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The Gender Difference in Child Maltreatment Fatalities         

(Originally published June 2024)

Several years ago, I co-authored (with colleagues at Casey Family Programs and elsewhere) an unpublished article, “Increased Risk for Fatal Maltreatment Among Boys: Exploration of Data from the NCANDS Child File,” (Puckett, et al, 2016), which analyzed child maltreatment fatality data for the years, 2007-2012. The study utilized six years of data totaling nearly 21 million CPS reports from the National Child Abuse and Neglect Data System Child File Data. Duplicate reports of child victims were removed from the sample in order to count individual children only once.


During this six-year period, male children were 57.4% of child maltreatment (CM) fatality victims; female children were 42.2% of CM fatality victims, with missing information regarding gender for 0.4% of fatalities.  Much to my surprise, this ratio did not vary much for abuse related fatalities vs. neglect related fatalities, or for different age groups of children, or among racial/ ethnic groups, with the exception of American Indian / Alaskan Native fatality victims, only 52% of whom were male.  Among Black child fatalities 58.3% were male, among White child fatalities 59.1% were male. Of child fatality victims classified as “Multiple Race / Ethnicity, 56.7% were male. Children, 4-7 years of age, had the highest percentage of male victims - 62.3%.


I recently reviewed annual “Child Maltreatment” reports which summarize NCANDS fatality data from 2013-22, which reveals a similar gender ratio for CM fatalities:


                                 Male                             Female


2013                          58%                                41.7%

2014                          58.3%                             40.9%

2015                          54.6%                             45.2%                      

2016                          60.3%                             39.7%

2017                          57.9%                             41.9%

2018                          57.8%                             42.0%

2019                          58.3%                             41.3%

2020                          60.1%                             39.5%

2021                          59.4%                             40.5%

2022                          60.3%                             39.7%


For the ten-year period, 2013-2022, the average percentage of male CM fatality victims in annual “Child Maltreatment” reports was 58.5%. The same almost 60/40 ratio in male vs. female CM fatalities is found in most reports on CM fatalities from various states, though in Washington the recent annual Family and Children Ombuds Office reports on child fatalities do not include information regarding the gender of child victims.


The vulnerability of boys 

Before I began working on the study of CM fatalities almost a decade ago, I was accustomed to reading studies on the subject with comments such as “boys are slightly more likely to die from child abuse or neglect than girls,” and without explanation of the gender difference in CM fatalities. There has been a tendency among researchers and child advocates to minimize the significance of the gender difference in CM fatalities.


My initial hypothesis was that boys were more likely than girls to engage in oppositional behavior that provokes harsh physical punishment from abusive parents, and therefore more likely to die from inflicted injury than girls. When I began to read research studies about all-cause child mortality, I was surprised to discover the following:


A. Boys have higher rates of mortality than girls in multiple disease categories and from accidental injury, suicide and homicide. A recently published study of all-cause and cause-specific mortality among US youth (Wolf, et al 2024) found an almost 2-1 difference in the ratio of male/female deaths (65.1% male, 34.9% female) between 1999 and 2020.  This gender difference in all-cause mortality is greater than the difference in CM fatalities because most deaths involved teenagers, with more than half of deaths occurring among youth,15-19, due in large part to suicide, homicide and motor vehicle crashes. 

B.  Boys have a higher mortality rate than girls at all ages and in almost every country (Balsara, et al 2013)

C. Girls generally have stronger immune systems and lower mortality from infection and respiratory conditions (Drevenstedt, et al, 2007)

D. Boys are more often born preterm; and premature boys have worse health outcomes than premature girls (Peacock, et al, 2012).

E.  Boys are more likely to have disabilities than girls (Boyle, et al, 2011). A study conducted by Emily Douglas (2016) found that children with disabilities were almost twice as likely as children without a disability to die from child maltreatment.

