Violent Death in Children in a Metropolitan County: Changing Patterns of Homicide, 1958 to 1982

(1)

Violent

Death

in Children

in a Metropolitan

County:

Changing

Patterns

of Homicide,

1958 to 1982

Jerome A. Paulson, MD, and Norman B. Rushforth, PhD

From the Departments of Pediatrics, Biology, and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland

ABSTRACT. Death rates from homicide in children younger than 15 years of age in the United States have increased during the last 30 years. Previous studies have suggested a typology consisting of fatal child abuse in young children and community violence in older children. We reviewed the data from the Cuyahoga County, Ohio, coroner’s office pertaining to homicides in children less than 15 years of age between 1958 and 1982 and obtained similar findings. The homicide rates for city children increased from 1.1 to 6.7/100,000 in the first 20 years and

then stabilized. Nonwhite boys had the highest death

rates except in one period. Assailants were usually ado-lescent and young adult men of the same race; however, 43% of children less than 5 years of age were killed by women. The older the child, the more likely the homicide was to have been committed by a nonrelative, outside of the home, and with a firearm. Overall, firearms are the leading cause of homicide (36.2%). The temporal char-acteristics of child homicides are also described. Pediat-rics 1986;78:1013-1020; homicide, child abuse, fatal inju-ries, community violence, firearms.

Whereas total US death mates of children younger than 15 years of age decreased systematically during the past 30 years, those from homicide have

dna-matically increased.1 Homicide has been one of the

leading causes of death in childhood2 and US rates are currently among the highest in the world.3

Several early studies 46 of pediatric homicide focused on the killing of children by their parents. These reports proposed typologic classification

Received for publication Aug 30, 1985; accepted Feb 19, 1986. Presented, in part, at the Ambulatory Pediatric Association Meeting, Washington, DC, May 9, 1985.

Dr Paulson’s current address is Joseph P. Kennedy, Jr, Foun-dation, Washington, DC 20005.

Reprint requests to (J.A.P.)

3800

Porter St, NW, 304,

Washing-ton, DC 20016.

schemes of child homicide primarily based on the

state of mind of the perpetrators.

More recent analyses using data from the US Department of Health and Human Services, and the Federal Bureau of Investigations-Uniform

Crime Reporting Systems, provide yp78 of

child homicide perpetrated by parents and

nonpar-ents. Jason et al,8 in reviewing data for victims

younger than 18 years of age, identify two broad categories of child homicide. The first, defined as “fatal child abuse” is intrafamilial, occurs most

often in children 3 years of age and younger, and is

associated with bodily force and poorly defined

precipitating events. The second type is extmafa-milial, occurs most often in children older than 12

years of age, and frequently involves firearms or

knives as lethal weapons. It occurs often during

arguments or criminal acts by the assailant. Jason

et a! define this type as “fatal parental-society neglect,” because it represents the death of children unsupervised in an adult environment. They con-cluded that characteristics of child homicide begin

to resemble those of adult homicide at an early age.

Homicides that occur in children between 3 and 12 years of age appear to be a mixture of the two types, an increasing proportion of the adult type occurring with increasing victim age.

Christoffel,9 using US data on the perpetrators and weapon for differing ages of victims, proposes three subtypes for homicides in children younger than 18 years of age. This typology focuses on the environmental risk to child victims and is based on their changing developmental vulnerabilities with age. She characterizes the three types as (1) infan-ticide (parental impatience with infantile behavior

erupts into violence, resulting in CNS injury not

seen in older victims), (2) fatal child abuse and

neglect after infancy (toddlers and preschool

(2)

inappro-pmiate demands face fatal punishment), and (3) homicide in the community (homicide involving vulnerability in later childhood, resulting from a discrepancy between increased mobility out of the home and judgment on the part of the school-aged child). Based on this typology, Christoffel proposes a public health approach in reducing fatal violence against children.

