[Child abuse and the lack of care. 2. An epidemiologic and social pediatric study of fatal child abuse and neglect in Denmark in 1970-1979].

The object of this investigation was to undertake an epidemiological, clinical and social pediatric study of cases of fatal child abuse and neglect in order to use the information in preventive work. A total of 38 children aged 0-13 years were registered in this retrospective study from all Danish forensic officers, pediatric departments, institutes of forensic medicine and the medico-legal council. At least 21% of the children had a history of failure to thrive and at least 21% had a chronic disease or handicap. At least 1/3 had been subjected to previous abuse and at least 11% of the siblings also. A minimum of 1/3 of the mothers and 18% of the fathers had a chronic physical or mental disease and most of the families came from the lower social groups. In nearly 1/3 of the cases, the crisis which precipitated the abuse was caused by the child's behaviour and, in nearly 1/3 of the cases, information was available about stressing factors in the adult concerned. The primary cause of death was head injury and, in order of frequency, intraabdominal injury, strangulation, drowning and neglect. Difficulties in the definition of fatal child abuse and neglect are the reasons for different incidences in various countries, but the present investigation showed an incidence of 0.8 child deaths from fatal child abuse per million inhabitants per year. In Denmark, at least four children die every year on account of child abuse.