North Carolina Office of the Chief Medical Examiner

Michelle Aurelius, MD

Chief Medical Examiner and Chair, NC CFPT

Office of the Chief Medical Examiner

NC Child Fatality Prevention Team Annual Summary

2018 Child Deaths in NC (ages 0-17 years)

Report prepared by:

Kerry Young, MS

Social/Clinical Research Associate, NC CFPT

Phone: 919.743.9058

Fax: 919.743.9099

E-mail: kerry.young@dhhs.nc.gov

2

TOTAL NUMBER OF DEATHS 2018

North Carolina under the Age of 18 Years

Throughout the 2018 calendar year, the State Center for Health Statistics (SCHS) reported 1,255

children died in North Carolina. Many of these deaths were expected and included children who

died from a known natural disease or illness. The North Carolina Medical Examiner system

investigated the cause and manner of death for 482 children.

The cases investigated by the Medical Examiner system included a number of natural deaths, as

well as accident, homicide, suicide and deaths for which no cause and/or manner of death could

be determined. The cases investigated by the Medical Examiner System are also assigned a means

of death which refers to how the death occurred. Means included unknown, motor vehicle, natural,

gun, asphyxia, drowning, blunt, fire, toxicology, other, SIDS, fall/jump, animal, electrocution,

exposure, medical treatment, environmental, falling object, and sharp.

Note: Total NC Death numbers retrieved from 2018 Child Death Fact Sheet https://schs.dph.ncdhhs.gov/data/vital/cd/2018/CFinNC2018.pdf

197, 41%

80, 16%33, 7%

57, 12%

116, 24%

Medical Examiner 2018 Child Fatalities

<1 years 1 to 4 years 5 to 9 years 10 to 14 years 15 to 17 years

<1 years 1 to 4 years 5 to 9 years10 to 14

years15 to 17

yearsTotal

Medical Examiner System 196 80 33 57 116 482

Total NC Child Fatalities (reported byState Center for Health Statistics)

806 118 75 113 143 1255

0200400600800

100012001400

North Carolina Child Fatalities, 2018

3

The Child Fatality Prevention Team (CFPT) staff reviews child fatalities that are

investigated by the Medical Examiner System. With a total of 1,255 North Carolina child deaths,

approximately 38% of all child deaths that occurred in North Carolina were reviewed by the

Medical Examiner CFPT. Represented below are child fatality reviews excluding pending cases,

5, which totals 477 children. Due to pending cases, numbers are subject to change. Of note:

• 22 fatalities occurred in NC to non NC resident children

• 7 children listed under infants are fetal deaths

2018 OCME Child Fatalities

Manner Means Number of Children

Accident

(170)

Animals 1

Asphyxia 31

Blunt 3

Drowning 31

Electrocution 1

Exposure 1

Fall 1

Fire 13

Gun 4

Medical Treatment 1

Machinery 1

Motor Vehicle 76

Toxin 6

Homicide

(52)

Asphyxia 5

Blunt 10

Gun 32

Motor Vehicle 1

Other 3

Unknown 1

Natural

(70)

Natural 67

SIDS 3

Suicide

(52)

Asphyxia 23

Fall/Jump 1

Fire 1

Gun 25

Motor Vehicle 1

Toxin 1

Undetermined

(126)

Asphyxia 1

Toxin 1

Unknown 122

Other 2

Fetal 7

Pending 5

4

ACCIDENTS

Each year, accidental deaths comprise the largest number of non-natural deaths of children in

North Carolina. In 2018, there were 170 deaths investigated by the NC Medical Examiner System

certified as accident in manner. The CFPT utilizes multiple means based upon circumstances of

these deaths.

Asphyxia

Accidental asphyxiation caused the deaths of 31 children in 2018. Infants constituted the

majority, 19, of the deaths with 16 deaths due to accidental asphyxiation in a sleep

environment—either during co-sleeping or by being placed in an unsafe sleep environment.

Twelve accidental asphyxiation deaths of children between the ages of 1 and 14 years

included 7 deaths due to choking, 3 deaths were related to positional asphyxia, 1 death

related to asphyxia due to a cord, and 1 death to smoke inhalation of a house fire.