Studies of violent death have been ongoing in

Cuyahoga County, Ohio (metropolitan Cleveland),

since the late 19505.10-13 In this urban county, the age-adjusted homicide mate for all victims has in-creased from a baseline level of 5.3/100,000 (1958 to 1962) to a peak of 19.6/100,000 county popula-tion (1973 to 1977) and then decreased to a level of 17.6 in the final 5-year period (1978 to 1982) under investigation. The most dramatic increase in hom-icide mates has been for homicide victims slain by firearms. The proportion of firearm homicide vic-tims increased from 54% to 74.2% during the 25-year time span of the study. Most victims were killed by assailants of the same race, with the highest mates among nonwhite men in the city.

15 has reported on cases in this popu-lation pertaining to child-child homicide and adult-child homicide.

The purpose of the present study was to system-atically analyze the data from the Cuyahoga County coroner’s office and to described trends in homicide rates in the county during the period 1958 to 1982 in children less than 15 years of age. Because the

typologies of child homicide previously proposed

are highly dependent on the age of the victim, we postulated that various characteristics of the hom-icides would be different for differing age groups of the victims.

MATERIALS AND METHODS

Cuyahoga County (“county”) consists of the city of Cleveland (“city”) and an adjacent aggregate of 38 cities, 18 villages, and four townships collectively referred to as “suburbs.” All known or suspected violent deaths in the county are investigated by the coroner, regardless of the fashion in which the violence arose (section 313.12, Ohio Revised Code). Moreover, only the coroner can sign a valid death certificate when injury, however sustained, is en-timely responsible for or is a contributory factor in causing death. Since 1936, Samuel R. Gerber, MD,

JD, has been county coroner. Under his direction, the professional staff has provided a set of uniform records based on consistent criteria for verdicts. Data from police reports, which include eyewitness accounts, and hospital records supplement the an-atomic, toxicologic, and other objective findings of the coroner’s staff. Such data are present for

vim-tually all cases.

Our analysis was based on statistical abstracts of the coroner’s files, broken down into five, 5-year time frames: 1958 to 1962, 1963 to 1967, 1968 to 1972, 1973 to 1977, and 1978 to 1982. Annual hom-icide mates were calculated using data from coroner’s

records for the number of deaths and from the US

Census Bureau publications for population figures.

The latter included a special census for the city of Cleveland carried out in 1965. Average annual hom-icide mates were calculated for the 5-year periods centered around the decennial census years, ie, 1958

to 1962 (1960), 1968 to 1972 (1970), and 1978 to

1982 (1980), using actual census figures as the

denominators. For the 5-year periods 1963 to 1967 (1965) and 1973 to 1977 (1975), the city, suburban, and county populations were estimated by linear interpolations of the decennial census figures, ex-dept for the period 1963 to 1967 (1965) for the city, where population data from the special census were used.

Theme were three justifiable homicides in the age group less than 15 years included in the data. Traffic manslaughters were not included. Fatalities were tabulated according to location of the homi-cide incident (city v suburbs) rather than the place of death or residence of victim. Race is designated

as white or nonwhite; the nonwhite county

popu-lation was 98.7%, 97.3%, and 92.6% black in 1960,

1970, and 1980, respectively.

Homicide rates were expressed as numbers of victims per 100,000 population in each of the 5-year periods, for age groups 0 to 4, 5 to 9, and 10 to 14

years. The number of homicides occurring in the

first week and first year of life were not sufficient for statistical analysis. Rates for the total age group,

0 to 14 years (Fig 1, left) are expressed as

age-adjusted mates for the periods, using the direct methods16 and US total population for 1970 as the standard population.

Statistical significance of changes in mates were

tested using x2 tests for Poisson variables.’7 The rates for the five periods were used in a hetemoge-neity test. Sets of homicide rates not compatible with Poisson variables with the same mean were subsequently tested for linear and nonlinear trends.

x2 goodness of fit tests and

x2

tests for contingency tables were used in testing for temporal

relation-ships in homicides, mode of lethal violence, and

assailant characteristics.17

RESULTS

Long-Term Trends in Homicide Rates

In the 25 years from 1958 to 1982, theme were

(3)

7 Victims <l5yrs 6 City 70 5 Victims l5yrs 60 4 50 City 3 County 40 2 30 1 20 1960 10

1970 1980 0

Suburbs

1960 YEAR

Fig 1. Age-adjusted homicide rates for city, suburbs, and county: Left, victims younger than 15 years of age; right, victims older than 15 years of age.