F.   Boys are four times more likely than girls to be diagnosed with autism (Sparks, et al, 2002).

G.   In the US, male youth and young adults have a suicide rate almost four times higher than females of the same age (Saunders & Panchal, 2023)

H. Boys are more likely than girls to be seen in emergency rooms with abusive head trauma (Crowley, et al, 2015)

I.  Boys heightened fatality risk is particularly acute among infants and other young children (Pongou, 2013)


Balsara, et al, comment: “Males die more than females from a wide array of underlying conditions. The potential genetic and hormonal mechanisms for the mortality differences between males and females warrant investigation.”


Implications for child protection

The heightened risk among boys of CM fatality appears to be due to several conditions more prevalent among boys than girls, conditions which increase the challenge of parenting infants and other young children. These conditions include prematurity, chronic illness, disability and other special needs, the inclination to engage in risky play activities, and oppositional behavior that elicits harsh physical punishment. Perhaps it goes without saying that female infants and other young children who have one or more of these conditions are as at risk of serious injury or CM fatality as male children.


Some children have more than one of these conditions at birth, and should be assessed as high risk for maltreatment when parents have one or more chronically relapsing conditions such as substance use disorder (SUD) and/ or depression.  As a rule, these children should not be referred to a community-based Plan of Safe Care absent CPS involvement, unless a parent (or parents) is already actively engaged in supportive services which include a child care component. In addition, there should be immediate outreach to a parent or parents by a public health nurse prior to or immediately following a CPS report.  A CPS report and subsequent investigation should never be first and only public agency response for children with disabilities or serious health conditions at birth or during the first two years of life.


There are also broader implications for how to improve CPS risk and safety assessments and safety plans when a child presents difficult child care challenges. Risk and safety of the highest risk children in CPS systems should be viewed as a relationship between conditions such as chronic illness and disabilities (both physical and emotional) that increase the burden of child care and the functional impairments of parents resulting from SUD, chronic and mental health conditions, as well as other factors such as severe cognitive impairments.  It is the combination of difficult parenting challenges that include a young child’s inconsolable crying with severe functional impairments to a parent’s (or parents’) cognitive and affective functioning that creates the highest risk of CM fatality or near fatality. In worst case scenarios, a child who is physically difficult to care for due to illness or disability cannot be comforted by caregivers who are irritable and quick to anger due to depression, PTSD, sleep disturbances, reactions to drugs or drug withdrawal, or for other reasons. When a parent with a history of childhood trauma hears disapproval or rejection in a young child’s inconsolable crying, the parent may respond with extreme physical punishment. Risk and safety assessments should give as much weight to child characteristics that increase the risk of CM fatality and near fatality as on parental risk factors, especially when parents have chronically relapsing conditions such as substance misuse and/or chronic mental illness.


Safety plans and service plans should include the goal of reducing the child burden in troubled families through child care, respite care, crisis nurseries, home health workers and by restoring connections to extended family members when these ties have been disrupted by substance misuse, domestic violence, etc.  It is much easier to reduce the burden of child care in families with special needs children than to mitigate functional impairments such as the difficulty in maintaining a parenting structure, recognizing and responding to danger and engaging in emotionally responsive interactions with children.  Progress in treatment programs is likely to be an up and down rocky road for months or years, but it’s possible to reduce the child care burden on a parent immediately. Caseworkers developing safety plans should make a strict distinction between therapeutic services and safety-oriented services.


For some families with histories of addiction and chronic mental illness, the only safe alternative to foster care is a residential treatment program for both the mother and infant. A key indicator of whether policymakers at both the federal and state level are serious about safe foster care reductions (as opposed to the reduction of foster care as an end in itself) is the scale of investment in residential Pregnant and Parenting Women (PPW) treatment programs for mothers with SUD, as well as the willingness to use foster care savings to develop a stronger array of family support services, including in rural counties. 


Almost 80% of CM fatalities occur among children, 0-3. Given the greatly elevated risk of CM fatalities and near fatalities among infants and toddlers, it seems remarkable that most large urban child welfare offices have not developed specialized units for children, 0-3. These units could be staffed by the most experienced and knowledgeable caseworkers and supervisors who are financially supported to complete (90 -100 hour) certification programs in infant and child development, substance abuse, mental health, developmental disabilities, and with a range of safety-oriented services to offer families, as discussed above.