0

1

2

3

4

<1 1 2 3 4 5 6 7 8 9 10 11

Months

2018 Infant Accidental Asphyxa Death by Month Age

19

7

4

1

0

5

10

15

20

<1 year 1-4 years 5 to 9 years 10-14 years 15-17 years

2018 Asphyxia Death by Age Category

5

Drowning

Drowning resulted in the deaths of 31 children in 2018. Twenty-one drownings occurred

in a pool, 2 drownings in a bathtub, 2 drownings in a creek, 2 drownings in a lake, 1

drowning in an ocean, and three drownings located in other locations identified as a

waterpark structure, toilet, and flooded road. Of the drowning deaths, 1 child was under 1

year of age, 18 children were ages 1 to 4 years, 5 children were ages 5 to 9 years, and 7

children were between 15 and 17 years old.

Vehicle-related

In 2018, there were 76 vehicle related deaths. Majority of these deaths, 44, were

passengers, while 18 of were drivers, and 14 were outside of a vehicles/pedestrian.

Types of vehicles involved included 34 passenger cars, 17 SUV’s, 3 pickup trucks, 3 vans,

and 1 commercial truck. In addition to motor vehicles, other modes of transportation

involved in collisions included 1 ATV’s, 1 bicycle, 1 golf cart, and 1 jet ski. Other vehicles

unknown or had multiple fatalities.

Influence of drug or alcohol contributed to 10 motor vehicle accidents. Five passengers or

were in vehicle driven by a driver under the influence of drugs or alcohol, 4 were the

decedent as the driver, and 1 was a decedent as the pedestrian struck by a driver under the

influence of drugs or alcohol.

Among the 18 drivers, 11 children were 17-years-old, 6 were 16-years-old, and 1 was 7-

years-old.

Of all the children involved in vehicle-related accidents, 27 children were either not

wearing seat belts or were improperly restrained. Regarding seat restraint use, of the 18

drivers, 5 were properly restrained; and of the 45 passengers, 21 were properly restrained.

2, 7%2, 6%

2, 6%

1, 3%

3, 10%21, 68%

2018 Accidental Drowning by Location

Bathtub Creek Lake Ocean Other Pool

6

Toxins

There were 6 deaths from toxic substances (i.e. poisoning). Three of these deaths were

children 15-17 years old, 1 child was between 5 and 9 years, 1 child was between 1 and 4

years, and 1 child was under 1 year of age.

Fire

There were a total of 13 deaths from fires/burns/carbon monoxide. Six of these children

were between 1 and 4 years old, 5 children were between 5 and 9 years old, and 2 children

were between 10 and 17 years old.

Fires/burns contributing to these deaths were 8 separate incidences, with some occurrences

claiming multiple lives. Among these 8 incidences, 9 deaths occurred in a residence setting,

3 deaths in a vehicle, and 1 death was a result of a severe burn. Two of the residence fires

did not have operational smoke detectors. Sources of the residence fires ranged from

kerosene heater, lighters, space heater, and a melted pot on a stove.

Proper

seatbelt use

at time of

accident Driver 5

Passenger 21

18

46

12

2

Motor Vehicle Deaths by Position

Driver Passenger Pedestrian Bicyclist

1

17

3

7 7

1512

6

13 4

0

5

10

15

20

<1 year old 1-4 years 5-9 years 10-14 years 15-17 years

Motor Vehicle Deahs by Age Categories

Driver Passenger Pedestrian

7

Other

Other deaths with an accidental manner, totaling 13 deaths, included

• 4 firearm deaths

• 3 blunt related trauma deaths

• 1 of each following means of death: animal, electrocution, exposure, fall/jump,

medical and machinery.

Three additional fatalities among the Accident manner of death were assigned blunt and

motor vehicle means of death with the addition of intrauterine fetal demise classification.

In two cases, the mothers were involved in a vehicle related accident while carrying the

decedent and in a third, the mother received abdominal trauma while carrying the child.