1970

5,153 (90%) occurred in the city. During this period, theme were 235 homicides of children between birth and 14 years of age. Of these, 189 (80.4%) occurred

in the city, 137 (58.2%) were nonwhite, 128 (58.7%)

were boys, approximately one half (117) were less than 4 years of age, 51 (21.7%) were 5 to 9 years, and 67 (28.5%) were 10 to 14 years.

The changing patterns of homicide mates for vic-tims less than 15 years of age were similar to those of victims 15 years and older (Fig 1). The homicide mates for children in the city increased nearly sev-enfold from the first 5-year interval to the fourth interval (P

<

.05) and then stabilized (Fig 1, left). The suburban mate remained stable throughout the quarter century. Overall, for the county, the rate increased from 0.9 to 3.2 (P

<

.005, Fig 1, left).

0 0 0 0 0 Co

0

> w I-. w 0 0 0 I

Homicide trends for older victims mirrored these changes, although the rates were almost tenfold greater throughout the time span of the study (Fig 1, might).

The numbers of homicides and homicide mates for children less than 15 years of age by mace and sex for the city and county are given in Table 1. (County census is given in Table 2.) Rates for nonwhites were higher than for whites of the same sex, nonwhite boys having the highest mates except for the initial period. During the last 10 years, white male rates were higher than those of white girls in both the city and the county.

Age-specific rates for victims 0 to 4, 5 to 9, and 10 to 14 years of age are given in Fig 2. Throughout the entire time span of the study, homicide mates

TABLE 1. Homicides for

Cuyahoga County, Ohio: 1

Children Young 958 to 1982*

em Than 15 Years of Age by Race a nd Sex for the City of Cleveland and

Group and Location

of Homicide 1958-1962 No. Rate 1963-1967 No. Rate 1968-1972 No. Rate 1973-1977 No. Rate 1978-1982 No. Rate

City of Cleveland White boys Nonwhite boys White girls Nonwhite girls Total Age-adjusted Cuyahoga County White boys Nonwhite boys White girls Nonwhite girls Total . Age-adjusted 0 0.0 5 2.2 3 0.8 6 2.7 14 1.1 LO 5 0.5 5 2.2 7 0.7 7 3.0 24 1.0 0.9 6 1.7 14 5.4 6 1.8 8 3.0 34 2.8 2.5 11 1.1 14 5.0 8 0.9 8 2.8 41 1.7 1.6 2 0.7 17 7.0 8 2.9 13 5.2 40 3.8 3.7 6 0.6 18 6.4 14 1.6 14 4.9 52 2.2 2.2 12 5.4 29 13.8 7 3.3 9 4.3 57 6.7 6.7 18 2.5 32 12.2 8 1.1 10 3.8 68 3.5 3.5 12 7.8 14 7.9 6 4.2 12 6.9 44 6.8 6.6 13 2.4 16 6.5 8 1.6 13 5.4 50 3.2 3.2

(4)

0 0 0 0

0

Cl)

I-0

>

w

I-w

0

I

5.0

4.0

3.0

2.0

1.0

0

TABLE 2. Census for Cuyahoga County, Ohio, Population Younger Than 15 Years of Age

Yr City Suburbs

Boys Girls Boys Girls

White Nonwhite White Nonwhite White Nonwhite White Nonwhite

1960 1970 1980

82,881 58,062 30,586

44,960 48,588 35,259

78,869 55,654 28,918

45,177 49,487 35,008

119,599 125,774

77,663

740 7,473 13,750

115,258 120,035

74,056

756 7,576 13,413

1970

YEAR

Fig 2. Age-specific homicide rates for victims younger

than 15 years of age for Cuyahoga County, Ohio.

for victims younger than 5 years of age were highest, increasing systematically with successive periods

(P

<

.02). An approximately parallel increase in mates for victims 10 to 14 years of age occurred (P

< .01), whereas mates for the age group 5 to 9 years peaked during the fourth quinquenium (Fig 2). Seg-megating the data by city v suburbs for the four mace-sex groups indicated that nonwhite city male victims younger than 5 years of age had the highest homicide mates of any group: 17.1 and 17.4 victims per 100,000 in the last two periods.