To reduce CM fatalities, there has to be more expertise in the child welfare workforce and better safety-oriented services for children at highest risk for serious harm due to child maltreatment.  Cases of older children with serious disabilities should also be assigned to specialized staff who have an array of safety-oriented support services at their disposal.



The gender difference in CM fatalities is due to boys’ heightened vulnerability to prematurity, disease, inflicted and accidental injuries, and physical and emotional disabilities when parents have functional impairments due to SUD, chronic mental health conditions, severe poverty and other conditions that markedly increase the difficulty of parenting a special needs child. Risk and safety assessments should assess caregiver risk factors in the light of the challenges to providing adequate care created by a child’s physical and mental health conditions. Children with complex and hard to meet needs resulting from both illness and physical disability, combined with hyper sensitivity, emotion dysregulation and/or behavior problems, will often require intensive services for a lengthy period of time.    


Assessments should clearly and concretely describe what a difficult to care for child needs to be safe and healthy, e.g. consistent use of medication, medical services, a smoke free environment, etc. 


Case plans should be developed to increase child safety by reducing child care burden when chronically ill, disabled or behaviorally troubled children remain in the home. Caseworkers should not conflate therapeutic services with safety-oriented services, and should not assume that entry into a substance abuse or mental health treatment program will immediately assure child safety.


Families with unusually high needs children whose parents have chronically relapsing conditions such as SUD or Major Depression require long term assistance. These are not families whose cases can be safely closed after 3-6 months of in-home services or 6 months following reunification. 



Balsara, S., Faerber, J., Sponer, N. & Feudner, “(2013), “Pediatric mortality on males versus females in the United States, 1999-2008, Pediatrics. 132 (4), 631-638.


Boyle, C., Schieve, L., Cohen, R., Blumberg, S., Yeargin – Allsopp, M. & Kogan, M. (2011), “Trends in the prevalence of developmental disabilities in US children, 1997-2008, Pediatrics, 127 (6), 1034-1042.


Child Maltreatment reports 2014 through 2022, Children’s Bureau, Administration on Children, Youth and Families, U.S. Department of Health and Human Services, Washington, D.C., available online.


Crowley, L., Morris, C., Maguire, S. Farewell, D. & Kemp, M. (2015), “Validation of a prediction tool for abusive head trauma,” Pediatrics, 136 (2), 290-298.


Douglas, E. (2016), “Testing if social services prevent fatal child maltreatment among a sample of children previously known to child protective services,” Child Maltreatment, 21 (3), 239-249.


Drevenstedt, G., Crimmins, E., Vasunilashorn, S. & Finch, C. (2008), “The rise and fall of excess male infant mortality, Proceedings of the National Academy of Sciences, 105 (13), 5016-5021.


Peacock, J., Marston, L., Marlow, N., Calvert, S. & Greenough (2012), “Neonatal and infant outcomes in boys and girls born prematurely,” Pediatric Research, 71 (3), 305-310.  


Pongou, R. (2013), “Why is infant mortality higher in boys than in girls? A new hypothesis based on preconception environment and evidence from a large sample of twins,” Demography, 50 (2), 412-444.


Puckett, A., Wilson, D., Graham, J.C., Sheldon-Sherman, J. & Corwin, T., “Increased Risk for Fatal Maltreatment Among Boys: Exploration of Data from the NCANDS Child File,” unpublished, available on request to


Saunders, H. & Panchal, N., “A Look at the Latest Suicide and Change Over the past Decade, KFF, published online, August 4, 2023.  


Sparks, B., Freidman, S., Shaw, D., Aylard, E., Echeland, D., Artru, A. & Dager, S. (2002), ‘Brain structural abnormalities in young children with autism spectrum disorder,” Neurology, 59 (2), 184-192. 


Wolf, E., Rivara, F., Orr, C., Sen, A., Chapman, D. & Woolf, S. (2024), “Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth, JAMA, 331 (20), 1732-1740; published online May 4, 2024.



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©Dee Wilson 


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