the vehicle before starting the car

28

Number of Deaths

Figure 21: Reviewed Motor Vehicle-Related Deaths by Restraint Use and Age, 1999-2004

350

Used

Not Used

300

250

200

185

150

100

50

6

26
0
Infant

34

72

56

46

1 to 6

7 to 14

Age Category

115 15 to 17

Findings: Among the infants and children who die in motor
vehicle-related incidents, infants are most likely to be restrained Almost two-thirds (62%) of 15 to 17-year-olds were not properly restrained
Facts: Research shows that caregiver use of booster seats
almost doubles when community education programs are utilized as an intervention (Accident Analysis & Prevention, 2003) A study by the Center for Injury Research and Prevention found that nationally for every 100 children killed in a crash wearing only a seat belt, 28 would have lived if they had been in a car seat or booster seat Findings from the National Institutes of Health show that the part of an adolescent's brain that controls thoughts of long-term consequences remains underdeveloped until the age of 25, which might explain the limited success of graduated licensing programs and driver education. These findings strongly correlate to crash statistics which show that the overall number of motor vehicle crashes significantly decreases around age 25

Opportunities for Prevention: Increase the availability of public information so
caregivers are aware of the state law that requires children to ride in a child safety restraint until age 6. Caregivers should learn that children do not fit into adult seat belts until they are approximately 4 feet tall and weigh approximately 80 pounds Increase public awareness that it is just as important to use child restraints when traveling locally as when traveling far from home. Twenty-five percent of all crashes occur less than 5 minutes from home and at low speeds (SafeKids, 2005) Incorporate non-use of safety belts as a point violation in TADRA Create culturally specific child safety seat programs. A focus group of Hispanic parents found that they felt more nurturing and that they believed their children were safer when they held the children in their laps while riding in vehicles (Kids Count Indicator Brief, July 2005)
A 12-year-old was given permission by her parents to drive their pick-up truck a short distance on a dirt road to the neighbor's house. She and her friend got into the truck. They drove onto a paved road where she lost control of the car and hit a tree. Both children were killed.

29

Finding: Driver error (49%) and speeding (23%) together
account for almost three-fourths of all MV crash deaths among 15 to 17-year-olds
Facts: Crashes involving young drivers typically are single-
vehicle, run-off-the-road crashes that involve driver error and/or speeding (Insurance Institute) Teenage drivers are more likely to tailgate and exceed the speed limit if there is a teenage male passenger in the front seat (National Inst. Of Child Health) Behavioral research indicates that experience measured in miles traveled may be more significant than the hours spent driving. After 1,000 miles, crash rates greatly decline (Accident Analysis and Prevention, 2003)
Opportunities for Prevention: Reduce distractions to teen drivers by strengthening
existing graduating licensing laws to increase limits on the number of teen passengers allowed in a car with a teen driver Parents should model driving without distractions i.e.

Figure 22: Primary Cause of Reviewed Fatal Motor Vehicle Crashes Among Teens Ages 15-17, 1999-2004 (N=466)

Other 61 (13%)
Unknown 53 (11%)

Speeding 106 (23%)
Mechanical Failure 2 (<1%)
Weather Conditions 16 (3%)

Driver Error 228 (49%)

restrict use of cell phones while driving Incorporate teen usage of cell phones during the
probationary driving period as a point of violation in TADRA
A sixteen-year-old was killed on a rural road when the car he was driving lost control in a curve and hit a tree. One week earlier he had received a citation for speeding.

Findings: The MV crash fatality rate is 1.7 times higher in
rural areas than in urban areas Rural motor vehicles crashes are more likely to be
fatal
Facts: Rural roads present a different driving environment
as they typically do not have the safeguards such as divided lanes, graded curves, or shoulders which are found on urban roads Studies show that the outcome of child injury is adversely affected in rural areas where there are not specialized pediatric emergency services. Pediatric intensive care units are predominately located in urban counties
Opportunity for Prevention: Telemedicine could prevent child fatalities by
facilitating access to pediatric critical care services in rural areas

Rate per 100,000 children ages 0-17

Figure 23: Reviewed Motor Vehicle-Related Death Rate (per 100,000 children ages 0-17) by
Rural versus Urban Locale, 1999-2004

11.0 10.0
9.0 8.0 7.0
6.1
6.0 5.0 4.0 3.0 2.0 1.0 0.0
Urban (N=666)

10.4 Rural (N=265)

30

Death Rate (per 100.000 Teens age 15-17)

Findings:
The MV crash fatality rates for 15 to 17-year-olds appear to have been stable for the last 4 three-year periods. The average rate for 2000 to 2004 was 28 deaths per 100,000
The rates among White males are the highest among the 4 displayed race/sex populations, and they are about 4 times the rates for African-American females

Figure 24: Motor Vehicle-Related Death Rates per 100,000 Teens Age 15-17, Three-Year Moving Average, 1999-2004 (Based on Adjusted Death Certificate Data)

60.0

White Male

White Female

AA Male

AA Female

50.0

40.0

30.0

20.0

10.0

Facts:

0.0

In an evaluation of the Teenage and Adult Driver Respon-

99-01

00-02

01-03

3 Year Periods

02-04

sibility Act (TADRA), Georgia's graduated driver's

ment (Rios, et al., 2006). The same evaluation showed an increase of

license provision enacted in

27% in overall restraint use

1997, showed a 37% decrease Ten percent of high school students report that they rarely or never wear

in fatal crashes by 16-year-old

a seat belt, and 27% rode with a drinking driver in the past month (Geor-

drivers, 5.5 years after enact-

gia Student Health Survey, 2005)

Findings:
Teens ages 15 17 accounted for nearly half of all fatalities
White males are associated with higher risk for death from motor vehicle-related incidents

Table 5: Demographics and Other Important Characteristics of

Reviewed Motor Vehicle-Related Deaths, 1999-2004 (N=961)

Rate per

100,000

C hildren

C haracteristic

C ategory

N umber (% ) ages 0-17

Fact:
The Governor's Office of Highway Safety (GOHS) reports that teenagers are disproportionately represented in crash deaths in Georgia. While they are 7% of the state's population, they represent 12% of all crash deaths

Age Race/Gender

Infant 1 to 6 7 to 14 15 to 17
W hite Male A-A Male Other Male W hite Female A-A Female Other Female

43

4.5%

181 18.8%

271 28.2%

466 48.5%

429 44.6%

167 17.4%

7

0.7%

257 26.7%

99 10.3%

2

0.2%

5.5 4.1 4.5 21.5
10.2 7.1 2.2 6.5 4.3
*

Opportunities for Prevention:
Never let a child put a shoulder belt under his arm or behind his back. Belts in these positions can result in serious injury in a crash

Promote the U.S. Consumer Product Safety Commission's campaign to educate riders on the safe use of ATV's. The campaign created new public service announcements and an educational website

31

Table 6: Other Important Characteristics of Reviewed Motor Vehicle-Related Deaths, 1999-2004 (N=961)

Characteristic

Category

Type of Vehicle

Car

(Decedent is the occupant) Truck/SUV/Van

All Terrain Vehicle

Semi-Tractor Trailer

M ot orc y c le

Bicycle

Bus

Farm Tractor/Vehicle

Riding Mower

Other

Unknown

Not Applicable

Number
460 226
44 2
15 24
2 2 1 19 20 146

Percent
47.9% 23.5%
4.6% 0.2% 1.6% 2.5% 0.2% 0.2% 0.1% 2.0% 2.1% 15.2%

Conditions of Roads

Normal Loose Gravel W et Other Unknown

769 80.0%

6

0.6%

74

7.7%

34

3.5%

78

8.1%

Alcohol/Drug Use

Alcohol/Drugs Involved Unknown Not Applicable

125 13.0% 356 37.0% 480 49.9%

Prevention Gaps: Georgia requires only that ATV's have a muffler, are
not driven on private property without permission, and are not used on paved roads. Georgia ATV requirements lack a minimum driver's age, a safety education certificate, a helmet law and passenger prohibition A national study showed that a child's restraint use often depended on the driver's restraint use. Almost 40% of unrestrained children are riding with unbelted drivers (Cody, 2002)
Resources: National Highway Traffic Safety Administration www.nhtsa.dot.gov/ Safe Kids Worldwide www.safekids.org American Academy of Pediatrics www.aap.org/family/ Governor's Office of Highway Safety www.gohs.state.ga.us Pedestrian Educating Drivers on Safety, Atlanta, Georgia www.peds.org

Statewide Opportunities for Prevention: Consider "offenders' programs" through the court
system as an educational alternative to fines Start or support child safety seat distribution and
education programs, such as those provided by health departments and Safe Kids Coalitions Community leaders can encourage, assure and support the enforcement of current restraint laws by providing incentives, alternatives and strict consequences to the public, law enforcement and courts. These can include community restraint use signage, offenders' programs (education as a formal alternative to monetary penalties) and 100% adjudication enforcement for any violator in that community Support efforts to require the National Highway Traffic Safety Administration to test backup warning devices, set performance standards for these devices and make them standard equipment on SUV's and pickup trucks

32

Drowning Deaths

Drowning Deaths

In Georgia, drowning has consistently been the second or third leading cause of unintentional injury-related death for children. Nationally, drowning remains the second leading cause of unintentional injury-related death for children ages 1-14 (CDC, 2005). Childhood drowning can happen in a matter of seconds with the child losing consciousness within 2 minutes. The majority of children who survive near-drowning were discovered within 5 minutes of their submersion. A child can drown in as little as 1 inch of water. Drowning for infants mostly occurs in bathtubs. Children ages

1-4 are most in danger around pools or other small bodies of water close to home. Teen drowning occurs most often in lakes or other natural bodies of water. Lack of supervision and improper barriers to bodies of water contribute greatly to these problems.
How does GA compare with the U.S. average? Children in Georgia ages 0-17 drowned at a rate of 2.01 per 100,000 from 1999 2003. This rate is 1.4 times higher than the national average of 1.45 per 100,000.

Deaths per 100,000 Pop

Figure 25: Numbers, Rates and Locations of Reviewed Deaths Due to Drowning Per 100,000 population, 1999-2004 (N=205)

4.0

3.5

3.0

2.5

2.0

1.5
Bathtub 100%
1.0

0.5

1.2

Wading Pool Other 3% 2% Natural 25%

Swim Pool 55%

Bathtub 15%

Swim Pool 48%

Other 3%

Bathtub 14%

Swim Pool 31%

Other

2.9

6% Natural

43%

Natural

Bathtub

49%

6%

0.9

1.0

Bathtub 3%

Swim Pool 18%
Other 5%

Natural 74%

1.8

0.0 Infant (n=9)

1 to 4 (n=87)

5 to 9 (n=35) Age Category

10 to 14 (n=36)

15 to 17 (n=38)

Findings:
Eighty-seven children between the ages of 1 and 4 years old died during this time period; this group had the highest drowning death rate (2.9 deaths per 100,000 population). The second highest drowning death rate was among teens between the ages of 15 and 17 years old
The type of body of water involved in drowning deaths clearly differed by age category o All infant drowning deaths occured in a bathtub o Children ages 1 to 9 years old were most likely to drown in a swimming pool o Children age 10 to 17 were most likely to drown in natural bodies of water (lakes and rivers)
Five of the 6 bathtub drowning deaths among children older than 10 years noted that the child had a history of seizure disorder

Facts:
Nationally, there are approximately 300 children who drown in swimming pools annually. More than half of the children drown in their family pool, and onethird drown in the pool of a family member or friend
Most bathtub drowning cases involve a child who was unsupervised (CPSC, 2006). After pools, more children drown in bathtubs than in any other product in or around the home (CPSC, 2006)
Baby bath seats or bath rings are not safety devices and are not substitutes for adult supervision
In a survey, nearly all parents (94%) report that they always actively supervise their children while swimming. However, deeper examination reveals that parents participate in a variety of distracting behaviors while supervising, including talking to others (38%), reading (18%), eating (17%) and talking on the phone (11%)

33

Findings: Overall, 72% of the pool and
bathtub drowning deaths occurred during the summer months between May and August Pool-related deaths showed a clear seasonal pattern, with these deaths occurring most frequently during the summer Bathtub related deaths did not show a seasonal pattern
Facts: Most young children who
drowned in pools were last seen in the home, had been out of sight less than 5 minutes, and were in the care of 1 or both parents at the time

Number of Deaths

Figure 26: Reviewed Deaths Due to Drowning in Pools and Bathtubs by Month of Occurrence, 1999-2004 (N=115)

30 Se ason of O ccurre nce

25 28%

M a y-A ug S e p -A p r

B a thtub

Pool

20 72% 16
15

19

16

10

14

9

1

5

9

3

1

5

5

3

3

3

2

2

0

1

1

1

1

Ja n

Fe b

Mar

Ap r

May

Ju n

Jul

Au g

Sep

Oct

N ov

D ec

M o nth o f O ccurre n ce

Nineteen percent of drowning deaths involving children occur in public pools with a certified lifeguard present Among all causes of unintentional injury death, drowning shows the greatest seasonal variation. Nationally, the majority of deaths occurs between May and August and are disproportionately represented on weekends (Pediatrics, 2003)

Findings: White males showed an
increase in the rate of drowning over the 6 year time period. In 2004, this group had the highest drowning rate White females also showed an increase in the rate of drowning from 1999-2004 The rate for African-American males decreased significantly from approximately 4.5 deaths per 100,000 to less than 2.5 deaths per 100,000 from 1999-2004 The rate for African-American females decreased by 38% from 0.8 deaths per 100,000 population in 1999 to 0.5 deaths in 2004

Figure 27: Drowning Death Rates per 100,000 Children Age 0-17, Three-Year Moving Average, 1999-2004 (Based on Adjusted Death
Certificate Data)
5

4.5

White Male

White Female

4

AA Male

AA Female

Death Rate (per 100,000 Children 0-17)

3.5

3

2.5

2

1.5

1

0.5

0 99-01

00-02

3 Year Periods

01-03

02-04

A 2-year-old slipped out of the house while his mother was sleeping. He drowned in the neighbor's pool. The mother awoke to sirens.
34

Table 7: Demographics and Other Important Characteristics of Reviewed Drowning Deaths, 1999-2004 (N=205)

Cha ra cte ri sti c Race/Gender
Alcohol or drugs a factor for decedent? Alcohol or drugs a factor for caretaker? Decedent wearing a floatation device?

