Avoidable factors in child death.

There were 131 deaths among children aged between birth and 14 years during a period of 18 months in one inner London area health authority. One hundred children died in hospital, 23 at home, and 8 elsewhere. Thirty three died of congenital, 46 of perinatal, and 34 of other medical causes. There were 18 violent deaths--16 among children over 1 year of age. Medical and social information, collected from analysis of records and interview with those involved, was considered by a review panel and the following conclusions were drawn: there was scope for prevention of congenital disease or malformation in only one of 33 cases; with routine pathological investigation the cause of death in postperinatal infancy was usually unclear--more detailed pathological investigation should be routinely available for the investigation of deaths in the first year of life; there were possible management failures in four of 8 non-malignant medical deaths in older children; malignant disease was promptly diagnosed; fatal accidents were almost entirely restricted to the children of families under marked psychosocial stress; and there was some evidence of faulty communication between health agencies and of the inappropriate routing of emergency admissions.