Characteristics of Homicides

Assailant Characteristics. During the last 10 years of the study when the age of the assailant was recorded, the majority of children (51.1%) were killed by assailants between 25 and 39 years of age. Only 7.6% of the victims were killed by other chil-dren (5 to 14 years of age); no deaths were caused by children less than 5 years of age (Table 3). The age group of the victim and the assailant were associated (P

<

.05). For victims 10 to 14 years of age, assailants were younger than those who per-petmated lethal violence on children 0 to 9 years of age.

The race and sex of the assailant by mace, sex, and age group of the victim are given in Table 4. Child homicide was almost exclusively intramacial:

96% of victims were killed by members of the same mace. The majority of assailants were men, but a

significantly higher proportion of the children less

than 5 years of age were killed by women (43% v

15%) than victims in the two older age groups,

irrespective of race (P

<

.005).

Although approximately one half of the homi-cides for all children were perpetrated by relatives,

the proportion of homicides by relatives decreased

systematically with increasing age of the victim (P

< .005): 71.7% for victim 0 to 4 years, 60.8% for

victim 5 to 9 years, and 13.4% for victim 10 to 14 years. For 1.7% of victims, the relationship between the victim and the assailant was unknown. A sim-ilam gradient was seen in the relative frequency of homicide occurring in the home of the victims (P

< .005): victims age 0 to 4 years (87.2%), 5 to 9

years (80.4%), and 10 to 14 years (56.7%). In 1.7%

ofcases, the location ofthe homicide was unknown.

Only five homicides were perpetrated by

assail-ants while committing another crime, four of which

occurred among victims was 10 to 14 years of age. Forty-seven homicides occurred during a quarrel. The proportion of such homicide increased with increasing age of the victim (P

<

.005): victims age

0 to 4 years (11.1%), 5 to 9 years (25.5%), and 10

to 14 years (31.3%).

Methods of Lethal Violence. In the county, the

mode of death varied significantly with the age of the victim (P

<

.005, Table 5) and is known for all

victims in the study. Among children 0 to 4 years

of age, the leading cause of death was violence with a blunt instrument, including hands and feet (42.7%), followed by asphyxiation (17.1%) and

fire-arms (15.4%). With increasing age of the victim,

violence with a blunt instrument decreased in mel-ative frequency as a method of lethal violence,

whereas deaths from firearms markedly increased.

Ten- to 14-year-old victims were killed most

fre-quently by firearms (62.7%), and violence with a

blunt instrument accounted for only 4.5% of the homicides.

Firearms were used more frequently in killing

male than female victims, 41.3% v 28.9%, but this

was due exclusively to a preponderance of male

(5)

propor-TABLE 3. Age of Assailant for Homicide Victims Younger Than Cuyahoga County, Ohio, 1973 to 1982, by Age of Victim*

15 Years of Age in

Age of Assailant (yr) Age of Victim (yr) Total

0-4 5-9 10-14

5-14 15-24 25-39 :40

Subtotal More than one Unknown Total

1 17 19 0 37 3 8 48

(2.7) (45.9) (51.4) (0) (77.1)

(6.2) (16.7) (100)

1 (4.0) 3 (12.0) 19 (76.0) 2 (8.0) 25 (80.6) 1 (3.2) 5 (16.1)

31 (100)

5 13 9 3 30 1 8 39

(16.7) (43.3) (30.0) (10.0) (76.9) (2.6) (20.5) (100)

7 (7.6) 33 (35.9) 47 (51.1) 5 (5.5) 92 (78.0)

5 (4.2) 21 (17.8)

118 (100)

Results are numbers (percentages) of victims.