Category White Male White Female A-A Male A-A Female Other Male Other Female Yes No Unknown Yes No Unknown Yes No Unknown

Num be r 92 32 60 16 1 4 5
105 95 6 78
121 3
193 9

Rate per 100,000

(%) Children ages 0-17

44.9%

2.2

15.6%

0.8

29.3%

2.6

7.8%

0.7

0.5%

*

2.0%

*

2.4%

51.2%

46.3%

2.9%

38.0%

59.0%

1.5%

94.1%

4.4%

Findings: African-American males had a drowning death rate

medic personnel is associated with a significantly better outcome for children with a submersion injury

that was 3.7 times higher than the rate for African-

(American Academy of Pediatrics, 2003)

American females

Participate and encourage children to take swim-

White males had a drowning death rate that was 2.8

ming lessons

times higher than the rate for White females

Reinforce the need for constant adult supervision for

Alcohol and drugs were known to be a factor in

children engaging in water-related activities by an

only a small proportion of deaths (less than 3%).

individual who can swim and is knowledgeable in

Among the children who died, alcohol and drug use

basic rescue techniques, including CPR

were unknown in 46% of the deaths. Alcohol and Raise awareness of indoor safety devices which can

drug use were unknown for the caretakers of 59%

help delay a toddler's access to dangers in the home,

of the children who died

including baby-gates and door-knob covers as

Statewide Opportunities for Prevention: Implement use of safety devices designed to avert
outdoor drowning dangers such as water motion sensors for pools/hot tubs as well as establishing effective barriers around ponds and open bodies of water Communities are usually governed by local ordinances regarding pool safety that are not always enforced if they are in place at all. Estimates predict that the widespread use of pool fencing would prevent 50-90% of deaths by drowning One in 5 parents (20 percent) believes that when lifeguards are present, the lifeguard is the main person responsible for supervising children in the water. However, the typical lifeguard-to-swimmer ratio at public swimming areas may be as great as 25 swimmers per lifeguard. Post warnings that children swimming with a lifeguard present are not necessarily protected Provide free CPR courses for the community. Immediate resuscitation before the arrival of para-

barriers to bathrooms, kitchens, garages, and toilet cover locks All bathtub drowning incidents should be evaluated for potential abuse or neglect. History of trauma, blame placed on younger siblings and delays in seeking treatment are all red flags for an abuse or neglect investigation (Medicine and Health, R. I., 2003) Encourage parents/caregivers to consistently use Coast Guard-approved Personal Flotation Devices (PFDs) for themselves and their children when involved in water-related recreational activities
Resources: American Academy of Pediatrics http://www.aap.org/family/tipppool.htm American Red Cross www.redcross.org National Safety Council http://www.nsc.org/library/facts/drown.htm U.S. Coast Guard, Office of Boating Safety http://www.uscgboating.org/ The United States Lifesaving Association

www.usla.org

35

Suffocation Deaths

Suffocation Deaths

Nationally, choking, suffocation and strangulation are leading causes of unintentional injury-related death in children under the age of 1 (Safe Kids, 2004). It ranks fourth as a cause of death in children 1 to 9 years old, surpassed only by motor vehicle injuries, drowning and fire related injuries (CDC, 2000). Most unintentional suffocations are caused by overlay, positional asphyxia, choking, confinement, or strangulation.

How does Georgia compare to the U.S.?
For 1999 2004, Georgia's rate of infant deaths by unintentional suffocation (1.45 per 100,000) is slightly higher than the national rate of 1.20 per 100,000. The rate of death by unintentional suffocation for infants under the age of 1 is 1.1 times higher (16.08 per 100,000) than the national average of 14.59 per 100,000.

Figure 28: Suffocation Deaths by Cause of Asphyxia, 1999-2004 (N=166)

Unknown 3 (2%)
Trapped in confined space 8 (5%)
Small object or toy in mouth 3 (2%)

Wedging 22 (13%)

Food 23 (14%)
Hanging 19 (11%)

Overlaying or rolling over decedent 54 (33%)

Other 5 (3%)

Object covering decedent's mouth or
nose 25 (15%)
Object exerting pressure on victim's
neck/chest 4 (2%)

Findings: The largest single number of suffocation deaths
were caused by someone overlaying or rolling over on the child who died Similar percentages of children were killed by an object covering the mouth or nose (15%), choking on food (14%) and wedging (compression of infant's body or face into a narrow space resulting in interference with chest wall movements and normal breathing) (13%) Accidental hanging was responsible for 19 (11%) suffocation deaths
Facts: The majority of childhood suffocations and asphyxi-
ations occur in the home (Safe Kids, 2004) Death to an infant by overlaying has been described
in literature as far back as 200 A.D.

An estimated 900 infant deaths that occur nationally each year are attributed to Sudden Infant Death Syndrome (SIDS) even when the infants were found in potentially suffocating environments, frequently on their stomachs, with their noses and mouths covered by soft bedding (Safe Kids, 2004)
Opportunities for Prevention: During the first 6 months of a child's life, parents
should consistently have materials available to them promoting the "Back to Sleep" message Never place a child to sleep on a soft mattress, pillow or comforter Never allow an infant to share the same sleep surface with another person Do not use long cords to attach pacifiers

36

Death Rate (per 100,000 Children 0-17)

Findings: Suffocation rates for African-
American females showed a substantial increase of 75% from 1.2 to 2.1 deaths per 100,000 population Suffocation-related death rates for African-American males showed a 30% decrease White females and White males showed decreases in suffocation-related deaths over time (26% and 24% respectively)

Figure 29: Suffocation-Related Death Rates per 100,000 Children

Age 0-17, Three-Year Moving Average, 1999-2004 (Based on

Adjusted Death Certificate Data)

3.0

White Male

White Female

AA Male

AA Female

2.5

2.0

1.5

1.0

0.5

Fact: African-American infants are
more likely than White infants to be placed on their stomachs and on soft bedding (Safe Kids, 2004)

0.0 99-01

00-02

01-03

3 Year Periods

02-04

Opportunity for Prevention: Distribute culturally sensitive education materials on the prevention of
suffocation-related deaths in infants to all caregivers, particularly those caregivers who are from low income or predominately African-American communities

Findings: More than two-thirds of the
suffocation-related deaths are to infants less than 1 year old. The rate for infant deaths is more than 4 times higher than the next highest rate The large majority of infant suffocation deaths (111) are sleep-related. The 2 infant deaths that are not sleeprelated choked on food Suffocation-related deaths occur at a slightly higher rate for males than for females

Table 8: Demographics of Suffocation Deaths, 1999-2004 (N=166)

Characteristic Category

Rate per 100,000 Number (%) Children ages 0-17

Age

Infant

1 to 4

5 to 9

10 to 14

15 to 17

113 68.1%

14.5

26 15.7%

0.9

6 3.6%

0.2

15 9.0%

0.4

6 3.6%

0.3

Race/Gender

White Male White Female A-A Male A-A Female Other Female

68 41.0%

1.6

27 16.3%

0.7

38 22.9%

1.6

29 17.5%

1.3

4 2.4%

*

Fact: Nationally, children ages 4 and
under, especially under the age of 1, are at greatest risk for all forms of suffocation and asphyxia-related deaths (Safe Kids, 2004)

Opportunities for Prevention: Do not allow children under age 6 to eat small, round or hard foods,
including hot dogs or grapes Tie up all window blind and drapery cords, or cut the ends and fit them
with safety tassels

A 2-year-old choked on a hot dog that her parents had given her to eat while they were at a fair. EMS personnel were on the scene immediately, but were unable to dislodge the hot dog and the child died.
37

Fire-Related Deaths

Fire and burns are the fifth leading cause of unintentional injury-related death among children ages 14 and under. Children under the age of 4 are at greatest risk for fire-related death (CDC, 2004).

half of all residential fires and 60% of fatalities occur in homes with no smoke alarms. Developing and rehearsing escape plans continues to be critical to the survival of a fire.

In Georgia, most fire-related incidents resulted in the deaths of more than 1 child. Although smoke alarms dramatically increase a child's chance of surviving a fire, recent research shows that children may not wake to the tone of the alarm. Most fires in Georgia occurred in homes with no smoke alarms. It is estimated that nearly

How does GA compare with the U.S. average? The crude rate of fire and burn related deaths for Georgia's children ages 0-17 at .91 per 100,000 is only slightly higher than the national average of .82 per 100,000.

Fire-Related Deaths
Number of Deaths

Figure 30: Reviewed Deaths Due to Fire by Month of Occurrence, 1999-2004 (N=137)

25 23

20

19

18

Season of Occurrence
20%

20 19

15

Spring/Summer

Fall/Winter

11
80%

10

9

7

5

4

3

3

1

0

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Month of Occurrence

Finding:
Eighty percent of fires resulting in death occurred between October and March; the remaining 20% happened during the spring and summer months

Fact:
Nationally, causes of fire-related deaths for children during winter months are attributed to heating. Causes of death for children during the summer months are attributed to open flame injuries (U.S. Fire Administration)

Two children, ages 2 and 5, died in a house fire started by candles. One parent was at home asleep while the other parent was at work. The sleeping parent awoke to a house full of smoke but could not reach the children in time to save them.
38

Rate per 100,000 Children Ages 0-17

Figure 31: Reviewed Fire-Related Death Rate (per 100,000 Children Ages 0-17) by Rural versus Urban Locale, 1999-2004

1.8

1.7

1.6

1.4

1.2

1.0

0.9

0.8

0.6

0.4

0.2

0.0 Urban (n=94)

Rural (n=43)

Type of Locale

Findings: Ninety-four fire-related deaths were in urban areas
and 43 were in rural areas Over the 6-year period, the rate of death from fire-
related causes was 1.8 times higher in rural areas than in urban areas ( 1.7 vs. 0.9 per 100,000 children)

Facts: While 66% of Americans have an escape plan in
case of a fire, only 34% of those with a plan have practiced it (National Fire Prevention Association) Eighteen to 24-year-olds are the least likely to have developed an escape plan

Table 9: Demographics of Reviewed Fire-Related Deaths, 1999-2004 (N=137)

Characteristic

Category

Rate per 100,000
Number (%) Children ages 0-17

Age

Infant

1 to 4

5 to 9

10 to 14

15 to 17

8

5.8%

1.0

64 46.7%

2.1

28 20.4%

0.8

28 20.4%

0.7

9

6.6%

0.4

Race/Gender

White Male White Female A-A Male A-A Female Other Male Other Female

39 28.5%

0.9

19 13.9%

0.5

42 30.7%

1.8

35 25.5%

1.5

1

0.7%

*

1

0.7%

*

Finding: The fire-related death rates were highest among
children ages 1 to 4 years old, African-Americans and males

Facts: Three in 10 reported home fires start in the kitchen -
more than any other place in the home Portable and fixed space heaters, including wood
stoves, cause a disproportionate share of home heating fire deaths

39

Figure 32: Fire-Related Death Rates by Race per 100,000 Children Age 0-17, Three-Year Moving Average, 1999-2004 (Based on Adjusted Death Certificate Data)

2.5

A-A

White

Death Rate (per 100,000 Children 0-17)

2.0

1.5

1.0

0.5

0.0 99-01

00-02

3 Year Periods

01-03

02-04

Findings: Both the number and rate of fire-related deaths
have increased over the 6-year time period; however there are differences by race Fire-related death rates have increased by 57% among African-Americans (from 1.4 deaths per

