Approximately 40,000 children younger than age 19 die each year in the United States. Reviewing the circumstances of a child’s death can help prevent future morbidity and mortality.
Child fatality review teams (CFRTs) help with this process. Teams have existed since the 1970s, and now all states, the District of Columbia, Guam and the Navajo Nation have teams.
A revised AAP policy statement provides an update on the evolution of CFRTs and calls for continued improvement in the review process to protect children from preventable deaths.
The policy Child Fatality Review, from the Section on Child Death Review and Prevention, Council on Injury, Violence and Poison Prevention and Council on Child Abuse and Neglect, is available at https://doi.org/10.1542/peds.2023-065481 and will be published in the March issue of Pediatrics.
Team makeup, functions
CFRTs are multidisciplinary and often include coroners/medical examiners, law enforcement officers, child protective services staff, public health workers and health care providers. Many teams review all children’s deaths, including those from automobile collisions, inflicted injuries, drownings and suicides, while some review specific diagnoses.
Pediatricians are a vital part of CFRTs. They help teams understand the medical component of a child’s death and often are a link between a team and the local health care system. Even without direct knowledge of a specific child’s death, pediatricians are important partners in preventing future deaths.
Need for child fatality review
Since the previous policy was published in 2010, research on and support for CFRTs have been growing.
By having a team examine the details of how and why a death occurred, more information can be uncovered than would be gleaned from just a death certificate. This information then can be used to identify strategies to prevent similar deaths.
An investigation, for example, might uncover that a particular road is the site of many crashes and lead to a simple “fix” that can benefit the community. In other cases, such as premature deaths, the etiology of deaths is more complex. By examining the whole picture around a death, incremental steps might be identified that can impact care.
Understanding the causes of sudden unexpected infant death (SUID) is one area in which CFRTs have played an important role. Teams helped in the identification of sleep hazards that went unrecognized for years.
Recommendations
Following are key recommendations in the policy statement:
- All local, state and/or tribal CFRTs should have pediatric physician representation.
- Pediatricians, along with AAP chapters, should use recommendations from CFRTs to inform local, state, tribal and national policies and legislation to reduce preventable child deaths and improve children’s health.
- Every child’s death should be investigated as appropriate and as resources allow, including a review by a CFRT. This includes a timely autopsy and a report by a certified pediatric forensic pathologist in appropriate cases, when available, especially those that are unexpected (including SUID), suspicious, obscure or otherwise unexplained.
- Pediatricians have a role in advocating for timely and consistent reporting on death certification and standardization of the certification process that can lead to improved data on which to base prevention strategies.
- Because reviewing the details of child deaths is emotionally difficult, team members should be given support, including professional training on secondary trauma, to help promote resilience.
Dr. Batra is a lead author of the policy statement and a member of the AAP Section on Child Death Review and Prevention and Council on Injury, Violence and Poison Prevention.
Resources
- National Center for Fatality Review and Prevention has links to state programs, infographics, guidance and peer-reviewed publications
- AAP Section on Child Death Review and Prevention