* Age group of assailant was recorded only for the last 10 years of the study period.

TABLE 4. Race and Sex of Assailant for Homicide Victims Younger Than 15 Years of Age in Cuyahoga County, Ohio, 1958 to 1982, by Age, Race, and Sex of Victim*

Assailant Victim’s Age (yr)

Boys Girls

White Nonwhite White Nonwhite

0-4 5-9 10-14 0-4 5-9 10-14 0-4 5-9 10-14 0-4 5-9 10-14

Male

White 12 7 16 0 0 1 10 8 5 0 0 0

Nonwhite 1 0 2 20 12 21 0 0 1 11 6 9

Female

White 9 4 0 1 1 0 10 2 0 0 1 0

Nonwhite 0 0 0 12 3 1 0 0 0 9 3 0

* Results are numbers of victims. Additional data: three nonwhite male, one white female,

and three nonwhite female children were the victims of more than one assailant; the

assailant was unknown in cases involving two white and ten nonwhite boys and eight white and ten nonwhite girls.

TABLE 5. Mode of Homicide for Victims You County, Ohio, 1958 to 1982, by Age of Victim*

nger Than 15 Y ears of Ag e in Cuyahoga

Mode of Homicide

0-4

Age of Victim (yr) Total

5-9 10-14

Firearms 18 (15.4)

Violence with blunt instrument, 50 (42.7) including hands and feet

Cuts and stabs 5 (4.3)

Asphyxia 20 (17.1)

Other 24 (20.5)

25 (49.0) 7 (13.7)

4 (7.8) 11 (21.6)

4 (7.8)

42 (62.7) 3 (4.5)

9 (13.4) 8 (11.9) 5 (7.5)

85 (36.2) 60 (22.5)

18 (7.7) 39 (16.6) 33 (14.0)

* Results are numbers (percentage) of victims.

tions of male and female homicides due to firearms

were equivalent. The proportionate use of firearms

was similar for white and nonwhite victims (white

male, 43.4%; nonwhite male 40.0%; white female, 28.9%; nonwhite female, 28.8%). For victims 5 years of age and older, homicides from firearms increased from the baseline period, peaking in the fourth quinquenium (Fig 3, left). For victims 0 to 4 years of age, firearm homicide mates tended to remain low throughout the 25-year span of the study. In

con-trast, rates of nonfirearm homicides increased

sys-tematically for this age group and were consistently higher than those for victims 5 to 9 and 10 to 14 years of age (Fig 3, might).

Among children 0 to 14 years of age, handguns accounted for 55.4% of fatalities caused by firearms. For the entire age spectrum, handguns accounted for 49.4% of homicides due to firearms (Table 6).

Temporal Characteristics of Homicides. The tern-pomal characteristics of homicides (time of the day, day ofweek, and month ofyear) for victims younger than 15 years of age were compared with those of culpable homicide for victims 15 years of age and older. For victims 15 years of age and older, a pattern of increasing homicide from noon until

midnight emerged, with continued high frequency

for the next three-hour period (1:00 AM to 3:00 AM)

(6)

Non-firearms

5.0 - Firearms 5.0

4.0 4.0

3.0- 3.0

10-l4yrs

::

S ,‘\5-gyrs

::

YEAR

1960 1970 1980

..

,

.R..

10-l4yrs

#{163}..‘?:.#{232}’

I

1960 1970 1980

* Results are numbers (percentages) of homicides.

25

Cl)

w

20

0

I

15- U-0

I-z w

0

LU Q.

10

5-0

1-3 4-6 7-9

AM.

Fig 4. Time of day of homicide by age of victim. -,

0 to 4 years (n = 108); A-A, 5 to 9 years (n = 51);

.. . .-U, 10 to 14 years (n = 67); x- . _ .x, 15 years (n

= 4,539).