100,000 children in 1999-2001 to 2.2 deaths per 100,000 in 2002-2004) The rate of fire-related deaths among Whites during the same time period has remained stable at 0.8 deaths per 100,000

Figure 33: Fire-Related Death Rates by Sex per 100,000 Children Age 0-17, Three-Year Moving Average, 1999-2004 (Based on Adjusted Death Certificate Data)

1.8

1.6

Female

Male

1.4

Death Rate (per 100,000 Children 0-17)

1.2

1.0

0.8

0.6

0.4

0.2

0.0 99-01

00-02

3 Year Periods

01-03

02-04

Findings:
Males and females show different patterns of firerelated fatalities over time
Among males, both the number of deaths and the rates have increased steadily over time. The death rate increased by 45% , (from 1.1 to 1.6 deaths per

100,000 population) between 1999-2001 and 20022004 Among females, the death rate has remained constant at approximately 1.0 death per 100,000 population

40

Table 9: Other Important Characteristics of Reviewed Fire-Related Deaths, 1999-2004 (N=137)

Cha ra cte ristic

Ca te gory

Num be r (%)

Fire Source

M at c hes / Light er Cigarettes Com bus t ibles Space Heater Faulty W iring Other (Stove, Candle, Etc.) Unknown

19 13.9%

2

1.5%

4

2.9%

18 13.1%

16 11.7%

36 26.3%

42 30.7%

Smoke Alarm Present/W orking Present/W orking

16

Present/Not W orking

16

Present/W orking Status Unknown

15

Not Present

13

Not Present, N/A

35

Unknown Presence/W orking Status Unknown 40

NA / NA

2

11.7% 11.7% 10.9%
9.5% 25.5% 29.2%
1.5%

Construction of the Fire Site

W ood Frame B ric k /S t one Trailer Other Unknown N/A

58 42.3%

11

8.0%

40 29.2%

4

2.9%

18 13.1%

6

4.4%

Multiple Fire Injuries or Death

Yes No Unknown

110 80.3%

18 13.1%

9

6.6%

Location of Decedent

Hiding In Bed Close to Exit Other (Bedroom, Floor, Etc) Unknown

12

8.8%

39 28.5%

26 19.0%

54 39.4%

6

4.4%

Findings:
For most of the fire incidents (80%), more than 1 child died
Fire-related death occurred most commonly in wood frame construction (42%) and trailers (29%). The type of construction was unknown for 13% of fire-related deaths
The causes of fires were varied. Similar proportions were caused by matches (13.9%), space heaters (13.1%) and faulty wiring (11.7%). Over half the deaths resulted from fires with unknown (30.7%) and other (26.5%) causes
Only 13% of deaths occurred when a working smoke alarm was known to be present

night so all members of the family can experience making an escape in the dark with little warning Consider keeping a baby harness near the crib so parents can keep their hands free while helping another child Lighters are not child-proof, they are merely childresistant. All lighters should be kept in a secured location away from children Encourage schools to help families develop safety plans that incorporate getting babies and toddlers, out of the house quickly Encourage training for families to develop and implement escape plans

Opportunities for Prevention: The chance of a child surviving a fire is increased
through the presence of a working smoke alarm and an able-bodied adult who is not under the influences of drugs or alcohol Test the smoke alarm after the children have gone to sleep to see if it is effective Let children hear what a smoke alarm sounds like so they can readily identify it Practice the fire safety plan in the middle of the

Resources: National Fire Protection Association http://www.nfpa.org/ SAFE KIDS Worldwide http://www.safekids.org Georgia Firefighters Burn Foundation http://www.gfbf.org/ U.S. Fire Administration http://www.usfa.fema.gov/public/

41

Intentional Injury-Related Deaths

Intentional Injury
Mechanism of Injury

From 1999 to 2004, local committees reviewed 533 child deaths resulting from intentional homicide and suicide. Males are more likely to be both victims and perpetrators of intentional injury (homicide and suicide). Homicide is the leading cause of intentional injury deaths to infants (under the age of 1) in the United States. In Georgia, the number of infant homicides during this review period (72) is 1.67 times higher than the number of motor vehicle-related deaths to infants (43). Violence is a major public health problem in the

United States. Homicide and suicide are the second and third leading causes of death, respectively, for adolescents every year in the U.S. Further reductions in childhood injury rates will require that injury prevention advocates and leaders work together to provide the ingenuity to devise new safety devices and programs, incentives to persuade the public to adopt a "culture of safety" as a social norm, and the political will to challenge the status quo and engage the public interest.

Homicide Deaths

Nationally, males are about 6 times more likely than females to die from homicide. The Bureau of Justice Statistics reports that the risk of homicide is greater in the first year of life than in any other year of childhood before age 17. Although many perpetrators of teen homicides are teens themselves, two-thirds are age 18 or older. Gang violence has been associated with many teen deaths. Gang homicides, more often than other homicides, are usually attributed to fear and retaliation. Gang homicides occur more often in the street than non-gang homicides, and they often involve unidentified assailants. While school-related homicides have received substantial attention in the media, school

shootings still remain relatively rare events. From 1990 to 2000, approximately 52 youth homicides have occurred in American schools (Pediatrics, 2005). While clearly a serious issue, the number of children and youth homicides that are school-related make up just 1% of the total number of child and youth homicides in the United States (CDC, 2006).
How does Georgia compare with the U.S. average? From 1999 to 2003, Georgia's child death rate due to homicide was 3.14 per 100,000 population. The U.S. rate for this same period was 2.54, which is 24% lower than the state rate.

Findings: Of the 378 homicide deaths of
children between 1999 and 2004, 159 (42%) were caused by firearms The number of children killed by firearms (159) is 1.4 times higher than the total number of children who were beaten/ struck (57), shaken (34), and cut/stabbed (22)
Fact: The CDC reports that the use
of firearms in homicide peaks during adolescence and young adulthood. From 1999 to 2004, there were 6,722 homicides perpetrated by children under the age of 17 with firearms, and 2,995 homicides without firearms (Bureau of Justice Statistics)

Figure 34: Reviewed Homicide Deaths by Mechanism of Injury, 1999-2004 (N=378)

Firearm 42.1%

159

Struck 15.1%

57

Shaken Baby 9.0%

34

Cut/Stabbed 5.8%

22

Suffocation 4.8%

18

Fire 4.0%

15

Undetermined 3.7%

14

Drowning 3.4%

13

Multiple Inflicted Injuries 2.9%

11

Motor Vehicle Incident 2.9%

11

Unknown Inflicted Injuries 1.9% 7

Other Inflicted Injuries 1.6% 6

Poison 1.3% 5

Thrown 0.5% 2

Fall 0.5% 2

Kicked 0.3% 1

Crushed 0.3% 1

0

20

40

60

80

100 120 140 160 180

Reviewed Deaths

Opportunities for Prevention: Educate new parents and caregivers about the dangers of shaking an
infant, and appropriate methods of coping with infant-related stress Reduce access to firearms and other weapons for all children Promote in-school and after-school programs teaching conflict resolution,
impulse control, anger management and empathy (e.g. Second Step violence prevention program)

42

Findings: Thirty-four percent of the

Figure 35: Relationship of Perpetrator Among Reviewed Homicide Deaths, 1999-2004

homicide perpetrators were natural parents (137), and

Natural Father (19.3%) Natural Mother (15.0%)

77 60

15% were a step-parent or parent's significant other

Acquaintance (14.5%) Mother's Significant Other (12.0%)
Other Non-Relative (10.0%)

58 48 40

Relationship of Perpetrator

Ninety-six children were killed by 1 of their friends or acquaintances (25%)

Friend (9.5%) Stranger (7.5%) Unknown (3.3%) Stepfather (2.0%)

13 8

38 30

Other Relative (1.8%)

7

Facts:

Babysitter/Child Care Worker (1.8%) Stepmother (<1%)

7 3

Infants are most likely to be killed by their mother in the

Sibling (<1%) 3 Grandmother (<1%) 3
Self (<1%) 1

first week of life, but are more likely to be killed by a male (usually their father or stepfather) after that period.

Grandfather (1%) 1 Foster Father (<1%) 1 Father's Significant Other (<1%) 1

0

10

20

30

40

50

60

70

80

Reviewed Deaths

Males are generally more

twice as high as female-on-male and female-on-female child homicides

likely than females to be killed since 2000

during the first year of life

(Child Trends Data Bank) Opportunities for Prevention:

The Bureau of Justice

Increase support for violence prevention programs

Statistics reports that male- Provide alternative after-school programs for children

on-male and male-on-female Implement programs to assist overwhelmed parents and caregivers with

child homicides are almost

childcare issues

Findings:

Figure 36: Homicide Death Rate per 100,000 Teens Age 15-17,

African-American males

Three-Year Moving Average, 1999-2004 (Based on Adjusted Death

continue to have the highest

rate of death from homicide.

25.0

Certificate data)

While this group has had a 21%

Death Rate (per 100,000 Teens Age 15-17)

decrease over the 6-year time

20.0

period, their rate remains more

than 4 times higher than that of 15.0
other race/gender groups

White Male White Female AA Male AA Female

African-American females

showed the largest decrease in

10.0

homicide rate, declining 40%

from 4.5 per 100,000 population

5.0

in 1999-2001 to 2.7 in 2002-

2004 The homicide rate declined by

0.0 99-01

00-02

01-03

02-04

33% in White males from 5.6 to

3 Year Period

4.2 per 100,000 population White females were the only

Fact:

Opportunities for Prevention:

Nationally, the homicide rate for Learn and teach children anger

group to show an increase over the 5-year time period, with a 52% increase from 2.3 to 3.5 homicides per 100,000 population

African-American male teens is 16 times higher than the rate for non-Hispanic White male teens, and 2 times higher than the rate for Hispanic male teens

management skills, and demonstrate behavior which devalues bullying and violence Support bullying prevention and gang awareness programs in schools and communities

Teenaged friends engaged in argument culminating in shooting death of victim.

43

Findings:

Table 11: Demographics of Reviewed Homicide Deaths,

The highest rate of homicides is

1999-2004 (N=378)

among infants, with a rate of 9.3 per 100,000 population. This rate is 66%

Demographics Category

Number (%)

Rate per 100,000 Children ages 0-17

higher than the rate among teens between the ages of 15 and 17 years Age Homicide rates are higher among African-Americans. The rate for

Infant 1 to 4 5 to 9 10 to 14 15 to 17

72 19.0%

9.3

99 26.2%

3.3

35

9.3%

0.9

50 13.2%

1.3

122 32.3%

5.6

African-American males is 3.3 times higher than for White males, and the

Race/Gender

White Male White Female

81 21.4%

1.9

64 16.9%

1.6

rate for African-American females is 2.2 higher than for White females Among both African-Americans and

A-A Male A-A Female Other Male Other Female

148 39.2%

6.3

80 21.2%

3.5

5

1.3%

*

0

0.0%

*

Whites, homicide rates are higher for

males than for females

Statewide Opportunities for Prevention

Facts:

Support bullying and violence prevention programs

Youth homicide is a serious problem in large urban

in every school system. A number of risk factors

areas, especially among African-American males.

have been associated with bullying behaviors: child

Homicides are the number one cause of death for

poverty; family violence and/or childhood traumas

African-American and Hispanic teens. Yet when

(physical and/or sexual abuse); racism, forms of

socio-economic status is held constant, differences

discrimination; abuse of alcohol, drugs and other

in homicide rates by race become insignificant

substances; inconsistent and/or excessive discipline

(MCH Child Death Review)

practices; media violence; academic failure; and

Nationally, males are overwhelmingly the perpetra-

abnormal neurological functioning

tors in homicides involving youth, accounting for

Recognize youth at risk for becoming perpetrators

more than 90% of incidents involving those 10-17

or victims of homicide. Major risk factors include:

years of age. Moreover, handgun homicides commit-

youth active in drug and gang activity with prior

ted by young males (15-18) between 1980 and 1995

histories of early school failure, delinquency and

increased by more than 150%, while the rate for

violence; easy availability of and access to fire-

females remained low and stable

arms; youth living in neighborhoods with high rates

of poverty and school failure; social isolation and

Prevention Gap:

family violence; youth with little or no adult supervi-

Georgia offers several prevention programs such as

sion; and prior witnessing of violence. Youth

First Steps (which provides expectant parents and parents of newborns with emotional support,

homicides usually occur in connection with an argument or dispute

parenting education, and referrals to community

services for a minimum of 3 months) and Healthy

Resources:

Families (which provides intensive, flexible, and

National Youth Violence Prevention Resource

culturally sensitive services for up to 5 years).

