Objective: To review cases of fatal child abuse, looking for any characteristic features of these cases.
Design and setting: A case review of all childhood deaths at The Children's Hospital, Camperdown, between January 1976 and December 1990. Cases with a definite diagnosis of child abuse were extracted. Cases where there was only a suspicion of child abuse as the cause of death were not included.
Subjects: Seventeen cases of fatal child abuse were reviewed with emphasis on autopsy findings and sociological data.
Results: All children who died were less than three years of age; nine were under one year. Seventy-six per cent died from head injury and 24% from asphyxia or strangulation. In addition to their fatal injuries, 41% had multiple bruises on the trunk and limbs. Thirty-five per cent had evidence of previous physical abuse.
Conclusions: The commonest age for fatal child abuse is the first year of life. When physical abuse occurs in children under three years, and particularly under one year, a thorough assessment, follow-up and institution of appropriate supportive services are essential, as the abuse may be an early warning of a subsequent fatal episode of abuse. The introduction of a process of review of child deaths may increase awareness of and help prevent fatal child abuse.