0 0 0 0

0

Cl)

I-0

>

w

I-w

0

I

Fig 3. Age-specific homicide rates by firearms and nonfirearms for victims younger than 15 years of age for Cuyahoga County, Ohio.

TABLE 6. Type of Firearm Used in hoga County, Ohio, 1953_1982*

Homicide,

Cuya-Types of Firearm Victim 0-14 Yr of Age

All Homi-cides

Handgun

Nonautomatic 38 (46.9)

Automatic 7 (8.4)

Subtotal 46 (55.4)

Other gun

Rifle 9 (10.8)

Shotgun 15 (18.7)

Miscellaneous 5 (6.0)

Unknown 8 (8.6)

Subtotal 37 (44.6)

1,422 (45.4) 141 (4.5) 1,563 (49.9)

93 (3.0) 272 (8.7) 93 (3.0) 1,113 (35.5)

1,571 (50.1)

age and older, homicides increased on Friday,

peaked on Saturday, and remained high on Sunday.

This pattern is significantly different from that

seen in victims younger than 15 years of age (P

<

.05). Although Saturday and Sunday had an above

average percentage of child homicides, Tuesday also had a relatively high frequency. In contrast,

Wednesday had relatively fewer child homicide

vic-tims. No distinct differences were noted among the

temporal relationships of the age groups 0 to 4, 5

to 9, and 10 to 14 years, but all three showed the

high Tuesday-low Wednesday pattern.

Although the relative homicide frequencies for

victims older than 15 years of age tended to increase

slightly throughout the year, in the case of the child

homicide victim, no systematic monthly patterns

were discernible. This was evident for the individual age groups and the combined group age 0 to 14

years.

DISCUSSION

We have described the pattern of child homicides

in a single metropolitan county during a time span

of 25 years. The homicide rate that we report, the

relative proportions of the various modes of death,

I I 1 1 I I I I the relationships in terms of race, sex, and age

10-12 1-3 4-6 7-9 10-12 between the victims and assailants are all

consist-P.M. ent with other reports in the litematune.8’10’21

A recent study of homicides in the city of Los

Angeles between 1970 and 1979 did have some

different findings than our study.22 They did not

see an increase in the age-adjusted homicide rates

different from those of younger victims (P

<

.005), for those less than 15 years of age, although the

whose pattern in time depended on the age group overall age-specific homicide rate of 3.9/100,000 for

of the victim. The differences in patterns among that age group is similar to ours. Those less than

the three age groups noted in Fig 4 presumably 15 years of age accounted for 5.4% of all homicide

relate to school attendance. cases in the city, compared to 3.7% in our study.

(7)

in Cuyahoga County. Because subunban mates

me-mained constant, this increase in county homicide

rates was due to the dramatic sixfold increase in

child homicide in the city of Cleveland. We consider that such increases reflect greater levels of lethal

violence directed toward children in this urban

community rather than enhanced reporting of

vio-lent child deaths as homicides. Although we do not

believe that theme were systematic errors in

classi-fication of incidents, we cannot eliminate the

pos-sibility of some misclassifications. During the study

period, the mates of classification of incidents as

fatal home accidents in children in the county

remained constant, and increases in the rates of

classification of incidents as violence of unknown

etiology closely paralleled those of child homicide

victims. Thus, theme was no evidence of decreases

in the. rates of other forms of violent death in

children that would have accompanied increased

homicide mates due to increased diagnosis of

homi-cides among violent death in this population. We

cannot eliminate the possibility of concomitant

in-creases in accidental deaths and classification of

incidents as homicide, but we believe this to be

unlikely.

Patterns of child homicide were highly dependent

on the age of the victim. Homicide rates were

consistently higher for children younger than 5

years of age and increased systematically with

suc-cessive 5-year periods. Rates for 5- to 9-year-old

children were lower and peaked during the fourth

quinquenium.This pattern was observed for victims

of firearms in the 5- to 9- and 10- to 14-year age

groups and was evident in the adult homicide rates.

In contrast, deaths from firearms in 0- to

4-year-old victims remained at low levels throughout this

study.