Center

These programs improve parental knowledge and confidence in infant and child care, and reach

http://www.safeyouth.org/ National Center for Victims of Crime

thousands of families each year. More support

http://www.ncvc.org

should be dedicated to ensuring that these types of

National Center for Injury Prevention and

programs can be fully staffed and expanded to

Control (NCIPC)

reach families and children in every county

http://www.cdc.gov/ncipc/

Twelve-year-old male was throwing eggs at a fifteen-year-old during Halloween. Fifteen-year-old shot twelveyear-old in chest because he would not stop throwing eggs at him.
44

Suicide Deaths

Suicide Deaths

Each year in the United States, thousands of teenagers commit suicide. There has been a significant increase in youth suicide, over 300% since 1950. While the suicide rate for high school students has remained relatively constant for the past ten years, the suicide rate for middle school students (age 10-14), has increased more than 100% during the same time period. In the United States, more than 4 times as many male youth die by suicide, but females attempt suicide more often and report higher rates of depression. Younger children may be less likely to complete suicide because they do not have the cognitive ability to plan and carry out a suicide attempt, but research also suggests that the increase in

suicide rates among younger children may be due to the increased likelihood of exposure to critical risk factors, such as serious depression, drugs and alcohol. Studies have found that for younger children exposed to such risk factors, the suicide rate is similar to that for older teens.
How does Georgia compare with the U.S. average? From 1999 to 2003, Georgia's child death rate due to suicide was 1.27 per 100,000 population. The U.S. rate for this same period was 1.38, which is 8% higher than the state rate.

Finding: Firearms and suffocation
(hanging) combined were used in 92% of the youth suicides in Georgia
Fact: From 1992 to 2002, the suicide
rate by firearm decreased, and suicide by suffocation increased. However, firearms remain the most commonly used suicide method among youth, regardless of race or gender (American Association of Suicidology)

Mechanism of Death

Figure 37: Reviewed Suicide Deaths by Mechanism of Death, 1999-2004 (N=155)

Firearm 47.1%

73

Suffocation 45.2%

70

Poison 3.9%

6

Fall 2.6%

4

Other Inflicted 0.6% 1

Motor Vehicle Incident 0.6% 1

0

10

20

30

40

50

60

70

80

Reviewed Deaths

Opportunity for Prevention: Reduce access and availability
of firearms to children and teens
Finding: Twice as many youth suicides
occur in the winter months (58 in December, January, February) than in the summer months (28 in June, July and August)
Opportunity for Prevention: Promote suicide screening and
counseling during Suicide Prevention Week in September

Sixteen-year-old and sibling outside playing "army" with friends. Child had disagreement, went inside, got shotgun, put it in his mouth and killed himself.
Figure 38: Reviewed Suicide Deaths by Month of Occurrence, 1999-2004 (N=155)
30

25

Number of Deaths

20

15

25

10 18 15

5

11

11

9

15 13

9

10

10

9

0 Jan Feb M ar A pr M ay Jun Jul A ug Sep Oct No v Dec
M onth of Occurre nce

45

Finding:
When the time of death was known and reported, the most common time period was in the late evening hours between 6 and 11pm (n=44) and in the early evening hours between 3 and 6pm (n=24)

Figure 39: Time of Death Among Suicide Deaths, 1999-2004 (N=155)

11pm -5am 9 (6% ) 5-8am 8 (5% )

Unknown 53 (35% )

8am -3pm 17 (11% )

Facts: Research has shown that most
adolescent suicides occur after school hours and in the teen's home Teens aged 15 and 16 who do not eat dinner with their parents on a regular basis are twice as likely to have attempted suicide as those who do (Annie E. Casey/ Kids Count Brief, 2005)
Opportunities for Prevention: Increase awareness of suicide warning signs, and
promote prompt action when warning signs are recognized among parents, caretakers, school personnel and communities

3 -6 p m 24 (15% )
6 -1 1 p m 44 (28% )
Increase availability and accessibility of mental health services to children and youth
Family support and parent education programs-- which are often geared to parents with very young children--should be redesigned to meet the needs of all families. Research shows that youngsters do better when parents have the kinds of managerial skills that allow them to locate and utilize programs and services (Furstenberg, 1999)

When decedent arrived home from school his mother began talking to him about his failing grades in school. He was given a list of chores to do. He went into his room. After a brief period of time his mother went to check on him and discovered him hanging by the neck in his closet. He used his karate belt to hang himself.

Findings: Children under age 15 are
most likely to kill themselves by hanging Children ages 15 years and older most commonly commit suicide with a firearm
Fact: The "Suicide in Georgia:
2005" fact book states that, among middle school students, 13% had reported that at some time in their lives, they had made a plan to commit suicide, and 8% had attempted it. Among high school students, 13% reported that at some time in the previous year (2003), they had made a plan to commit suicide and 9% had attempted it (Georgia Division of Public Health)

Figure 40: Mechanism of Suicide by Age Group, 1999-2004 (n=154)

10-14 (n=41) 5%

Firearm Suffocation Other

15-17 (n=113) 9%

37%
40% 58%

51%

Opportunities for Prevention:
Support suicide screening and intervention in elementary and middle schools statewide
Closely monitor children for changes in behavior, such as a loss of interest in favorite things, changes in school performance, or withdrawal from friends and family
46

Findings: White males have the highest rates
of suicide (58.1%) Older teenagers are most at risk for

Table 12:
Demographics

Demographics of Suicide Deaths, 1999-2004

(N=155)

Rate per 100,000

Category

Number (%)

Children ages 0-17

suicide (72.9%) Facts:

Age

5 to 9

10 to 14

15 to 17

1

0.6%

*

41 26.5%

1.1

113 72.9%

5.2

If a male teen has attempted suicide

in the past, he is more than 30 times Race/Gender White Male

90 58.1%

2.1

more likely to complete suicide in a subsequent attempt, while a female with a past attempt has about 3

White Female A-A Male A-A Female Other Male

31 20.0%

0.8

24 15.5%

1.0

6

3.9%

0.3

4

2.6%

*

times the risk to complete another suicide attempt. Approximately a

Gender

third of teenage suicide victims have

Male Female

118 76.1%

1.7

37 23.9%

0.6

made a previous suicide attempt

Race

Stressful life events often precede a

African-American White

30 19.4%

0.6

121 78.1%

1.5

suicide and/or suicide attempt. Such stressful life events include getting into trouble at school or with a law enforcement agency, fighting or breaking up with a boyfriend or a girlfriend, and fighting with friends. They are rarely a sufficient cause of suicide, but they often act as precipitating factors in young people

measures that enhance resilience or protective factors. Some identified protective factors are: learned skills in problem solving, impulse control, conflict resolution, and nonviolent handling of disputes; family and community support; access to effective and appropriate mental health care and support for help-seeking; restricted access to highly

Opportunity for Prevention: Promote suicide prevention through risk reduction

lethal methods of suicide; and cultural and religious beliefs that discourage suicide and support selfpreservation instincts

Victim was at home with family and friends when she was told to go clean her room. After several minutes, she went upstairs alone to her brother's room to watch TV. Victim's little brother came into his room approximately 15 minutes later and found victim had hung herself from bedpost on bunk bed.

Findings: Suicide rates and numbers
have decreased in all race and gender groups over the time period. White females had the greatest percent decrease (43%), with rates declining from 4.8 suicide deaths per 100,000 population in 19992001 to 2.7 in 2002-2004 White males showed the second largest percent decrease (18%), with rates going from 12.4 to 10.2 suicide deaths per 100,000 population. However, White males remain approximately 3 times more likely than all other teens to commit suicide

Figure 41: Suicide Death Rate per 100,000 Teens Age 15-17, Three Year Moving Average, 1999-2004 (Based on Adjusted Death Certificate Data)

14.0 12.0

White Male White Female AA Male AA Female

10.0

Death Rate (per 100,000 Teens Age 15-17)

8.0

6.0

4.0

2.0

0.0 99-01

00-02

01-03

3 Year Periods

02-04

Suicide rates have decreased by smaller amounts for African-Americans; among African-American males the rate decreased by 17% and among African-American females, the suicide rate decreased by 5%

47

Facts: Overall suicide rates for 15-19 year olds have more
than doubled since the 1950s, but have declined 34% nationally since peaking in 1994 In the 10-14 age group, White youths were far more likely to complete suicide than African-American youths (ranked third and seventh leading cause of death, respectively) Although their rates are lower than for White youth, African-American youth (age 10-14) showed the largest increase in suicide rates between 1980 and 1995 (233%)

Although rates vary somewhat by geographic location, within a typical high school classroom, it is likely that 3 students (1 male and 2 females) have made a suicide attempt in the past year
Opportunities for Prevention: Use culturally appropriate suicide awareness and
prevention efforts in schools and communities Recognize risk factors for suicide: impulsive or
aggressive behavior; use of alcohol or drugs; family instability or significant family conflict; presence of a psychiatric disorder; talk of suicide; and exposure to another's suicide

The victim left a note advising that he planned to commit suicide. He was upset over a break up with a girlfriend. He was a star baseball player and the incident was completely unexpected to the family.

Prevention Gap:

The Georgia Suicide Prevention Plan, developed in

children by reducing early risk factors for depres-

2001, aims to prevent deaths due to suicide and

sion, substance abuse and aggressive behaviors and

other self-harmful acts by promoting awareness that

building resiliency. In addition to the potential for

suicide is a serious public health problem and that

saving lives, youths benefit from an overall enhance-

many suicides are preventable, to develop broad-

ment of academic performance and a reduction in

based support of suicide prevention, and to develop

peer and family conflict

and implement strategies to reduce the stigma

To detect youth most likely to be suicidal, confiden-

associated with being a consumer of mental health,

tially screen for depression, substance abuse, and

substance abuse and suicide prevention services.

suicidal ideation. If a youth reports any of these,

Easily accessible and widely available mental health

further evaluation of the youth can take place by

counseling in schools should be supported as a part

professionals, followed by referral for treatment as

of the prevention efforts

needed

Statewide Opportunities for Prevention: Provide support services for youth experiencing

Caution should be used in the development of suicide prevention programs for youth because researchers have found that some types of suicide

stress, confusion, depression, substance abuse, and/

prevention efforts may be counterproductive. For

or behavioral problems

example, some school-based youth suicide aware-

Organize and involve local communities in suicide

ness and prevention programs have had unintended

prevention planning

negative effects (National Institute of Mental

Promote overall mental health among school-aged

Health)

Resources: Georgia Suicide Prevention Plan http://georgiasuicidepreventionplan.org/

Suicide Prevention Action Network http://www.spanusa.org/GSPP.html
48

Firearm-Related Deaths

Firearm-Related Deaths

On an annual average, firearms kill 5,285 children in the United States. At least 25 million American households have handguns and 50% of owners keep them loaded. Nearly two-thirds of firearm-owning parents with school-age children believe they keep their firearm safely away from their children. However, fewer than half of the U.S. families with firearms and children store those firearms locked (either in a locked place or secured with a trigger lock) and separate from ammunition. Seventeen states currently have Child Access Prevention legislation to regulate child access and usage of firearms (including Florida and Virginia). Georgia does not currently have a Child Access

Prevention law, negligent owner law, or a minimum age for possession of rifles or shotguns. In addition, Georgia children under age 18 can possess a firearm if they are at their own residence, and under the control of their parent or guardian.
How does Georgia compare to the U.S. average? From 1999 to 2003, Georgia's child death rate due to firearms was 2.09 per 100,000 population. The U.S. rate for this same period was 1.85, which is 13% lower than the state rate.

Findings: Eighty-six percent of all firearm-related deaths of
children were intentional. Of these, 159 (59%) were homicides and 73 (27%) were suicides Thirty-one (12%) firearm-related deaths were unintentional
Facts: Numerous studies have shown that there is a clear
association between the presence of firearms in the home and suicides Unintentional shootings among young people most frequently happen when children or youth obtain a gun and play with it, not realizing that it is real, or loaded, or pointed at themselves or a friend

Figure 42: Reviewed Firearm-Related Deaths by Intent, 1999-2004 (N=268)

Suicide 73 (27%)

Unknown Intent Unintentional

5 (2%)

31 (12%)

Homicide 159 (59%)

Opportunities for Prevention: Practice and promote safe gun storage in every

Elected officials, faith leaders, and educators all can

community. If guns were not present in the home, if they were designed with safety features making them more difficult for children to fire, or if they were stored safely, the risk to young children could

play key roles in enforcing social norms against youth gun use. Poverty, discrimination, and violence are often linked, therefore, each should be addressed in any plan to reduce violent behavior

be virtually eliminated

A 13-year-old female went to her mother's bedroom closet and retrieved a pistol after arguing with her mother and being grounded from seeing her boyfriend. She then called her brother into the room to say goodbye and shot herself in the abdomen.

49

Finding: Firearm-related deaths were
31% more likely to occur in an urban county (2.1 urban firearm-related deaths vs. 1.6 rural firearm-related deaths)

Figure 43: Reviewed Firearm-Related Death Rate (per 100,000 Children Ages 0-17) by Urban versus Rural Locale, 1999-2004
2.5
2.1 2.0

Rate per 100,000 Children Ages 0-17

1.6

Facts:

1.5

Gang problems occur most

often in larger cities; however,

many smaller cities do experi-

1.0

ence gang conflict to a lesser

degree (Center for the Study

0.5

and Prevention of Violence,

1997)

The lack of economic opportu-

0.0

Urban (N=223)

Rural (N=42)

nities for inner-city youth has

Type of Locale

led many gang members to continue gang membership rather than "growing out" of their gangs and entering conventional adult roles (ibid.)

