Laura A. Seewald, Heather A. Hartman, Philip Stallworth, Eugenio Weigend Vargas, Peter F. Ehrlich, Heather Dykstra, Cynthia Ewell Foster, Rebeccah Sokol, Douglas Wiebe, Patrick M. Carter; Childhood Firearm Deaths During Intimate Partner Violence Incidents: 2004–2020. Pediatrics November 2024; 154 (Supplement 3): e2024067043Q. 10.1542/peds.2024-067043Q
Abstract
Intimate partner violence (IPV), defined as physical violence, psychological aggression, sexual abuse, and stalking in current or former intimate relationships, is a public health problem that impacts children and adolescents both directly and/or as collateral victims.1–4 Over 15-million children in the United States are exposed to IPV annually,5 and 6% to 10% of violent pediatric deaths are IPV related incidents.2,3 Firearm presence during IPV encounters increases risk for fatal outcomes fivefold,6 and firearms are the most common mechanism of death during childhood IPV incidents.2–4 Previous work on childhood IPV deaths used the US National Violent Death Reporting System but has not examined incident details that may differ between firearm and nonfirearm childhood IPV deaths.2–4 This work describes characteristics of childhood firearm IPV incident deaths and differences between firearm and nonfirearm childhood IPV deaths with data from an alternative reporting system, the National Fatality Review-Case Reporting System (NFR-CRS), used by child death review teams.
Methods
Data are from the NFR-CRS for children ages 0 to 18 years-old who died between 2004 and 2020 as reported from 37 states. NFR-CRS development details, variables, and limitations are described elsewhere.7 Childhood IPV incident deaths were included in this sample if the mechanism of death was identified as bodily force or weapon (eg, firearm) and the mechanism intention included IPV. We report descriptive analyses for the child’s demographics, mechanism of death, incident details, and firearm characteristics, as well as unadjusted logistic regressions for bivariate comparisons (ie, odds ratios) of firearm versus nonfirearm childhood IPV deaths. Recognizing race and ethnicity as social constructs and as reported on death certificates, categories were collapsed into white and non-Hispanic versus other, given low counts within other categories. Child maltreatment history, IPV victimization history, open child protective service (CPS) cases, and number of deaths during the incident were not included in bivariate analyses because of substantial missing data (>10%) but are described below. Variables with missing data are noted when applicable and reported percentages or unadjusted logistic regressions exclude missing data. This study was exempt per University of Michigan’s Institutional Review Board.
Results
Four-hundred-and-sixty-four childhood deaths from bodily force or weapon were classified as an IPV incident in the NFR-CRS between 2004 and 2020 (Table 1). Within the sample, 43.6% (n = 337-of-464) and 37.1% (n = 170-of-464) of decedents had prior maltreatment or IPV victimization reports, respectively, and 8.0% had open CPS cases at time of death (n = 387-of-464). Firearms were the most common mechanism of death (64.7%). Other mechanisms of death included: bodily force (19.0%), knife or sharp object (17.2%), another weapon (7.1%) (eg, rope), and unknown (1.7%). For childhood firearm IPV incident deaths, handguns were used most often (72.3%), with the primary caregiver (58.3%) often cited as the firearm owner. There were higher overall number of deaths during an incident (n = 361-of-464) when a firearm was used (mean = 3.1) compared with all other mechanisms (mean = 1.8). In bivariate comparisons, children who died in an IPV incident with a firearm compared with another mechanism were more likely to be older, and the person responsible was more likely to be the parent