1, 7%

3, 19%

1, 6%

1, 6%

1, 6%

4, 25%

1, 6%

1, 6%

3, 19%

2018 All Other Means of Accidental Manner

Animals Blunt Electrocution

Exposure Fall Gun

Medical Treatment Machinery Fetal

8

HOMICIDES

There were 52 children who died at the hands of another in 2018.

Once these deaths are given a manner and means of death, the CFPT staff separates

homicides into 2 categories; homicides that occur at the hands of a parent or caregiver and

homicides that do not.

Homicide by Parent or Caregiver

Homicide by Parent or Caretaker deaths accounted for 18 of the 52 total child homicides

in 2018. Infants, children under 1 year of age, accounted for half, 9, of those deaths. There

were 9 deaths between the ages of 1-17 years:

• Seven deaths among ages 1 to 4 years

• One death among ages 5-9

• One death among ages 10-14 for 1 death.

Regarding means, blunt force trauma was the assigned means for 10 deaths, 4 deaths with

an asphyxia means, one death with a means of firearm, and 3 deaths with an other means

of death.

Homicides by Other

Other homicides, in which the parent or caregiver was not a suspect or perpetrator,

comprised 34 of the 52 total 2018 child homicides. Teenagers between the ages of 15 and

17 years accounted for 25 of the homicides. Ages 0 to 4 years accounted for 1 death, ages

5 to 9 years for 2 deaths and 10 to 14 years for 6 deaths. Thirty-one of the 34 deaths (91%)

not by parent or caregiver were due to firearms, 1 death due to asphyxiation, 1 death by

motor vehicle, and 1 death with a means of unknown.

Of all the homicides, Black non-Hispanic children comprised the majority of homicides,

31 deaths; 14 deaths were White non-Hispanic children, 3 were white Hispanic, 2 were

American Indian, 1 Asian, and 1 unknown Hispanic.

0

5

10

15

20

25

30

<1 year 1 to 4years

5 to 9years

10 to 14years

15 to 17years

2018 Homcide by Age

Homicide by P/C Homicide by other

0

5

10

15

20

25

30

35

Asphyxia Blunt Firearm MotorVehicle

Other Unknown

2018 Homicide by Means

Homicide by P/C Homicide by other

9

NATURAL

Seventy deaths were determined to be natural in manner. Of these, 3 death were given a

classification of Sudden Infant Death Syndrome (SIDS), and 67 deaths were other natural

causes.

The top 5 means of death with a natural manner in 2018 were: complications of pneumonia,

congenital heart defect, seizure, complications of prematurity, and underlying neurological

disorder.

0

2

4

6

8

10

12

<1month

1month

2months

3months

4months

5months

6months

7months

8months

9months

10months

11months

12months

2018 Natural Means by Ages in Months Under 1 year of Age

0

20

40

60

80

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

2007-2018 Homicide Trends

Hom by parent or caregiver Homicide not by parent or caregiver Total

28

19

6

11

6

0

10

20

30

<1 year 1-4 years 5-9 years 10-14 years 15-17 years

2018 Natural Manner by Age Category

10

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS) means of death falls under the Natural manner of

death. There were 3 infants who died from SIDS in 2018. For two of the deaths, infants

were placed on their side and found in another position.

102

138

101

5339

29 23 2512 11 8 3

21

26

50

50 72 88

7381 99

111 116107

0

20

40

60

80

100

120

140

160

180

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

2007-2018 Infant Death SIDS vs <1 Year Undetermined Unsafe Sleep Environment

SIDS <1 Year Undetermined Unsafe Sleep Environment

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SUICIDES

Suicide was the manner of death of 52 children in 2018. Most of the deaths with a suicide

manner were of children between the ages of 15 to 17 years, accounting for 35 deaths

(67%). Additionally, there were 17 deaths with a suicide manner of children between the

ages of 10 to 14 years.

Males accounted for 39 deaths, females for 13 deaths.

The means of death in suicides included 23 deaths from an asphyxia event, 25 deaths from

use of a firearm, 1 death from toxin, 1 death due to a motor vehicle crash, 1 death from a

fire, and 1 death due to a fall/jump.