Opportunity for Prevention: Promote programs that teach effective parenting skills among economi-
cally disadvantaged families. Research shows that children at risk for injury often come from disadvantaged homes and tend to be poorly supervised. In addition, parents of injured children tend to be less edu-

cated, emotionally overwhelmed, lack energy, and are less involved with

their children (Journal of Pediatric Psychology, 1986)

Findings: The security status was unknown for almost 2/3 of
firearm-related child deaths When the status of the firearm was known (98), it
was most often in an unsecured (i.e. easily accessible) location (78%)

Figure 44: Reviewed Firearm-Related Deaths by Status of Firearm Security, 1999-2004 (N=268)
Secured 22 (8%)

Facts: Although some oppose safe storage because they
believe it makes guns less accessible for selfdefense, this concern must be weighed against the risk that a child could find and use guns that are not stored safely Safe storage gun practices have the potential to decrease unintentional shootings by making guns less accessible to children and youth Guns are most likely to be stored loaded and unlocked in households in the South, in households with teenagers, and in households where someone is employed in law enforcement (American Journal of Public Health, April 2000)
Opportunity for Prevention: Support protective gun safety manufacturing. Rela-
tively inexpensive product modifications could make guns more difficult for children to fire and could
50

Unsecured 76 (28%)
Unknown 170 (64%)
reduce unintentional firearm injuries caused when children do not realize a gun is loaded. More sophisticated devices that allow only the rightful owners of guns to fire them could prove even more useful in reducing youth firearm injury and death, because they could keep youth from being able to intentionally fire guns obtained wrongfully from family, friends, illegal gun markets, or through theft Sibling accidentally shot decedent thinking gun was a toy. Found gun on apartment grounds playground trash can. Gun was loaded.

Finding: Handguns were used most often in firearm-related
deaths in Georgia (70%), with shotguns and rifles together being used only 24% of the time
Opportunity for Prevention: Keep handguns away from children by explaining
the potential for serious injuries. While gun safety programs frequently warn children not to touch guns, there should be more consideration that the "don't touch" message alone may enhance the allure of guns

Figure 45: Reviewed Firearm-Related Deaths by Type of Firearm, 1999-2004 (N=268)

Other 2 (1%)
Shotgun 34 (13%)

Unknown 14 (5%)

Rifle 30 (11%)

Handgun 188 (70%)

Death Rate (per 100,000 Teens Age 15-17)

Findings:
Firearm-related death rates have remained relatively constant over the 6-year time period
Rates are highest among males, particularly among AfricanAmerican males, whose rate is approximately twice that of White males
The rates for White and African-American females have remained similar over the 6 years

Figure 46: Firearm-Related Death Rate per 100,000 Teens Age 15-

17, Three-Year Moving Average, 1999-2004 (Based on Adjusted

Death Certificate Data)

30.0 25.0

White Male White Female AA Male AA Female

20.0

15.0

10.0

5.0

Fact:
Research consistently shows that parents remain a powerful influence on adolescents and young adults, and can play an important role in fostering healthy development and preventing risky behaviors (Simpson, 2001; National Council of Economic Advisors, 2000). In particular, parent involvement is a major influence in helping young people avoid drinking and drug use, violent

0.0 99-01

00-02

01-03

3 Year Periods

02-04

behavior, and the kind of mental health problems that lead to suicide attempts

Opportunity for Prevention:
Multi-pronged efforts are needed to strengthen parents' and other caretaking adults' involvement with young people, fortify youth development agencies and other community organizations that serve adolescents and their parents, and seize opportunities to introduce or bolster policies that concern at-risk youth. Many societal factors affect the well-being of young people; strategies to keep them healthy and safe require proactive, coordinated efforts (H.H.S., 2004)

51

Table 13: Demographics and Other Important Characteristics of Reviewed Firearm-Related Deaths, 1999-2004 (N=268)

Demographics

Category

Rate per 100,000 Number (%) Children ages 0-17

Age

Infant

1 0.4%

0.1

1 to 4

19 7.1%

0.6

5 to 9

17 6.3%

0.5

10 to 14

60 22.4%

1.6

15 to 17

171 63.8%

7.9

Race/Gender

White Male White Female A-A Male A-A Female Other Male Other Female

101 37.7%

2.4

32 11.9%

0.8

111 41.4%

4.7

20 7.5%

0.9

4 1.5%

*

0 0.0%

*

Use of Firearm at Time of Injury

Shooting at other person Shooting at self Target shooting Playing Other Unknown

131 48.9% 76 28.4% 2 0.7% 27 10.1% 13 4.9% 19 7.1%

Person handling the Firearm

Decedent Acquaintance Family Member Stranger Unknown

84 31.3% 72 26.9% 40 14.9% 39 14.6% 33 12.3%

Findings: The firearm-related death rate was highest among
teens age 15-17 years; it is 5 times higher than the rate for 10 to 14 year olds African-American males have the highest firearmrelated death rate (4.7 deaths per 100,000 population), which is almost twice as high as the rate for White males At the time of the death, 131 (49%) perpetrators were intentionally shooting the gun at another person (the victim); 76 (28%) were shooting at themselves
Fact: In states where fewer homes have guns, there are
fewer accidental firearm deaths and fewer teen suicides. In comparison to the four states with the lowest levels of gun prevalence, the four states with the highest prevalence had twice as many teen suicides and about 10 times as many gun-related accidental deaths (National Council of Economic Advisors, 2000)
Prevention Gap: A Child Access Prevention law in Georgia could
possibly protect children from unintentional shooting

deaths. Stiff penalties for negligent gun storage and thorough marketing of the law to all communities, as seat belt requirements are marketed, would provide education and may help to change the lax gun storage practices of many families
Statewide Opportunities for Prevention: Secure all firearms in a safe, secure, and childproof
location. Store firearms and ammunition in separate locations Promote development of school and communitybased risk reduction firearm safety programs for children, parents and other caretakers Promote and train gun owners on the use of firearm safety devices, including trigger locks and lockboxes Teach and promote conflict resolution skills as well as personal firearm safety precautions for children
Resources: Center to Prevent Handgun Violence www.handguncontrol.org National Rifle Association Safety Guide for Parents www.nrahq.org/safety/eddie/infoparents.asp

52

Race, Ethnicity and Disproportionate Deaths

Race, Ethnicity and Disproportionate Deaths

The 2005 estimated population in Georgia is 9,072,576 people. While the U.S. population grew by 13.1% from 1990 to 2000, the state of Georgia grew twice as fast, gaining 26.4% more residents. About 2.7 million are African-Americans (29.7% of the state population), compared to 12.8% of the U.S. population. Approximately 6 million Georgians are non-Hispanic Whites (66.1% of the state population), compared to 80.4% of the U.S. population. There are about 646,568 Georgians of Hispanic ethnicity. Of the total population in Georgia, about 26.4% are children (US Census Bureau).
The infant mortality rate (the death rate for infants per 1,000 live births) has continued to steadily decline over the past several decades, from 26.0 per 1,000 live births in 1960 to 6.9 per 1,000 live births in 2000. The United States ranked 28th in the world in infant mortality in 1998. This ranking is due in large part to disparities

which continue to exist among various racial and ethnic groups in this country, particularly African-Americans. Infant mortality among African-Americans in 2000 occurred at a rate of 14.1 deaths per 1,000 live births. This is more than twice the national average of 6.9 deaths per 1,000 live births. The leading causes of infant death include congenital abnormalities, pre-term/low birth weight, Sudden Infant Death Syndrome (SIDS), problems related to complications of pregnancy, and respiratory distress syndrome.
Data generated by death certificates are presented here to illustrate certain health disparities between racial and ethnic groups. Race is divided into 3 groups: "White", "African-American", and "Other" (which refer to children of Asian, Native American, or Pacific Islander origin). Hispanic ethnicity is omitted from the graphs, unless otherwise noted.

Findings: White male infants are 32% of
the infant population, but only 26% of the infant deaths, compared to African-American male infants, who are 16% of the infant population, but 30% of the infant deaths White female infants are 30% of the infant population, but 20% of the infant deaths, compared to African-American female infants, who are 16% of the infant population, but 22% of the infant deaths

Percent

Figure 47: Deaths to Children <1 and Percent of Population in Georgia by Race and Gender Based on Adjusted Death Certificates, 1999-2004

35 32
30 26
25
20
15

30 20

% Population % of Deaths 30

22

16

16

10

5

0 White Male

White Female

AA Male

AA Female

Percent

Figure 48: Deaths to Children 1-17 and Percent of Population in

Georgia by Race and Gender Based on Adjusted Death

Certificates, 1999-2004

40 37

% Population

% of Deaths

35

31

30

30

25

24

21

20

18

17

16

15

10

5

0 White Male

White Female

AA Male
53

AA Female

Findings: White males are 31% of the
child population, and 37% of the child deaths (a 6% difference); while African-American males are 18% of the child population, and 24% of the child deaths (also a 6% difference) White females are 30% of the child population, and only 21% of the child deaths (a difference of 9%), compared to AfricanAmerican females, who are 17% of the child population, but 16% of the child deaths

Cause of Death

Figure 49: Reviewed Hispanic Deaths by Cause of Death, 1999-2004 (N=172)

MVC

45

Medical

27

SIDS/SUID

25

Homicide

25

Drowning

15

Fire

14

Suffocation

6

Unknown Intent

3

Poison

3

Firearm

3

Unknown

2

Suicide

2

Other Injury 1

Fall 1

0

5

10

15

20

25

30

35

40

45

50

Number of Deaths

Findings: Among deaths eligible for
review, motor-vehicle deaths are the leading cause of death for Hispanic children (45) Hispanic children are equally likely to be victims of medical deaths (27), sleeprelated infant deaths (25), and homicide (25)

Finding: Among death certificate-
reported causes of death, Hispanic children are most likely to die from medical causes, such as congenital abnormalities and prematurity

Figure 50: Deaths to Hispanic Children Under Age 18 in Georgia, All Causes Based on Adjusted Death Certificate, 1999-2004 (N=602)

Medical

426

MVC

51

Homicide

31

SIDS

30

Drowning 18

Fact: Hispanics have a lower infant
mortality rate compared to non-Hispanic Whites and African-Americans. One study found that Hispanics had healthier birth outcomes compared to African-Americans, due to higher education, no preterm delivery history, prenatal care, marriage, and no daily tobacco use, despite similar socioeconomic characteristics (Amer Journal of Obst and Gyn, 2003)

Cause of Death

Fire 14 Suffocation 7
Unknown 6 Other Injury 5 Unknown Intent 3
Poison 3 Firearm 3 Suicide 2 Other SIDS 2
Fall 1

0

50

100 150 200 250 300 350 400 450 Number of Deaths

Table 14: Number and Percent of Deaths to Hispanic Children Under Age 18 in Georgia, as a Percent of the Population, 19992004

Hispanic Male Hispanic Female Non Hispanic Male
Non Hispanic Female

# of Deaths 354 248
5572

% of Deaths 3.5 2.5
55.1

Population % of Population

493,524

3.7

447,556

3.3

6,379,024

47.5

3932 10106

38.9 6,101,700 100.0 13,421,804

45.5 100.0

Findings: Hispanic males make up 3.7% of the child population, and 3.5% of child deaths. The child death rate for
Hispanic males is 71.7 per 100,000 population, which is 21% lower than the rate for non-Hispanic males Hispanic females make up 3.3% of the child population, and 2.5% of child deaths. The child death rate for
Hispanic females is 55.4, which is 16% lower than the rate for non-Hispanic females

54

History of Child Fatality Review

1990 - 1993 Legislation established the Statewide Child Fatality Review Panel with responsibilities for compiling statistics on child fatalities and making recommendations to the Governor and General Assembly based on the data. It established local county protocol committees and directed that they develop county-based written protocols for the investigation of alleged child abuse and neglect cases. Statutory amendments were adapted to: Establish a separate child fatality review team in
each county and determine procedures for conducting reviews and completing reports Require the Panel to: o Submit an annual report documenting the
prevalence and circumstances of all child fatalities with special emphasis on deaths associated with child abuse o Recommend measures to reduce child fatalities to the Governor, the Lieutenant Governor, and the Speaker of the Georgia House of Representatives o Establish a protocol for the review of policies, procedures and operations of the Division of Family and Children Services for child abuse cases
1996 - 1998 The Panel established the Office of Child Fatality
Review with a full-time director to administer the activities of the Panel Researchers from Emory University and Georgia State University conducted an evaluation of the child fatality review process. The evaluation concluded that there were policy, procedure and funding issues that limited the effectiveness of the review process. Recommendations for improvement were made to the General Assembly Statutory amendments were adopted to: o Identify agencies required to be represented on
child fatality review teams, and establish penalties for non-participation o Require that all child deaths be reported to the coroner/medical examiner in each county
1999 - 2001 Child death investigation teams were initially developed in four judicial circuits as a pilot project, with six additional teams later added. Teams assumed responsibility for conducting death scene investigations of child deaths that met established criteria within their judicial circuit Statutory amendments were adopted which resulted
in the Code section governing the Child Fatality

