Despite pronounced reductions in child mortality in industrialised countries, variations exist within and between countries. Many child deaths are preventable, and much could be done to further reduce mortality. For the family, their community, and professionals caring for them, every child's death is a tragedy. Systematic review of all child deaths is grounded in respect for the rights of children and their families, and aimed towards the prevention of future child deaths. In a Series of three papers, we discuss child death in high-income countries in the context of evolving child death review processes. This paper outlines the background to and development of child death review in the USA, England, Australia, and New Zealand. We consider the purpose, process, and outputs of child death review, and discuss how these factors can contribute to a greater understanding of children's deaths and to knowledge for the prevention of future child deaths. Key messages• Child mortality rates in high-income countries are low compared with the rest of the world. However, international mortality rates vary substantially for different age groups, and modifiable factors can be identified in many deaths • Although high-income countries have reliable death registration processes, concerns exist about the accuracy of cause of death data and the ability of such processes to inform health strategy to prevent future child deaths • Processes for child death review have been developed in several countries to systematically gather comprehensive data for children's deaths, to identify potentially remediable factors, and to make recommendations for system improvement Search strategy and selection criteria We searched Medline for papers published in English from Jan 1, 1990, to Dec 5, 2012, using the following terms: (death* review*.mp or fatalit* review*.mp or perinatal mortalit* review*.mp or serious case* review*.mp or critical incident* review*.mp), limited to all child (0-18 years). We reviewed the titles and abstracts of 122 papers. We then retrieved the full text of 31 papers relevant to internally reported processes for child death review. Alongside this process, we searched LexisNexis with the terms "child mortality review", "child death review", "child welfare case 3 reviews", "infant mortality review", "fetal and infant mortality review", "multidisciplinary child death reviews", and "safeguarding children panels". We retrieved relevant full texts on the basis of abstract review. We excluded state-level government reports from the USA. The combined searches provided an annotated bibliography of 81 papers about processes for child death review (appendix).
When one parent kills the other, children are confronted with multiple losses, involving their attachment figures and their direct living environment. In these complex situations, potentially drastic decisions are made, for example, regarding new living arrangements and contact with the perpetrating parent. We aimed to synthesize the empirical literature on children's mental health and well-being after parental intimate partner homicide. A systematic search identified 17 relevant peer-reviewed articles (13 independent samples). We recorded the theoretical background, methodology, and sample characteristics of the studies, and extracted all child outcomes as well as potential risk and protective factors. Children's outcomes varied widely and included psychological, social, physical, and academic consequences (e.g., post-traumatic stress, attachment difficulties, weight and appetite changes, and drops in school grades). Potential risk and protective factors for children's outcomes included 10 categories of pre-, peri-, and post-homicide characteristics such as cultural background of the family, whether the child witnessed the homicide, and the level of conflict between the families of the victim and the perpetrator. We integrated the findings into a conceptual model of risk factors to direct clinical reflection and further research.
A recent Australian study of people experiencing poverty, involving in‐depth interviews with 20 participants, suggests that a complex process leading to poverty in adult life can stem from abusive and adverse experiences in childhood. It is considered that these experiences of abuse and adversity may begin a process of ‘negative chain effects’ (Rutter, 2000) resulting in a pathway into poverty caused by ‘accumulated adversity’ (Seth‐Purdie, 2000). The development and maintenance of human capital, defined as the sum of a person's physical, psychological and economic capabilities, are strongly influenced by the extent of adversity experienced over a person's life course, particularly experiences of adversity in early childhood (Seth‐Purdie, 2000). In this paper, the experiences of childhood abuse and adversity reported by the interviewees will be outlined and discussed in the light of theory and research related to development during childhood and adolescence. Copyright © 2007 John Wiley & Sons, Ltd.
A B S T R AC TThis paper reports on a study which sought to obtain greater knowledge and understanding of the life circumstances of a group of people who had experienced adversity and abuse in childhood. A qualitative research strategy involving in-depth interviews with individuals was used to help achieve the study's aim. The study found that interviewees detailed multiple risks to their development during childhood and adolescence, including experiences of child abuse, being placed in care and major grief and loss experiences. Most had left home in their mid-teenage years and had little or no contact with their families of origin. Interviewees had very limited social networks and described difficulties in making and keeping friends. Many reported unstable and often violent personal relationships. As suggested by attachment theory, this study supports the notion of developmental continuities from adverse childhood experiences into later life, particularly in relation to personal and social relationships. Recommendations for a number of suitable methods of intervention and support are outlined.
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