Major Causes of Early Childhood Death From Injury Identified

Homicide, accidental suffocation, motor vehicle accidents, fire, drowning, and choking were the major causes of injury-related death for children less than a year of age, according to a study by researchers at the National Institute of Child Health and Human Development (NICHD). The study appears in the May 3 issue of Pediatrics.

"This important study examines some major causes of death for small children," said NICHD Director Duane Alexander, MD. "The study provides vital information for planning interventions that can help prevent this needless, tragic loss of life."

The investigators were led by Ruth Brenner, MD, MPH, of NICHD's Division of Epidemiology, Statistics, and Prevention Research. They began by analyzing a set of linked infant birth and death certificates, compiled by the National Center for Health Statistics, for the years 1983 through 1991. Homicides claimed the greatest number of lives. A listing of deaths by all categories follows.

  • Homicide : 2345 (22.6 percent)
  • Suffocation : 1839 (17.7 percent)
  • Motor vehicle accident 1580 : (15.2 percent)
  • Fire : 990 (9.5 percent)
  • Drowning : 745 (7.2 percent)
  • Choking on food : 734 (7.1 percent)
  • Choking on objects : 609 (5.9 percent)
  • Other unintentional injuries : 1097 (10.6 percent)
  • Injuries of undetermined intent : 431 (4.2 percent)

The study found that infants were more likely to die from injuries if their mothers were young, unmarried, had lower levels of education, had more older children, had received prenatal care either late or not at all, or were Native American or African American. Infants who died from an injury were more likely to be of low birth weight, premature, and male. In addition, the researchers found that specific injuries corresponded with specific risk factors. For example, children born to mothers who were younger or had given birth previously were at twice the risk for suffocation. Infants born to Native American mothers were at greatest risk for motor vehicle-related deaths and drownings, while the rate of death from choking was highest among low-birth weight infants.

Dr. Brenner cautioned that the study was limited to information that was listed consistently on birth and death certificates, such as birth weight on birth certificates, and cause of death on death certificates. This limitation prevented the researchers from examining the influence of paternal characteristics and other important factors, such as household income.

Dr. Brenner added that efforts to prevent childhood injuries and injury-related deaths should continue to focus on such general strategies as the use of car safety seats for infants and visiting home nurse programs for young, unmarried mothers. She pointed out, however, that there is also a need to develop specific intervention strategies for children at particularly high risk of death.

"Our study identified groups of infants at increased risk of death due to injury," she said. "This will help in the design of more focused interventions to prevent injuries in high risk groups of children.

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