Review Panel, child fatality review committees, and child abuse protocol committees being completely rewritten. This was an attempt to provide greater clarity and a more comprehensive, concise format The Panel's budget was increased
2002 2005 The Panel published and distributed a child fatality
review protocol manual to all county committee members Statutory amendments were adopted which resulted in the following: o Appointment of District Attorneys to serve as
chairpersons of local committees in their circuits o Authority of the Superior Court Judge on the
Panel to issue an order requiring the participation of mandated agencies on local child fatality review committees. Failure to comply would be cause for contempt o Authority of the Panel to compel the production of documents or the attendance of witnesses pursuant to a subpoena o Director of the Division of Mental Health added as a member of the Panel Funding was secured and an on-line reporting system was established for both the child fatality review report and the coroner/medical examiner report A collaboration was established between the Office of Child Fatality Review and the National Center for Child Death Review A Statewide Model Child Abuse Protocol was developed and distributed to all Protocol committee members A Prevention Advocate was added, by policy, to all child fatality review committees. Statewide training was conducted for all prevention advocate members A quarterly newsletter was created and distributed. The newsletter is sent to all child fatality review members and contains useful information about the process as well as prevention Annual awards were established for the Child Fatality Review Coroner of the Year and Child Fatality Review County Committee of the Year. Awards are presented at the annual Child Fatality and Serious Injury Conference sponsored by the Panel, DHR, GBI and the Office of the Child Advocate A sub-committee of the Panel was formed to begin working on a Statewide Prevention Plan. The subcommittee also includes outside agencies working in the prevention field

55

Appendix A Criteria For Child Death Reviews
Child Fatality Review Teams are required to review the deaths of all children under the age of 18 that meet the criteria for a coroner/medical examiner's investigation.
"Eligible" Deaths or Deaths to be Reviewed by Child Fatality Review Committees
O.C.G.A. 19-15-3(e)
The death of a child under the age of 18 must be reviewed when the death is suspicious, unusual, or unexpected. Included in this definition are incidents when a child dies:
1. as a result of violence 2. by suicide 3. by a casualty (i.e. car crash fire) 4. suddenly when in apparent good health 5. when unattended by a physician 6. in any suspicious or unusual manner, especially if under 16 years of age 7. after birth but before seven years of age if the death is unexpected or
unexplained 8. while an inmate of a state hospital or a state, county, or city penal
institution
56

Appendix B Child Fatality Review Timeframes and Responsibilities

If child is (r4es0i4d)en2t0o6f-t6h0e4c3ounty, 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 and Chairperson 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 19-15-3(e), medical examiner or coroner wil4l0complete 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.

If cause of death does not meet the criteria for review pursuant to Code Section 19-15-3(e), 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 Georgia Child Fatality Review Panel.

If the committee determines that the death resulted from: 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, then the committee will send a copy of the report within 15 days of completion to the district attorney of the county in which the committee was created.

Committee transmits a copy of its report within 15 days of completion to the Office of Child Fatality Review.

57

Appe ndix C.1 Tota l Child Fa ta litie s Ba se d on Adjuste d De a th Ce rtifica te (N=10,620)

W hite

W hite

A-A

A -A

Other

Other

Age

Cause of Death Male Female Male Female Male Female

Infant (Age <1)

Drowning

5

3

2

2

Fall

1

2

1

Fire

3

4

3

Hom ic ide

14

13

28

25

M edic al

1394

1117

1690

1271

78

58

MVC

14

19

13

7

1

1

Other Injury

6

5

6

5

Other SIDS

1

4

1

1

Poison

4

5

2

1

S IDS

234

159

226

157

7

4

S uffoc at ion

47

21

29

31

3

Unknown Intent

5

2

4

1

Unknown

28

13

23

16

1

1

Total

1756

1360

2029

1522

88

67

W hite

W hite

A-A

A -A

Other

Other

Age

Cause of Death Male Female Male Female Male Female

1 to 4

Drowning

53

25

19

5

2

2

Fall

5

1

2

1

Fire

23

9

13

24

1

Firearm

2

1

Hom ic ide

23

23

37

28

3

M edic al

162

106

121

99

4

12

MVC

67

45

33

14

1

1

Other Injury

9

7

8

9

1

Poison

4

1

7

S uffoc at ion

10

7

6

5

1

Unknown Intent

3

2

2

Unknown

4

1

8

4

Total

365

225

256

191

11

18

W hite

W hite

A-A

A -A

Other

Other

Age

Cause of Death Male Female Male Female Male Female

5 to 14

Drowning

24

11

40

12

2

Fall

2

Fire

16

4

28

13

Firearm

7

2

7

Hom ic ide

21

20

31

20

1

M edic al

190

146

140

150

8

6

MVC

156

103

69

63

4

2

Other Injury

21

17

8

4

Poison

3

1

3

1

S uffoc at ion

13

6

9

1

Suicide

25

9

10

3

1

Unknown Intent

4

2

2

1

Unknown

5

2

3

Total

485

323

349

271

14

10

W hite

W hite

A-A

A -A

Other

Other

Age

Cause of Death Male Female Male Female Male Female

15 to 17

Drowning

33

2

20

2

Fall

1

Fire

3

3

3

1

1

Firearm

10

4

Hom ic ide

34

17

77

13

1

M edic al

89

65

69

65

1

2

MVC

284

146

94

41

3

Other Injury

11

3

8

4

1

Poison

15

5

1

S uffoc at ion

6

1

Suicide

78

24

15

4

3

Unknown Intent

3

1

2

Unknown

3

2

2

4

Total

570

268

296

134

9

3

58

Total
12 4 10 80 5608 55 22 7 12 787 131 12 82 6822
Total
106 9 70 3
114 504 161 34 12 29
7 17 1066
Total
89 2 61 16 93 640 397 50 8 29 48 9 10 1452
Total
57 1 11 14 142 291 568 27 21 7 124 6 11 1280

Appendix C.2 Total Reviewed Child Fatalities (N=10,461)

White White A-A

Age

Cause of Death Male Female Male

Infant (Age <1)

Drowning

5

2

1

Fall

1

2

Fire Homicide Medical

2

4

13

13

22

43

42

67

MVC

11

14

11

Other Injury

2

3

5

Poison

2

3

SIDS/SUID

207

132

201

Suffocation

42

17

26

Unknown Intent 5

2

4

Unknown

14

2

13

Total

347

231

355

White White A-A

Age

Cause of Death Male Female Male

1 to 4

Drowning Fall Fire Firearm

43

19

17

4

1

2

21

9

12

2

Homicide

19

21

32

Medical

32

18

29

MVC

58

36

26

Other Injury

5

6

3

Poison

4

1

5

Suffocation

10

5

6

Unknown Intent 3

2

Unknown

2

1

5

Total

203

117

139

White White A-A

Age

Cause of Death Male Female Male

5 to 14

Drowning

21

10

29

Fall

2

Fire

14

4

27

Firearm Homicide Medical

7

2

7

19

18

27

31

28

25

MVC

129

87

52

Other Injury

13

5

7

Poison

3

1

3

Suffocation

11

5

5

Suicide

19

9

10

Unknown Intent 4

2

2

Unknown

4

1

Total

275

172

196

White White A-A

Age 15 to 17

Cause of Death Male Female Male

Drowning Fall

23

1

13

1

Fire

2

2

3

Firearm

9

3

Homicide

30

12

67

Medical

11

9

23

MVC

231

120

78

Other Injury

3

2

Poison

11

5

1

Suffocation

5

1

Suicide

71

22

14

Unknown Intent 3

1

2

Unknown Total

3

1

1

403

173

208

A-A Female
1 1 2 24 74 6 1 2 141 25 1 9 287 A-A Female
5
21 1 24 26 10 1
4 2 4 98 A-A Female
9
11
20 32 47
1
3 1 3 127 A-A Female
1
1
12 11 36 2
3
3 69

59

Other Male
7 1 1 7
1 17 Other Male 1 1 3 1 1
7 Other Male
1 4
1
6 Other Male
1 1
3
5

Other Female
4 3 7 Other Female 2 1
5 1 1 1 11 Other Female 2
2 1
5 Other Female
1 2
3

Total
9 4 8 72 233 43 11 8 692 113 12 39 1244
Total
87 8 64 3 99 111 132 16 10 26 7 12 575
Total
71 2 56 16 85 118 320 25 8 21 42 9 8 781
Total
38 1 9 12 122 56 466 7 17 6 113 6 8 861

Appendix C.3 Reviewed Child Fatalities with Abuse/Neglect Findings (N=709)

White White A-A

A-A

Other

Age

Cause of Death Male Female Male Female Male

Infant (Age <1)

Drowning

3

1

1

1

Fire

1

1

Homicide

13

13

21

23

Medical

2

1

9

7

MVC

3

3

5

2

Other Injury

1

4

Poison

1

1

SIDS/SUID

15

17

44

17

Suffocation

11

5

9

12

Unknown Intent

2

1

3

1

Unknown

6

1

4

5

1

Total

57

44

100

68

2

White White A-A

A-A

Other

Age

Cause of Death Male Female Male Female Male

1 to 4

Drowning

22

8

15

4

Fall

4

2

Fire

11

5

3

4

Firearm

1

1

Homicide

18

17

31

23

1

Medical

1

3

2

MVC

15

10

9

1

1

Other Injury

1

3

1

Poison

3

1

1

Suffocation

1

2

2

Unknown Intent

1

2

2

Unknown

2

1

3

Total

80

45

72

39

2

White White A-A

A-A

Other

Age

Cause of Death Male Female Male Female Male

5 to 14

Drowning

7

3

10

3

Fire

2

7

2

Firearm

1

2

Homicide

7

11

10

14

1

Medical

2

2

2

MVC

13

16

9

10

Other Injury

1

2

Poison

1

Suffocation

1

Suicide

1

1

Unknown Intent

2

1

Unknown

1

1

Total

36

33

43

33

1

White White A-A

A-A

Other

Age

Cause of Death Male Female Male Female Male

15 to 17

Drowning

1

Fire

1

Homicide

1

11

1

Medical

2

2

3

MVC

7

5

2

Suicide

4

2

2

Unknown

1

Total

11

10

19

5

0

Other Female
3 3 Other Female 2
1 1 1 5 Other Female 1
1 Other Female
0

Total
6 2 70 19 13 5 2 93 40 7 17 274
Total
51 6 23 2 90 7 36 6 5 6 5 6 243
Total
24 11 3 43 6 48 3 1 1 2 3 2 147
Total
1 1 13 7 14 8 1 45

60

Appendix C.4

Pre ve nta bility for Re vie w e d De a ths w ith Suspe cte d or

Confirm e d Abuse or Ne gle ct (N=709)

Pre ve nta bility

Ca use of De a th

Missing Not at All Possibly Definitely

Drowning

3

79

Fall

6

Fire

3

8

26

Firearm

5

Homicide

2

20

37

157

Medical

5

30

4

MVC

1

19

91

Other Injury

2

12

Poison

8

S IDS / S UID

2

82

9

S uffoc at ion

6

41

Suicide

4

6

Unknown Intent

3

12

Unknown

19

7

Total

3

30

213

463

Pre ve nta bility for Re vie w e d De a ths w ith No Suspe cte d or

Confirm e d Abuse or Ne gle ct (N=2,752)

Pre ve nta bility

Ca use of De a th

Missing Not at All Possibly Definitely

Drowning

5

10

47

61

Fall

1

1

3

4

Fire

2

60

38

Firearm

4

22

Homicide

4

21

30

107

Medical

7

322

135

15

MVC

10

95

327

418

Other Injury

1

16

15

13

Poison

1

1

15

18

S IDS / S UID

12

225

339

23

S uffoc at ion

2

9

42

66

Suicide

1

27

70

47

Unknown Intent

1

11

7

Unknown

1

10

27

3

Total

45

740

1125

842

61

Appendix D Eligible Deaths Reviewed/Eligible Deaths, Georgia, 1999- 2004

Dade 5/6

Catoosa 23/24

Murray Fannin

Towns

24/26

10/12 Union 5/6

Rabun 4/6

Walker

Whitfield 37/41

22/28

Chattooga Gordon

8/13

20/23

Floyd Bartow

Gilmer 14/17 Pickens

5/6

Habersham

White

Lumpkin 6/6

9/9

25/27 Stephens 14/14

17/19 Dawson 9/10
Cherokee Forsyth

Hall 39/47

Banks 3/6

Franklin 11/13

Hart 2/8

45/49 36/39 53/56 42/44

Jackson Madison Elbert

Ha4rP9/a1Co/3l15sla7k6or/4nro7Plla2u6D2l/d3o9i4n3u/3g0g816la6C/Fs37ao2F/yb16eub7tlCtt37oel0naD/y18eto88Kn6HGa/Re2l2wb2n03oi7nr03cy/n/k22edN903taet97lwe/W32Bt8o0a1an/l7rt2ro/3o12nMw17O/oc29ro5g/C2n9a8el6an/e/r39kG2e1r8eO5/e/1g2n1l0ee4t/hT4oarlipa06Wef//We08ir5lark/o6errsMencDLiu0nf/cf1ioeCln2o3lu/2m6bia

