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Injury prevention in child death review
  1. Brian D Johnston1,2,
  2. Theresa M Covington3,4
  1. 1Harborview Injury Prevention and Research Center, Seattle, Washington, USA
  2. 2Department of Pediatrics, University of Washington, Seattle, Washington, USA
  3. 3National Center for Child Death Review, Washington DC, USA
  4. 4Michigan Public Health Institute, Okemos, Michigan, USA
  1. Correspondence to Dr Brian D Johnston, Harborview Injury Prevention and Research Center, 325 Ninth Avenue – Box 359774, Seattle, WA 98104, USA; bdj{at}

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The death of a child is always a shocking and tragic event. But as human communities pass through the epidemiologic transition, infant and child mortality declines to a point where these events are also unexpected and perceived as fundamentally unnatural. Due to improvements in public health, immunisations, sanitation and basic medical care, most parents, in most parts of the world, can expect a child born in the early years of the 21st century to attain maturity. Thus, when a child does die, it is both profoundly disturbing and very likely to be sudden and unexpected—the consequence of violence, injury or another external cause.

Functions of CDR

Faced with a child death, communities are predictably interested in understanding what happened, especially for violent deaths of young children. Communities demand the assignment of an accurate cause and manner, with any evidence of intentional injury or criminal neglect addressed by law enforcement. This is the first level of death review: ensuring justice for child victims and safeguarding their survivors.

The formal, multidisciplinary process of child death review (CDR) was developed in the USA in the late 1970s as a direct response to this most basic task.1 Communities became concerned that cases of inflicted injury and child homicide were being overlooked or misclassified. They reasoned that a process promoting information sharing among social services, law enforcement, child welfare, public health, and the medical examiner or coroner might reduce the risk of misclassified child abuse deaths.2 3 National expansion of the CDR process was justified on the basis of this ‘critical need for the systematic evaluation and case management of suspicious child deaths’.1 As a result, there is now a CDR process in almost every US …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.