Child Deaths Stand Out

February 8, 2008 - Injury Free Coalition for Kids of Baltimore

Children were twice as likely to die of injuries in Baltimore as they are in Maryland or the nation as a whole, a new study has found -- with homicides accounting for almost 60 percent of the deaths.

The report, analyzing fatal injuries among children from 2002 through 2006, also showed that homicides declined during most of that period before rebounding in the final year. An average of 27 children died in homicides annually, about 10 percent of the citywide toll. Many were teenagers.

"What stands out is that kids in Baltimore are eight times more likely to die from homicides as children nationwide or in Maryland as a whole," said Caroline Fichtenberg, an epidemiologist with the Baltimore City Health Department.

Cause of death A new four-year study of child mortality in Baltimore City shows that children die more often from murder than any other cause.

Source: Baltimore City

"It's not necessarily a surprise, but when you quantify how much worse we're doing, it makes you really step back and think again about what we can be doing to prevent these deaths."

On a more hopeful note, the fatal injury rate among children declined 29 percent over the period. Accidental-injury deaths dropped by half and homicides by a quarter, despite the uptick in 2006.

This year, one child has died in a homicide -- a 14-year-old boy in Cherry Hill who was found bleeding from a gunshot wound in his left shoulder.

Thirty-five percent of the fatal injuries were considered accidental, with motor vehicle accidents accounting for the largest proportion, followed by residential fires. City children were a third less likely to die in car accidents as children nationwide, but four times as likely to die in fatal fires.

The report covered children from 1 to 17 years of age. Infants less than a year old were excluded because most fatalities among this group have unexplained causes -- including Sudden Infant Death Syndrome, Fichtenberg said.

"For me, what the report does is show how much and where we have problems in Baltimore that are different from what's usual in the United States," said Dr. Joshua M. Sharfstein, the city health commissioner. "... it also highlights the relatively large number of fire deaths we have in Baltimore."

The report, providing a snapshot of fatal childhood injuries according to cause and demographics, was prepared by a fire fatality review committee led by Sharfstein and made up of officials from many city agencies.

Over the five-year period, some 22 children died in house fires, accounting for more than a quarter of accidental deaths. A new state regulation aimed at reducing those fires will require the sale of self-extinguishing cigarettes by July.

Sharfstein has proposed a regulation that would require an earlier startup date for those cigarettes in the city, although he said two companies -- Philip Morris and Lorillard -- have agreed on a voluntary basis.

Black, non-Hispanic children had higher death rates than white children for every type of fatal injury except suicide, according to the report. They were six times more likely than white, non-Hispanic youths to be victims of homicide and 20 percent more likely to die in a fatal accident.

Among black children, those 16 and 17 years old had the highest death rate from injuries -- 107.4 per 100,000 children -- which was three times higher than the rate among 13- to 15-year-olds.

Across all groups, gunshots were the most common cause of homicide deaths, accounting for 65.5 percent of the total. They were followed by stabbings (11.3 percent) and blunt-force injury (8.5 percent), followed by arson, asphyxiation and other causes.

Though many of the city's homicides are drug-related, fatal drug overdoses are extremely rare among children. Fichtenberg said there was one fatal overdose in that age group over a 12-year period ending in September 2007.

Last year, a 2-year-old girl died of a methadone overdose after her mother gave her the drug to quiet her, according to police.

Speaking broadly about children killed in homicides, Sharfstein said the drug culture plays a large role but so does the wide availability of guns.

"It doesn't mean the disputes are about drugs," he said. "There is too much access to guns, too much reaching for guns to settle an argument."


Jonathan Bor
Baltimore Sun Reporter

Caroline Fichtenberg
Baltimore City Health Department