Heard 9/10

Coweta 34/39

17/25 51/53

Spalding 19/20

Butts 8/8

Jasper 5/8

Putnam 8/13

3/3 18/19 Richmond

Hancock 3/4

Glascock

47/75

Troup 23/28

Meriwether 3/12

Pike 8/8

Lamar

5/9

Monroe 6/8

Upson

Baldwin

Jones 5/12

10/17

3/3

Jefferson

Washington 5/12

1/4

Burke 10/18

QCuCh4ita/SlMm4attH59tyueaaR/6asw11nh/arc2/1oar3noi0o33rsdgt4c//3o5ehleepWMehTe1aa4bT/rl10/sebi4o2/tro5enr/St5er cll2hTS/al35eu39y1/ym//l5L91o1et2Cr/e1Me6rr3aa/09wc/o5fo3nDPr9/1dC1oe/410ora/3iB0H51lscy3Tiph37ob/u8/4ub7r/2sn82PteoTWurnw4lai/1liB4sBc8g//kol2ge5e7ixsnWc/97kH/Dil1le2kio1ly5il/nd5/1sgo2eLnT1ae97ul//f9rW2ae3inrhsJeJo1eMe7h/5le1fT/on/f7r1rnsD0e23to/uga1/nt4ovleimTsEno8e6Amo1/r/1pm4y1a4p/4nb1luis8nCegTal6aJn/t79etd8n/nl1Ee/ak10vrlil13na/sBn6Lsuo12lSnl/o01cgc/6r2Bhe/L78rviy4be1a0enE0n/r/4ft1fy38i3n/g1Ch5haam7t8h/a8m5

0/0 Calhoun Dougherty

4/4

28/35

Early

Baker

7/7

0/0 Mitchell

Miller

18/18

Worth 13/13

Irwin 3/3
Tift 7/11

Berrien Colquitt Cook 12/14

Coffee 17/21
Atkinson 5/10

Bacon 3/6

Wayne 4/12

Pierce 7/15

Ware

Brantley

McIntosh 7/7
Glynn 29/32

2/3 Seminole

17/20 3/7

Lanier

5/7 15/17

7/8

Decatur 5/16

Grady 23/23

Thomas Brooks 16/23 11/12

1/2

Clinch

Lowndes

5/5

42/43 Echols

Charlton 3/9

Camden 19/20

2/2

62

APPENDIX E 1999 - 2004 Child Fatality Reviews, By County, By Age Groups

Appendix E represents county level data for the Child Fatality Review process from 1999 through 2004. The data is presented for 4 age groups (infants less than 1 year old, children from 1 to 4 years of age, children 5 through 14, and teenagers ages 15 through 17). Four numbers are provided for each age group:
Total Deaths: The total number of deaths (all causes) for that age group. This number is based on Georgia death certificate data and only includes deaths to Georgia residents under the age of 18. This does include deaths of Georgia residents that occurred in other states and were reported back to Georgia, but it does not include deaths of out-of-state residents that occurred in Georgia. The review team of the child's county of residence has the responsibility of reviewing deaths. However, the residence determined by the team may not match the residence reported on the death certificate. There were 132 deaths over the sixyear period that had different Georgia counties of residence on the death certificate and the CFR report, and the death certificate resident county was used for the data analysis.
Reviewable Deaths: The number of SIDS/SUID, unintentional, unknown cause, or violence-related deaths (reviewable deaths) according to the death certificate classifications. Although other deaths due to medical or natural causes may be eligible for review according to OCGA 19-15-3(e), SIDS/SUID deaths are explicitly required to be reviewed, and unintentional/violence related deaths should be

reviewed as "sudden or unexpected deaths." Thus, this number represents a minimum number of deaths that should be reviewed. This is a subset of total deaths.
The death certificate is not a "perfect" determinant of reviewable deaths. For example, a death certificate may be filed with "R99" (undetermined) for the cause of death. The review team may have autopsy or toxicology information that identifies a specific cause. If that is a medical cause, the CFR review team could decide that it is not a reviewable death and may not complete a review. Five such deaths were identified in 2004, but these deaths are not excluded from this set of reviewable deaths. Thus, the number of reviewable deaths is a slight overestimate, and the calculated proportion of reviewable deaths reviewed is an underestimate.
Reviewable Deaths Reviewed: The number of SIDS/SUID, unintentional, unknown cause, or violence related deaths that were reviewed. This number is a measure of how well a county identified and reviewed the minimum number of appropriate deaths. This is a subset of the total "reviewable" deaths.
Total Deaths Reviewed: This is the total number of child deaths from 1999 through 2004 for which a Child Fatality Review Report was submitted. It includes deaths due to natural causes (other than SIDS) in addition to those deaths that were identified as eligible for review. This is based on the county of residence identified from the death certificates.

63

64

COUNTY
Appling Atkinson Bacon Baker Baldwin Banks B arrow B art ow Ben Hill B errien Bibb Bleckley B rant ley B rook s B ry an Bulloch B urk e Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherok ee Clark e Clay Clayton Clinch Cobb Coffee Colquitt

All Deaths

Infant 1 to 4 5 to 14 15 to 17 Total

22

7

11

3

43

12

1

5

4

22

7

4

3

2

16

3

1

1

5

44

6

13

4

67

6

3

2

11

32

5

10

7

54

55 13

15 11

94

20

4

5

3

32

12

1

6

7

26

195 27

22 29 273

9

4

2

15

7

2

2

4

15

12

1

6

7

26

12

2

5

6

25

57

7

10 11

85

24

9

3

7

43

16

1

2

3

22

4

1

4

1

10

30

6

9

4

49

13

2

5

5

25

62

9

13 25 109

31

7

7

4

49

10

3

4

3

20

208 24

34 24 290

7

2

2

11

18

2

3

7

30

80 16

20 23 139

75

7

13 11 106

4

1

5

252 34

36 31 353

5

3

3

1

12

383 66

80 68 597

47

7

13

6

73

46

6

9 11

72

Eligible Dea ths

Infant 1 to 4 5 to 14 15 to 17

5

4

7

2

3

1

3

3

1

3

2

6

2

7

2

1

3

2

9

3

9

6

16

4

9

10

6

2

2

1

3

1

6

4

22 15 10

25

2

3

2

1

2

4

1

5

6

3

2

2

6

9

4

6

8

4

7

2

5

3

1

1

3

1

3

7

4

6

3

1

3

5

12

6

9

20

10

6

4

4

2

3

2

2

35 12 19

19

1

2

4

1

2

6

20

9

9

18

13

3

6

10

35 19 14

20

2

2

1

51 28 47

47

5

3

7

6

5

1

6

8

Total
18 10
6 0 17 6 27 39 11 14 72 7 7 12 13 27 18 8 4 20 9 47 24 9 85 3 13 56 32 0 88 5 173 21 20

Eligible Review ed

Infant 1 to 4 5 to 14 15 to 17

5

4

5

3

2

1

1

1

4

1

3

2

2

1

5

2

6

4

16

4

8

8

5

2

2

3

1

6

2

17 13

8

15

2

3

2

1

2

2

1

5

5

3

1

2

4

6

3

5

6

1

4

1

4

3

1

1

3

1

3

7

4

5

3

1

2

3

12

2

7

16

9

6

4

4

2

1

34 12 18

14

1

2

3

1

2

2

19

8

9

17

13

3

4

8

25 15 12

18

2

2

1

47 28 46

46

4

1

7

5

4

1

5

7

Total
14 5 3 0
10 3
17 36
9 12 53
7 5 11 10 20 10 8 4 19 6 37 23 3 78 3 8 53 28 0 70 5 167 17 17

All Review ed

Infant 1 to 4 5 to 14 15 to 17 Total

9

6

7

1

23

3

2

5

1

1

1

3

0

5

1

3

2

11

2

1

3

7

2

6

4

19

17

5

8

9

39

5

3

2

1

11

6

1

6

2

15

23 14

10 16

63

2

4

2

8

1

2

2

5

2

1

5

5

13

3

1

2

4

10

7

3

5

6

21

1

4

1

4

10

3

1

1

3

8

1

3

4

9

4

5

3

21

1

1

2

3

7

24

3

8 17

52

9

6

4

4

23

2

2

4

37 14

24 15

90

2

1

2

5

5

2

3

2

12

19

8

14 17

58

16

4

6

8

34

0

40 20

17 19

96

1

3

3

1

8

54 39

55

50 198

4

2

7

5

18

6

2

5

7

20

65

All Deaths

COUNTY Infant 1 to 4 5 to 14 15 to 17 Total

Columbia

42

5

18 18

83

Cook

14

3

4

21

Coweta

62

8

19 12 101

Crawford

5

3

3

11

Crisp

26

7

4

4

41

Dade

7

1

4

12

Dawson

7

2

5

14

Decatur

27

1

9

7

44

DeKalb

593 72 124 91 880

Dodge

12

5

6

8

31

Dooly

12

5

1

4

22

Dougherty 101 18

11

4 134

Douglas

63

9

19 15 106

Early

14

3

5

2

24

Echols

3

1

4

Effingham

32

3

9

9

53

Elbert

10

1

7

5

23

Emanuel

32

4

5

6

47

Evans

12

2

3

2

19

Fannin

15

1

3

5

24

Fayette

30 12

8 20

70

Floyd

74 12

18 12 116

Forsyth

69 12

21 13 115

Franklin

13

3

7

4

27

Fulton

648 87 119 116 970

Gilmer

24

4

5

4

37

Glascock

3

1

1

5

Glynn

58

8

9

9

84

Gordon

44

4

6

6

60

Grady

29

6

9

9

53

Greene

17

2

3

3

25

Gwinnett

452 80

88 74 694

Habersham 23

8

9

5

45

Hall

122 20

20 18 180

Hancock

14

2

1

17

Haralson

17

4

4

7

32

Harris

14

2

7

8

31

Hart

16

2

3

3

24

Heard

16

2

5

23

Henry

104 13

23 21 161

Houston

105 19

14 11 149

Irwin

8

2

1

11

Eligible Deaths

Infant 1 to 4 5 to 14 15 to 17

2

10

14

3

3

1

13

5

9

12

1

2

2

7

5

3

2

2

4

4

1

5

5

1

5

5

79 35 58

61

1

1

3

7

2

4

1

3

17 12

3

3

14

4 10

10

1

1

3

2

1

1

3

2

4

6

3

5

5

4

1

4

1

1

2

2

6

1

5

5

4

4

12

19

6 14

10

15

4 14

11

3

1

5

4

128 45 67

86

5

4

4

4

1

1

1

15

3

8

6

12

1

4

6

10

1

5

7

7

3

1

58 46 49

56

8

7

7

5

15

8

9

15

1

2

1

6

4

1

4

1

3

8

3

1

1

3

5

1

4

13

6 18

16

15 10

7

10

3

Total
26 7
39 5
17 6
10 16 233 12 10 35 38
7 2 15 8 14 6 12 25 49 44 13 326 17 3 32 23 23 11 209 27 47 4 15 12 8 10 53 42 3

Eligible Reviewed

Infant 1 to 4 5 to 14 15 to 17

2

7

14

1

2

9

5

9

11

6

4

2

2

2

3

3

1

5

1

1

3

68 28 40

50

1

4

2

4

1

2

14

9

3

2

10

4

5

10

1

1

3

2

1

1

2

1

1

4

3

3

3

1

2

2

1

5

1

4

5

2

2

8

18

6 13

8

13

4 14

11

3

1

5

2

119 40 64

83

3

4

4

3

1

1

1

14

3

7

5

9

1

4

6

10

1

5

7

4

3

1

56 45 48

51

8

7

6

4

10

8

7

14

2

1

3

1

2

3

1

1

5

4

12

6 17

16

13

8

6

6

3

Total
23 3
34 0
14 5 9 5
186 5 9
28 29
7 2 8 6 6 3 10 17 45 42 11 306 14 3 29 20 23 8 200 25 39 3 4 5 2 9 51 33 3