Inspection of the age-specific homicide mates for

children in the three age groups (0 to 4, 5 to 9, 10

to 14 years) for the 5-year periods of the study

indicated increases in the mates of homicide for

successive cohorts. Such relationships have been

observed for mates of adolescent and young adult

suicides in this population.23 The analysis of hom-icide mates into age, period, and cohort components is relatively complex and will be the subject of

subsequent study. However, the increasing rates of

homicide for child victims suggest the possibility of

changes in parenting behavior coincident with

other observed increased mates of violent death in

the 225

Relatively fewer child homicides occurred in the

home, and fewer were perpetrated by relatives as

the age of the victim increased. Those committed

with other felonies occurred almost exclusively with

10- to 14-year-old victims, and in older victims a

greaten proportion of the homicides occurred during

or following a quarrel. A significantly higher

pro-portion of victims in the youngest age group was killed by women, whereas in the older age group

the perpetrators tended to be younger men or boys.

Most of the victims 0 to 4 years of age were killed

by blunt instruments, but the frequency of this

mode decreased systematically with the age of the victim. Conversely, with increasing age, more

vic-tims were killed by firearms or by means of cuts

and stabs. Surprisingly, as many as 15% of the

younger victims were killed by firearms, with

sim-ilar mates in male and female victims, irrespective of race. In the oldest age groups, many more boys

were shot to death than girls. Handguns accounted

for more than 55% of all childhood homicides.

Victims 10 to 14 years of age had a closer

tem-poral pattern to that seen in adults in terms of the hour of the day for the homicide incident. Patterns

for the other two age groups of child homicide were

distinct, with higher frequencies of homicide during different periods of the day.

The observed difference in (1) homicide mate

trends, (2) age and sex of the assailant and

mela-tionship to the victim, (3) location of the homicide and method of lethal violence, and (4) time of day

of the homicide event, for the three age groups of

child victims were somewhat consistent with the

typologies of child homicide advocated by both

Jason7 and Chmistoffel.9 For the youngest age group

(0 to 4 years), the characteristics of the homicide

suggest fatal child abuse. Such homicides tend to

be intrafamilial, occurring primarily in the home,

and are associated with bodily force administered

to an infant or small child. Homicides for victims

10 to 14 years of age have many of the

character-istics of adult homicides: extrafamilial, perpetrated

outside the home, primarily by firearms with a

preponderance of male assailants and victims. Such homicides bear the properties of “fatal

parental-society neglect” proposed by Jason7 and “homicide

in the community” proposed by Chmistoffel.9 Many

of these cases “may represent children drifting into an adult life style and environment for which they

are not developmentally or emotionally prepared

and in which they do not receive adequate parental

societal supervision.”8

The homicide committed against victims 5 to 9

years of age showed characteristics somewhat

in-temmediate between those of the younger and older

age groups. This suggests that homicides in this age

group may be a mixture of the other two types,

consistent with the findings of Jason.7 As with the

data for lethal violence against children in the

United States studied during a more restricted time

(8)

began to resemble those of adult homicides at an early age of the victim.

CONCLUSIONS AND RECOMMENDATIONS

1. Children 4 years of age and younger are most likely to be killed by a parent, at home, by a blunt instrument. This is most consistent with a pattern of fatal child abuse. We are currently reviewing the individual coroner’s reports, as opposed to the sta-tistical data summaries used for this paper, to de-temmine how often there was evidence of prior abuse. Are the children who die known to the medical and/or social systems in the community? Had any attempt at intervention been made? Were the episodes of violence that lead to death a first-time event for the child and their families? The answers to these questions have implications for structuring surveillance and intervention systems. Clearly, because large numbers of young children are dying at the hands of their parents, such sys-tems are inadequate.

2. Children of all ages die as a result of injuries sustained from firearms. More than 15% of those younger than 4 years of age, 49% of those 5 to 9 years, and nearly 63% of those 10 to 14 years die of firearm injuries. Slightly more than 55% of these firearm fatalities are due to handguns.

