Background There is a lack of national data on child homicides in South Africa and child abuse is considered to be a major problem. Yet, there is a limited understanding of the relationship between child deaths and abuse.

Aim To describe the incidence of both overall child homicide and fatal child abuse by age and gender.

Methods A national retrospective study at a stratified random sample of 38 mortuaries was conducted to identify all child homicides for the year 2009. Data was gathered from mortuary files, autopsy reports and police interviews.

Results South Africa has a child homicide rate of 5.5 per 100 000 under 18 years. The age pattern indicates a bimodal age distribution with child homicides more likely to occur in the age group 0–4 years for females, 8.3 per 100 000, while older males were more likely to be victims, 21.7 per 100 000 in the 15–17 age group for males. Nearly half (45%) of all child homicides are due to child abuse, with such murders more likely to occur in the 0–4 age group. Children who were killed due to abuse were more likely to be killed at home with 64% of these children were killed by a mother.

Significance Rates of child homicide in South Africa are higher than the global average in particular for younger children with such deaths more likely to be child abuse related.