All Reviewed

Infant 1 to 4 5 to 14 15 to 17 Total

2

1

8 14

25

1

2

3

10

5

10 11

36

0

8

5

3

4

20

2

3

5

3

1

5

9

1

1

3

5

85 38

53 57 233

2

4

6

2

4

1

2

9

15 10

3

2

30

11

4

5 10

30

3

2

4

2

11

1

1

2

2

1

2

4

9

4

3

7

3

1

2

6

2

1

3

7

1

4

12

7

3

3 12

25

23

8

15

8

54

15

4

15 11

45

3

1

6

2

12

143 54

82 97 376

3

4

4

3

14

1

1

1

3

17

3

7

6

33

10

4

4

6

24

14

4

7

7

32

5

1

3

1

10

66 46

50 53 215

9

7

6

4

26

12

9

9 14

44

2

1

3

4

1

1

6

2

3

5

1

1

2

5

4

9

18

9

17 19

63

18 10

8

6

42

3

3

66

COUNTY
Jac k s on Jas per Jeff Davis Jeffers on Jenk ins Johns on Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin M c Duffie M c Int os h Macon Madison Marion Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens P ierc e Pike Polk Pulaski Putnam Quitman Rabun Randolph

All Deaths

Infant 1 to 4 5 to 1415 to 17 Total

36

7

8

9

60

12

2

2

16

17

1

3

5

26

20

2

3

2

27

8

1

6

3

18

5

3

2

10

18

3

5

6

32

12

3

4

2

21

7

1

2

10

36

8

9 10

63

11

2

6

7

26

97 11

13

9 130

6

3

1

10

4

1

1

6

122 13

8 17 160

8

5

3

16

31

1

6

8

46

11

2

2

6

21

13

2

4

1

20

12

3

6

6

27

7

2

2

11

14

9

2

2

27

4

2

6

23

4

3

6

36

17

3

2

1

23

7

3

10

8

3

7

3

21

21

6

10

9

46

277 26

30 26 359

43 20

12

7

82

16

4

5

2

27

9

1

2

12

54

7

16 13

90

19

4

2

1

26

26

2

5

7

40

9

2

3

7

21

5

2

5

12

24

7

7

4

42

1

4

4

1

10

20

2

6

2

30

6

1

1

1

9

8

1

2

2

13

13

3

1

17

Eligible Deaths

Infant 1 to 4 5 to 14 15 to 17 Total

8

4

5

8

25

5

1

2

8

5

1

2

4

12

1

1

2

4

3

1

4

3

11

1

1

4

2

1

5

12

2

3

2

2

9

1

1

2

8

4

6

5

23

1

2

4

6

13

24

7

7

5

43

1

1

1

1

21

7

4

11

43

1

2

3

6

9

4

6

19

2

5

7

5

1

2

1

9

7

2

5

6

20

2

2

4

3

6

1

2

12

2

1

3

8

2

3

5

18

2

3

2

1

8

2

2

4

1

2

3

3

9

6

5

6

9

26

52 15 18

19 104

14 12

6

6

38

1

2

4

2

9

1

1

2

4

11

4

8

11

34

6

1

2

1

10

7

1

4

7

19

3

2

3

7

15

2

2

4

8

1

6

5

4

16

4

3

1

8

4

2

5

2

13

1

1

1

1

4

2

2

2

6

1

3

1

5

Eligible Review ed

Infant 1 to 4 5 to 14 15 to 17 Total

1

3

3

4

11

3

1

1

5

3

1

1

5

1

1

2

1

4

1

8

1

1

2

3

5

1

3

1

5

1

1

6

2

5

4

17

1

1

4

5

11

21

7

7

5

40

0

1

1

21

6

4

11

42

1

2

3

6

8

4

6

18

2

5

7

4

1

1

6

6

2

3

4

15

2

2

4

1

2

3

2

2

8

2

3

5

18

1

2

2

1

6

1

2

3

1

2

3

3

9

5

5

5

9

24

46 14 17

19

96

14 11

6

6

37

1

2

3

6

1

1

2

4

8

3

6

9

26

2

1

3

6

1

4

6

17

1

2

4

7

2

2

4

8

3

2

4

9

1

2

1

4

3

1

2

2

8

1

1

1

1

4

1

1

2

4

3

3

All Review ed

Infant 1 to 4 5 to 1415 to 17 Total

2

3

3

4

12

4

1

1

6

3

1

1

5

1

1

2

1

4

1

8

3

1

4

2

3

5

1

3

1

5

1

1

2

12

2

7

7

28

1

1

6

5

13

22

7

8

8

45

0

1

1

27 11

5 15

58

1

2

3

6

9

1

5

6

21

2

5

7

4

1

1

6

6

3

3

4

16

2

2

2

6

1

2

3

2

2

9

3

3

5

20

1

2

2

1

6

1

2

3

1

2

4

3

10

5

6

6

9

26

56 16

20 20 112

15 11

6

6

38

1

2

3

6

1

1

2

4

10

3

7

9

29

2

1

3

9

2

5

6

22

1

2

4

7

3

2

5

10

3

2

4

9

1

2

1

4

3

1

2

2

8

1

1

1

1

4

1

1

1

2

5

1

3

4

67

All Deaths

COUNTY Infant 1 to 4 5 to 14 15 to 17 Total

Richmond

206 26

39 29 300

Roc k dale

31

9

9 13

62

Schley

4

2

2

1

9

S c reven

21

4

6

2

33

Seminole

10

1

3

5

19

Spalding

62 13

8

2

85

Stephens

12

6

4

8

30

Stewart

6

1

1

8

Sumter

34

3

5

1

43

Talbot

5

3

1

2

11

Taliaferro

2

2

Tattnall

17

2

3

7

29

Tay lor

6

3

2

11

Telfair

6

1

5

4

16

Terrell

13

3

1

17

Thom as

38

6

8

7

59

Tift

30

7

10

4

51

Toom bs

20

1

3

8

32

Towns

5

3

4

12

Treutlen

6

1

7

Troup

53 10

11 11

85

Turner

9

3

2

4

18

Twiggs

9

1

3

2

15

Union

6

3

5

14

Ups on

13

1

7

3

24

W alker

35

6

15

6

62

W alton

42 12

14

7

75

W are

24

2

8

6

40

W arren

7

1

1

1

10

W ashington 17

2

3

1

23

W ayne

23

4

5

6

38

W ebster

2

1

1

4

W heeler

2

2

4

4

12

W hite

14

2

4

3

23

W hitfield

67 10

13 15 105

W ilcox

9

2

1

1

13

W ilkes

10

4

2

2

18

W ilkinson

9

2

4

1

16

W orth

11

3

7

6

27

Tota ls

6,822 1,066 1,452 1,280 10,620

% Eligible Re view e d

Eligible De aths

Infant 1 to 4 5 to 14 15 to 17

30 12 12

21

9

5

4

11

1

1

1

3

1

4

2

1

2

3

9

5

4

2

2

4

2

6

2

1

7

3

2

1

2

2

3

1

2

1

2

2

1

3

3

1

6

4

7

1

3

4

3

3

1

1

1

11

4

6

3

1

1

2

4

3

10

4

9

7

6

6

7

6

1

1

6

2

3

5

1

1

4 16
2 1
5 1,214
83.3

7 1 1
2 562 82.6

3 2 7 1 2 4 4 812
81.7

4 2 3 1 6 3 8 4
7 3 2 4 2 5 4 4 1 1 5 1 4 3 11 1 2 1 2 989 81.4

Total
75 29
3 8 8 20 14 3 12 5 0 10 5 9 5 23 11 14 6 1 28 8 2 6 9 28 23 17 3 12 12 1 7 9 41 5 6 5 13 3,577
82.3

Eligible Revie w ed

Infant 1 to 4 5 to 14 15 to 17 Total

21

7

6

13

47

8

5

3

11

27

1

1

2

1

1

4

6

1

1

2

3

7

9

5

3

2

19

2

4

2

6

14

1

1

6

3

9

0

0

3

1

2

1

7

1

2

2

5

2

1

3

3

9

2

2

3

4

4

5

16

1

4

2

7

3

2

3

8

1

1

3

5

0

11

4

4

4

23

3

1

1

3

8

1

1

2

3

5

3

3

8

3

7

4

22

7

6

3

4

20

6

5

4

15

1

1

1

3

3

1

1

5

2

2

4

1

1

3

4

7

4

2

3

9

13

7

6

11

37

2

1

1

4

1

1

1

2

5

1

1

2

5

2

4

2

13

1,011 464 663

805 2,943

All Review ed

Infant 1 to 4 5 to 14 15 to 17 Total

28

9

8 13

58

8

5

4 11

28

1

1

2

2

2

4

8

1

1

2

3

7

11

7

3

2

23

2

4

2

6

14

1

1

10

3

1

14

0

0

3

1

2

1

7

1

2

2

5

2

1

3

3

9

2

2

4

4

4

5

17

1

4

2

7

3

1

2

3

9

1

1

3

5

0

15

8

5

4

32

3

1

1

3

8

1

1

1

3

2

2

3

7

5

1

6

8

3

8

4

23

8

8

3

4

23

9

2

5

4

20

1

1

1

1

4

4

1

1

6

2

1

2

5

1

1

2

2

4

4

10

6

2

3

11

16

9

8 11

44

2

1

1

1

5

1

2

1

2

6

1

1

2

6

2

4

2

14

1,244 575 781 861 3,461

DEFINITIONS OF TERMS AND ABBREVIATIONS USED IN

THIS REPORT

AA - African-American
Child Abuse and Neglect an act, or failure to act, on the part of a parent or caretaker that results in serious physical or emotional harm, sexual exploitation, or death of a child.

Motor Vehicle-Related Death incidents that include the occupants of a vehicle, pedestrians struck by motor vehicles, bicycles, and occupants or riders of any other form of transportation (ATV, go-carts, etc.).

Child Abuse Protocol Committee - County level representatives from the office of the sheriff, county department of family and children services, office of the district attorney, juvenile court, magistrate court, county board of education, office of the chief of police, office of the chief of police of the largest municipality in county, and office of the coroner or medical examiner. The committee is charged with developing local protocols to investigate and prosecute alleged cases of child abuse.
Child Fatality Review Report - A standardized form required for collecting data on child fatalities meeting the criteria for review by child fatality review committees.

Natural Cause - Refers to death resulting from an inherent, existing condition. Natural causes include congenital anomalies, diseases of the nervous system, diseases of the respiratory system, other medical causes and SIDS.
"Other" Race - Refers to those of Asian, Pacific Islander, or Native American origin.
"Other" as Category of Death - Includes deaths from poisoning and falls (unless otherwise indicated).
Perpetrator - Person(s) who committed an act that resulted in the death of a child.

Child Fatality Review Committee - County level representatives from the office of the coroner or medical examiner, county department of family and children services, public health department, juvenile court, office of the district attorney, law enforcement, and mental health, and prevention advocate.
Drowning Deaths Deaths that occur from water-related submersion and suffocation.

Preventable Death - One in which with retrospective analysis it is determined that a reasonable intervention could have prevented the death. Interventions include medical, social, educational, legal, technological, or psychological.
Reviewed Death - Death which has been reviewed by a local child fatality review committee and a completed Child Fatality Review Report has been submitted to the Georgia Child Fatality Review Panel.

Eligible Death - Death meeting the criteria for review including Risk Factor - Refers to persons, things, events, etc. that put death resulting from SIDS, unintentional injuries, intentional an individual at an increased likelihood of dying. injuries, medical conditions when unattended by a physician,

or any manner that is suspicious or unusual.

Sleep-Related Infant Death all deaths to infants that occur

Firearms any weapon that fires a high-velocity projectile, and includes rifles, pistols, revolvers, shotguns, handguns, and BB guns.

while sleeping but have no medical cause. Included are SIDS, SUIDS, and all suffocation/asphyxia deaths related to a sleep environment.

Fire-Related Death Death resulting from fire or burn-related injuries sustained in a fire, and includes deaths from smoke inhalation.

Sudden Infant Death Syndrome (SIDS) - The sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of

the death scene and review of the clinical history. In this Form 1 - A standardized form required for collecting data on all report, SIDS is not considered a "medical" cause. child fatalities by coroners or medical examiners.

Georgia Child Fatality Review Panel - An appointed body of 17 representatives that oversees the county child fatality review process, reports to the governor annually on the incidence of child deaths, and recommends prevention

Sudden Unexplained Infant Death (SUID) - is a category used by child fatality review committees for deaths that appear to be SIDS but have other risk factors that could have contributed to the infant's death.

measures based on the data.

Trend - Refers to changes occurring in the number and

Injury - Refers to any force whether it be physical, chemical (poisoning), thermal (fire), or electrical that resulted in death.

distribution of child deaths. In this report, the actual number of deaths for each cause is relatively small for the purpose of statistical analysis, which causes some uncertainty in

estimating the risk of death. Intentional - Refers to the act that resulted in death being one

that was deliberate, willful, or planned. It includes homicide and Unintentional Death - Refers to the act that resulted in death

suicide.

being one that was not deliberate, willful, or planned.

Medical Cause - Refers to death resulting from a natural cause
other than SIDS. 68