We believe that the problem of child homicides and, indeed, that of all homicides is an extremely complex one, involving numerous social, economic, and other influences. Nevertheless, it seems ob-vious that firearms are in the same environment as children and that the removal of those firearms would lead to a decline in the number of childhood homicides.

REFERENCES

1. Characteristics ofAmerican Children and Youth: 1980,

Cur-rent Population Reports. US Bureau of the Census publica-tion No. 114. Government Printing Office, 1982, p 23 2. Better Health for Our Children: A National Strategy, vol III:

A Statistical Profile. US Department of Health and Human Services publication No. (PHS) 79-55071. Government Printing Office, 1981, tables 20 & 21

3. World Health Statistics Annual Yearbook. Berne, Switzer-land, World Health Organization, 1981

4. Resnick PJ: Child murder by parents: A psychiatric review of felicide. Am J Psychiatry 1969;126:325-334

5. Scott, PD: Parents who kill their children. Med Sci Law 1973;13:120-126

6. D’Orban PT: Women who kill their children. Br J Psychia-try 1979;134:560-571

7. Jason J: Child homicide spectrum. Am J Dis Child

1983;137:578-581

8. Jason J, Gilliland JC, Tyler CW Jr: Homicide as a cause of pediatric mortality in the United States. Pediatrics

1983;72:191-197

9. Christoffel KK: Homicide in childhood: A public health problem in need of attention. Am J Public Health

1984;74:68-70

10. Hirsch CS, Rushforth NB, Ford AB, et al: Homicide and suicide in a metropolitan county: I. Long term trends. JAMA

1973;223:900-905

11. Rushforth NB, Hirsch CS, Ford AB, et a!: Accidental firearm fatalities in a metropolitan county (1958-1973). Am J

Epi-demiol 1975;100:499-505

12. Rushforth NB, Ford AB, Hirsch CS, et al: Violent death in a metropolitan county: Changing patterns in homi-cide(1958-1974). N Engi J Med 1977;297:531-538

13. Ford AB, Rushforth NB, Rushforth N, et al: Violent death in a metropolitan county: II. Changing patterns in suicides (1958-1974). Am J Public Health 1979;69:459-464

14. Adelson L: The battering child. JAMA 1972;22:159-161

15. Adelson L: Slaughter of the innocents: A study of 46 homi-cides in which the victims were children. N EngI J Med

1961;264:1345-1349

16. Colton T: Statistics in Medicine. Little, Brown & Co, Boston, 1974, p 47

17. Snedecor GW, Cochran WG: Statistical Methods, ed 7. Ames, Iowa State University Press, 1980, pp 197-201 18. Klein D, Reizen MS, Van Amburg GH, et al: Some social

characteristics of young gunshot fatalities. Accident Anal Prey 1977;9:177-182

19. Jason J, Carpenter MM, Tyler CW: Underrecording of infant homicides in the United States. Am J Public Health 1983;73:195-197

20. Kaplun D, Reich R: The murdered child and his killers. Am

J Psychiatry 1976;133:809-813

21. Copeland AR: Homicide in childhood: The Metro-Dade County experience from 1956 to 1982. Am J Forensic Med Pathol 1985;6:21-24

22. University of California at Los Angeles, Centers for Disease Control: the Epidemiology of Homicide in the City of Los Angeles, 1970-79. US Department of Health and Human Services, Public Health Service. Atlanta, Centers for Disease Control, August 1985

23. Rushforth NB, Ford AB, Sudak HS, et al: Increasing suicide rates in adolescents and young adults in an urban commu-nity (1958-1982): Tests of hypotheses from national data, in Sudak HS, Ford AB, Rushforth NB (eds): Suicide in the

Young, Boston, John Wright, 1984, pp 45-68

24. Holinger PC: Violent deaths among the young: Recent trends in homicide and accidents. Am J Psychiatry

1979;136:1144-1147

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1986;78;1013

Pediatrics

Jerome A. Paulson and Norman B. Rushforth

1958 to 1982