2416

2717 17

25 30 3224

32 35 39

5 6 8 7 7 10 9 15 13 15 11 13

0

50

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

2018 Suicide by Gender

Male Female

0

10

20

30

40

50

60

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Suicide by Age 2007-2018

5-9 Years 10-14 Years 15-17 Years total

2325

1 1 1 1

0

5

10

15

20

25

30

2018 Suicide by Means

33%

67%

2018 Suicide by Age Category

10 to 14 years 15 to 17 years

12

UNDETERMINED

There were 126 deaths that were certified as undetermined manner. Of those, 122 deaths

were certified as unknown means, 1 death was certified as an asphyxiation, 1 death was

related to toxin, and 2 deaths with of other means of death.

Of the undetermined manner, 118 children were under 1 year of age, 7 children were ages

1-4 years, and 1 child was age 15-17 years.

As is the case for most of the infants with an undetermined manner, when a known risky

or potential unsafe sleeping situation is noted, the possibility of asphyxiation as a result of

suffocation cannot be entirely excluded which leads to the certification of an unknown

means of death.

112

123

2018 Undetermined Child Fatalities by Means

Asphyxiation Toxin Other Unknown

0

20

40

60

80

100

120

140

<1 year 1 to 4years

5 to 9years

10-14years

15 to17

years

2018 Undetermined Means by Age

13

SPOTLIGHT ON INFANT DEATH

Infants are defined as children under 1 year of age. With a total of 196 infant deaths in

2018, below represents the breakdown by manner and means.

Manner Means Number of Children

Accident

(38)

Asphyxia 19

Blunt 2

Drowning 1

Exposure 1

Motor Vehicle 4

Toxin 1

Homicide

(10)

Asphyxia 1

Blunt 6

Firearms 1

Other 2

Natural

(28)

Natural 25

SIDS 3

Undetermined

(118)

Asphyxia 1

Unknown 114

Toxin 1

Other 2

Fetal 7

Pending 5

*Includes Pending Cases

0

5

10

15

20

25

30

35

<1 month 1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10months

11months

2018 Infant Fatality by Age in Months

14

Infant Unsafe Sleep Fatalities

Total number of sleep related deaths in NC: 124

Among the infant accidental asphyxiation deaths, 8 of the 17 deaths were in a co-sleeping

environment.

Among the undetermined unknown deaths, 60 of the 107 deaths were in a co-sleeping

environment.

This makes for a total of 68 potential co-sleeping related fatalities. An additional 56 infants were

in other unsafe sleep environments such as extra items in the crib, an unsafe sleep location (adult

bed, on pillow(s), on couch, etc.).

Accidental Asphyxiation Undetermined Asphyxia

and Unknown

Co-sleeping at time of death 8 60

Other potential unsafe sleep

environment related 9 47

Total potential unsafe sleep

environment deaths 17 107

124

25 22 16 18 27 17 17

8063

94 96103 116 107

22

21

28 1810 8

3

0

50

100

150

2012 2013 2014 2015 2016 2017 2018

Infant Fatality 2012-2018

Accident-sleep related Undetermined-sleep related SIDS

15

2018 Infant Unsafe Sleep Fatalities by Residence County

*Not listed, counties with no infant unsafe sleep fatalities

* Two children were not residents of North Carolina.

Number of

Fatalities Counties of Residence

1

Alexander, Bertie, Burke, Caldwell, Cherokee, Cleveland, Halifax, Henderson, Iredell, Johnston, Lee, Lenoir, Lincoln, New Hanover, Pasquotank, Pender, Perquimans, Randolph, Richmond, Rowan, Sampson, Scotland, Union, Washington, Watauga, Wayne

2 Brunswick, Buncombe, Cabarrus, Harnett, McDowell, Montgomery, Nash, Orange, Person, Robeson, Stanly, Vance, Wilkes, Wilson

3 Catawba, Duplin, Onslow, Rockingham

4 Craven, Durham

5 Alamance, Cumberland, Guilford, Wake

6 Forsyth, Gaston

7 Davidson

8 Mecklenburg