Lives Cut Short
In a press release, announcing the publication of data on child maltreatment in Federal Fiscal Year 2023, the U.S. Administration on Children and Families reported that the number of child maltreatment deaths decreased slightly in Federal Fiscal Year 2023 versus 2022. But the reality is we don’t know how many children died of maltreatment – in either year. Because of restrictive definitions, failure to consult all available sources, and the decision not to investigate certain maltreatment-related deaths, state data submissions greatly underestimate the number of child fatalities that are due to maltreatment.
On January 8, 2025, the Administration on Children and Families (ACF) of the U.S. Department of Health and Human Services published Child Maltreatment 2023 (CM2023), its latest compendium of data on states’ responses to reports of child abuse and neglect. These resources, produced by the Children’s Bureau of ACF, are based on data that states submit to the National Child Abuse and Neglect (NCANDS) data system. CM2023 provides data for FFY 2023, which ended on September 30, 2023. Based on reports from 49 states (all but Massachusetts), the District of Columbia, and Puerto Rico, CM 2023 estimated that there were a total of 2,000 child maltreatment deaths in FFY 2023 and a national maltreatment fatality rate of 2.73 per 100,000 children.
Experts agree that these annual estimates from the Children’s Bureau are too low. Child death review (CDR) teams often identify significantly more maltreatment deaths than states report to NCANDS. Out of six state CDR teams that attempted to identify all child maltreatment deaths in a recent year, all but one estimated a higher number than the state reported to NCANDS, as shown in the table below.1
Number of Child Maltreatment Fatalities Reported by NCANDS and by CDR State NCANDS CDR Year Arizona 43 116 2023 Colorado 40 49 2022 Missouri 61 179 2022 Nevada 27 78 2021 North Dakota 9 7 2020-2021 Tennessee 43 75 2019 Our project has also produced evidence that NCANDS data underestimates child maltreatment fatalities. The Lives Cut Short database compiles information from publicly available sources like media reports, fatality reports released by states and other entities, and Medical Examiner reports obtained by request from selected jurisdictions. Using only these incomplete sources, the project has counted more child maltreatment deaths than those reported to NCANDS by 10 states for FFY 2022 and 12 states for FFY 2023 as of February 6, 2025.
Reasons for Undercounting
Our analysis of commentaries included with state NCANDS submissions suggests a number of reasons why maltreatment fatalities may be missed.
Failure to Consult All Available Sources
Many states report only the fatalities that were deemed maltreatment by their investigative units and fail to access other sources, including vital statistics data, or information from child death review teams, law enforcement agencies, and medical examiners or coroners. Some state child welfare agencies may be unable to gain access to certain data sources, such as tribal information systems.3
Restrictive Definitions
Some states have overly restrictive definitions of child maltreatment fatalities. Arizona reports that it includes only fatalities where abuse or neglect was the sole cause of death as maltreatment fatalities, rather than including deaths where it was a contributing factor, per the NCANDS definition.4 Child neglect deaths are often not identified and instead classified as accidents, even when poor supervision or parental substance use clearly have contributed to the death. Some states may be adopting more restrictive definitions because of the growing attention to activists who claim that neglect is being confused with poverty. In Texas, the legislature narrowed the definition of neglect in legislation that took effect in FFY 2022, requiring the existence of both “blatant disregard” for the consequences of a parent’s action or inaction and either a “resulting harm or immediate danger.” After adoption of this new definition, the maltreatment fatality count fell from 206 in FFY 2021 to 176 in FFY 2022.
Screening Practices
Report screening practices also influence how many maltreatment fatalities are reported. For example:
- Ohio notes that some county agencies will not investigate child fatality reports if there are no other children in the home or the other children are not deemed to be at risk of maltreatment.
- Texas changed its screening policy in State Fiscal Year 2023 so that reports of a child fatality that include no explicit concern for abuse and neglect are not investigated unless the reporter and other pertinent sources had no concern for abuse or neglect.
- Two states reported changing their screening practices related to sleep deaths in opposite ways.
- Illinois added a new administrative review process for sleep-related deaths. A senior administrator reviews the investigation to ensure that death included evidence of “blatant disregard.” The state links this new policy with its decrease of 24.6% in child fatalities in FFY 2023.
- Moving in the opposite direction from Illinois, Maryland attributed an increase in reported fatalities to a policy change requiring local agencies to screen in sleep-related fatalities as part of its prevention effort.
