A 9-month-old female child nearly died on March 1, 2024, as a result of physical abuse. Luzerne County Children and Youth Agency indicated the report on May 24, 2024, naming the victim child’s mother’s paramour as the perpetrator. On the date of the incident, it was reported that the victim became unresponsive, and emergency medical services were contacted. The child presented to the hospital and was found to have abusive head trauma and multiple fractures. The injuries sustained were of varying ages and were indicative of a pattern of repeated abuse. It was determined through the investigation that the mother’s paramour was the sole caregiver of the child at the time the injuries were sustained.
–Pennsylvania Department of Human Services, 2024 2nd Quarter Fatalities/Near Fatalities
For every child who dies of abuse or neglect, an unknown number suffer life-threatening or serious injuries. In deciding which cases of abuse or neglect require public disclosure of some information and findings, Congress mandated equal treatment for child fatalities and “near fatalities.” But in reality, much less information about near fatalities is released by states and the federal government.
The Child Abuse Prevention and Treatment Act, the federal cornerstone of child protection systems in the United States, requires states to have provisions which allow for public disclosure of cases of child abuse or neglect resulting in a fatality or near fatality. A near fatality is defined as “an act that, as certified by a physician, places the child in serious or critical condition.” There is no requirement that states routinely report on fatalities or near fatalities where maltreatment is involved; they can comply with the law by responding to requests for information about specific incidents. The federal Children’s Bureau does request fatality data every year as part of a state’s annual submission to the National Child Abuse and Neglect Data System (NCANDS), and all states but Massachusetts submitted fatality data for Federal Fiscal Year (FFY) 2023. But NCANDS does not include near fatality data.
Not surprisingly, given the lack of any requirement or request from the federal government, few states routinely release data on near fatalities due to maltreatment. Out of the 18 states we identified that release some information about child maltreatment fatalities without a request,1 we found only 112 that are currently reporting any information on near fatalities due to maltreatment. Among the nine states for which fatalities and near fatalities could be easily separated, there is considerable diversity in the number of fatalities compared to near fatalities. And surprisingly, only three of the states reported more near fatalities than fatalities, with the other six reporting more fatalities.
The differences among states are not due to different definitions of near fatalities. All but Texas use the CAPTA definition of a near fatality as “an act that places a child in serious or critical condition.” Texas law contains the CAPTA definition but the Texas Department of Family and Protective Services (DFPS) points out that there is no agreed-upon meaning among hospitals or medical professionals for words like serious or critical condition. Therefore, DFPS worked with child abuse pediatricians to add wording to its definition stating that a “near fatality consists of an act of abuse or neglect to a child who, without imminent medical intervention, would likely have died as a result of the maltreatment.”3
Rather than definitional issues, perhaps these varying state numbers reflect differences in how many near fatality cases are reported in different states by hospitals, police or other reporters. It is widely agreed that child maltreatment fatalities are underreported by states. It seems that this problem may be more severe with near fatalities.
Two states also release information on what they call “egregious” incidents of abuse or neglect. Colorado law defines an “Incident of egregious abuse or neglect” as “an incident of suspected abuse or neglect involving significant violence, torture, use of cruel restraints, or other similar, aggravated circumstances that may be further defined in rules promulgated by the state department pursuant to this section.” Wisconsin’s similar definition adds “exposure of a child to a dangerous situation” to the conditions included in the Colorado definition.
Within the group of cases reviewed by its Child Fatality Review Team (those with child welfare involvement within three years of the incident), Colorado reported 48 egregious incidents in 2023, 160 percent of the number of fatalities and 120 percent of the number of near fatalities. This ratio suggests how much is missed by not counting those cases. Wisconsin does not release a count of such incidents, and counting them would require opening each of the incident reports listed on the website.
Given the discrepancies among the few states that report the number of child maltreatment fatalities and near fatalities, these numbers cannot be relied upon to tell us how many children actually suffer life-threatening injuries or illness due to abuse or neglect. More likely, they tell us more about the proportion of near fatality incidents that are reported to CPS. As for egregious incidents that are not found to be near fatalities, we have almost no information at all. Lives Cut Short has already called attention to the underreporting of child fatalities nationwide. But the need for reporting of near fatalities and egregious incidents must also be recognized.