Numbers Don't Tell the Whole Story
A Biennial Review of Child Fatalities in Houston and Harris County

Of Texas' most densely populated areas, which include Harris, Dallas, Travis, Tarrant and Bexar counties, Harris County records the highest number of child fatalities, ages 0 to 17, with 624, but ranks third in death rates per 100,000 at 65.2.

In a national comparison of death rates for the same age range, broken into age groups, Harris County was in the middle of the pack, and ranked well below the national averages.

A biennial report recently presented by the Houston/Harris County Child Fatality Review Team offered a summary of findings concerning the deaths of children in Houston and Harris County that occurred in 1998 and 1999. Members of the team include law enforcement officials, prosecutors, medical examiners, justices of the peace, health care professionals, child protective services specialists, public and mental health professionals, educators and child advocates.

The HHCCFRT began in April of 1994. It is a local, multidisciplinary, multi-agency team whose primary purpose is to conduct a review of records and information pertaining to the death of each child who dies in Harris County; compile and analyze the data to identify patterns or trends in the deaths; and contribute to the development and implementation of interventions to prevent and reduce these deaths.

In 1995, the Texas Legislature amended the Family Code to include child fatality review team guidelines.

The ultimate goal of a child fatality review system is an improved response to all child fatalities. By sharing information, team members discover the circumstances surrounding a child's death. They identify gaps or breakdowns in agency services designed to protect children, and work to revise agency procedures and professional investigation protocols. As a result of the team's efforts, child fatalities are more accurately recorded and prevention initiatives can be developed.

"I would really like to stress the significance of this type of team," said Cindy Kilborn, Harris County Health Department. "The cooperation and trust among the team members within these agencies who are working together in this area, and across the state, have allowed this process to work."

"It is our intention and hope that agencies involved in children's issues use this information to implement prevention programs, and eventually eliminate the reasons these deaths occur," she said.

In Harris County in 1998 and 1999, there were 1,276 deaths of children 17 years old and younger.

"Even though our area has the greatest number of deaths in Texas," said Polina Strug, an epidemiologist and the HHCCFRT coordinator, "numbers don't tell the whole story."

Strug said it is important to look at the death rates, which is the number of deaths in relation to the population.

"Although we are concerned about all the reasons that children die, our primary effort is to focus on reducing preventable deaths and injuries - both intentional and unintentional," Strug said. "As a result, 651 deaths were reviewed by team members."

In 1998 and 1999, the five leading causes of Harris County child fatalities were: injuries - intentional and unintentional; conditions arising in the perinatal period; congenital anomalies; symptoms, signs and ill-defined conditions, including Sudden Infant Death Syndrome, or SIDS; and infections and parasitic diseases.

Intentional Injuries

Intentional injuries included homicide, suicide, child abuse and firearm fatalities. Homicides contributed to 43 deaths in 1998 and 41 deaths in 1999. Fifty-four percent of these deaths were firearm-related. Fifteen of the children who were murdered had at least one prior involvement with Children's Protective Services. The most common homicide location was in the child's home, and in 10 instances, the perpetrator had a criminal history.

There were 25 suicides in 1998 and nine in 1999, which was a five-year low for Harris County. Twenty-six percent of these suicide victims tested positive for drugs or alcohol, and 41 percent left a suicide note.

Child abuse contributed to 15 deaths in 1998 and 17 deaths in 1999. Some of the precipitating events to these deaths included crying, disciplining or toilet training, and revenge toward the child or the other parent.

Unintentional Injuries

Some of the unintentional injury-related deaths included motor vehicle crashes and drownings. In 1998 there were 41 deaths due to motor vehicle crashes and 59 in 1999. In 39 of the cases, the child was inappropriately or not-at-all restrained. Eight of these crashes occurred on interstates and 21 on state highways. The majority of injuries resulting in fatalities occurred on Harris County streets. In 70 of the 100 deaths during this two-year period, the child was the only victim. Nine child deaths resulted from a collision with an 18-wheeler, and in 25 percent of the crashes, alcohol and/or drugs were involved.

Drowning accounted for 19 deaths in 1998 and 16 deaths in 1999. Sixty-six percent of the drowning fatalities in Harris County occurred between April and July. Failure to provide adequate supervision resulted in 23 deaths, and in 20 cases, 13 had a fence or gate around the pool, but in 11 cases, it was unlocked.

SIDS

Sudden Infant Death Syndrome is defined as the sudden, unexpected death of a previously well infant, under age 1, in which a complete postmortem autopsy, examination of the death scene, and a review of the clinical history fails to reveal an adequate cause of death. SIDS is the single most common cause of death among 1-to-12 month old infants.

In the two-year period, 64 infant deaths were classified as SIDS-related deaths. Eighty-six percent of these occurred among infants aged 1-to-4 months. In more than 40 percent of the total cases, parents said the child had a recent cold, congestion, or flu-like symptoms. In 11 of the cases, a blanket, pillow or other object was covering the child's face, nose or mouth.

To reduce the risk of SIDS, the American Academy of Pediatrics recommends that healthy babies be put to sleep on their backs. Forty-five of the children who died of SIDS in 1998-99 were discovered positioned on their stomachs.

"As we continue to collect information concerning the circumstances of child deaths, within a few years, we will be able to identify possible trends in our community," Strug said. "The Houston/Harris County Child Fatality Review Team believes that a community that does not know how its children are dying cannot save them."

"It is important that we gather this data," said Harris County Judge Robert Eckels. "There are few things that are as tragic as the death of a child. The statistics in this report will tell us the things that we can take and develop through our city, county and state agencies. The information that the Child Fatality Review team has gathered will help us do a better job of identifying the causes of these deaths."

The HHCCFRT recommends the following guidelines to prevent childhood fatalities:

* Provide young adults with parenting education.

• Everyone in a car should be properly buckled in. Make sure that a car seat is properly installed and is the right size for the child.
• Don't leave children unattended in a pool or tub.
• Healthy babies should sleep by themselves, on their backs, on a firm, uncluttered surface.
• Don't give a child food that can easily lodge in the throat. Never leave young children unattended while they're eating foods like hotdogs, hard candies or nuts
• Have a plan to deal with crying infants - never touch a child in anger.

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©2006 Texas Medical Center

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