Substantiation Policies and Practices
The number of maltreatment fatalities identified also depends upon how a department decides whether a fatality was due to maltreatment. One factor that might influence such decisions is the level of evidence or standard of proof it requires to substantiate an allegation. In New York, this was changed from “some credible evidence” to “a fair preponderance of the evidence” in FFY 2022. The number of victims found in New York dropped from 56,760 in FFY 2021 to 50,056 in FFY 2022 in the aftermath. New Jersey reports that the Assistant Commissioner for Child Protection and Permanency ultimately determines if a child fatality was the result of maltreatment. This diversion of the decision to a high level which is more open to political influence could help explain the state’s very low reported fatality rate.
The maltreatment fatality estimates seem to be such a low priority for states, and draw so little attention, that errors in either direction are likely. For example, Jessica Calefati, a reporter for the Baltimore Banner noticed that Maryland had one of the highest child maltreatment fatality rates in the country, which happened to be second only to that of Mississippi. When she asked a senior official at the Department of Human Services for an explanation, he said he had not looked at the data. Later, a department spokesperson responded that the agency had erroneously reported any death investigation as a maltreatment fatality, instead of only those deaths where child maltreatment was ruled to be a contributing factor. The state reported that it was currently reviewing data from the past five years to provide an accurate count of confirmed maltreatment fatalities.
Exhibit 4A from CM2023 shows that estimated child maltreatment fatalities increased every year from FFY 2019 to FFY 2022 before decreasing slightly in FFY 2023. But such a small reduction of less than 3 percent over the previous year cannot be statistically distinguished from random fluctuation, especially because it is based on much-smaller numbers from the individual states. Even aside from statistical fluctuations, year-to-year changes may reflect alterations in policy and practice that may affect fatality counts.
Conclusions
It remains incredibly difficult to draw conclusions based on the child maltreatment fatality data contained in the Children’s Bureau’s annual child maltreatment reports. The overall estimate of child maltreatment fatalities is likely to be too low because state and local agencies collect information, define maltreatment fatalities, and make decisions in ways that likely cause them to miss fatalities that were due to maltreatment. Trends over time are difficult to assess because states often change these definitions and practices – often with only limited details provided and lack of systematic documentation of the changes. It is worth noting that the same issues affect counts of maltreatment victimization in general, not just fatalities.
In its press release announcing CM2023, the Biden Administration endorsed the need for more comprehensive and consistent data on child maltreatment fatalities, announcing “an intent to fund a new National Technical Assistance Center that will work with states and their partners to improve reporting, analysis, and understanding of child maltreatment fatalities.” ACF issued a Notice of Funding Opportunity for this Center on January 14, 2025. Whether this grant will be distributed by the new administration is unknown.
But technical assistance is not enough. The Commission to Eliminate Child Abuse and Neglect Fatalities recommended in its final report that the federal government establish a “national standardized classification system to include uniform definitions for counting child abuse and neglect fatalities and life-threatening injuries.” The system should reconcile information from multiple agencies, such as medical examiners or coroners, vital statistics offices, child death review teams, and criminal justice agencies. It is only by establishing such uniform standards that we can capture the full number of maltreatment fatalities that are due to child abuse and neglect.
1. The exception was North Dakota, where the numbers are very small and could be influenced by differences in reporting periods between the CDR team and the state Department of Health and Human Services (DHHS). Moreover, North Dakota reports in CM 2023 that DHHS works intensively to identify all child maltreatment fatalities in the state.
2. Arizona Child Fatality Review Team, 31st Annual Report; Colorado Child Maltreatment Prevention System, Leading Causes of Death: 2018-2022; Georgia Child Fatality Review Panel Annual Report, Calendar Year 2023; Indiana Statewide Child Fatality Review Committee, Report on Reviews Completed During 2021; Missouri Child Fatality Review Program, Preventing Child Deaths in Missouri: Annual Report for 2023; Nevada Division of Child and Family Services, 2021 Statewide Child Death Report. Submitted by the Executive Committee to Review the Death of Children; North Dakota Child Fatality Review Panel, Detailed Annual Report: 2020 & 2021; Tennessee Department of Health, 2021 Child Fatality Annual Report: Understanding and Preventing Child Deaths in Tennessee.
3. Montana’s child welfare agency reports that due to the lack of legal jurisdiction, it cannot report on child deaths that occurred in cases investigated by the Bureau of Indian Affairs, Tribal Social Services or Tribal Law Enforcement.
4. Arizona Department of Child Safety, Child and Family Services Plan, Federal Fiscal Years 2025-2029, p. 173.
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