DEE WILSON CONSULTING
The Increase in Injury Related Child Fatalities
(Originally published October 2024)
In the last Sounding Board, I discussed the decline in the health of American children and increase in all-cause child mortality from 2007-2023 based on two Journal of the American Medical Association (JAMA) articles, “Trends in Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms,” (2025) by Forrest, et al, and “The New Crisis of Increasing All-Cause Mortality in US Children and Adolescents,” (2023) by Woolf, et al. This month’s commentary continues the discussion of the increase in all-cause child mortality, with an emphasis on fatalities from injuries, including child homicide and suicide.
Woolf, et al, state that “Suicides among individuals aged 10-19 years began to increase in 2007, and homicide rates for this age group began increasing in 2013.” Between 2007 and 2019, these researchers assert, “mortality rates for suicide increased by 69.5% and homicide rates increased by 32.7%.” They add: “Likely contributors to both trends include increased access to firearms and a deepening mental health crisis among children and adolescents.” According to Woolf, et al, during one year – from 2019-2020 – “Injury mortality (of) ages 10 to 19 years rose by 22.6% … Much of this surge involved homicides, which increased by 39.1%, and deaths from drug overdoses, which increased by 113.5%.” Deaths from car crashes “which had decreased for decades, increased 15.6% in 2020.”
Woolf, et al, comment that “The increase in pediatric injury deaths predates the COVID-19 pandemic, which, these authors assert,” may have poured fuel on the fire.” Most of the increase in all-cause child mortality was among youth, 10-19 years of age, but all-cause mortality among children, 1-9 years “also increased in 2021 (by 8.4%) … Among children 1-9 years, injuries explained two thirds (63.7%) of the increase in all-cause mortality in 2021, including a 45.9% increase in deaths involving fire or burns.”
These authors maintain that it was not COVID-19 that accounts for the increase of all-cause child mortality, but rather the increase in injuries, especially deaths (due to homicide, suicide and accidental) from firearms. The increase in US all-cause child mortality reversed decades of progress in reversing pediatric mortality, these researchers state. Woolf, et al, opine:
“This increase in all-cause pediatric mortality has ominous implications. A nation that begins losing its most cherished population – its children – faces a crisis like no other.”
Firearm related child and adolescent homicides
An article recently published in JAMA Surgery by Rook, et al, discusses a study of child and adolescent firearm related homicides from 2020 through 2021 based on data from the National Violent Death Reporting System Restricted Access Database. This study found that more than 80% of victims were male, with a median age of 16 and that almost one quarter (24.6%) of fatalities occurred at home. “… in-home homicides were more often associated with murder-suicide, child abuse and intimate partner violence.” And: “of the 310 in-home homicides for which the assailant relationship was identified, a parent was reported in 129 (41.6%).”
Homicide accounted for 57.3% of firearm-related child and adolescent fatalities and suicide for about a third of the fatalities. Rook, et al, found that more than two-thirds (67.9%) of victims were Black; 15.8% were Hispanic, 1.1% were American Indian/ Alaskan Native, 1% were Asian, and 13.5% were White. Black youth make up approximately 14% of the US child population.
The shocking percentage of Black child and adolescent firearm-related homicide victims found in this study is similar to the finding of Woolf, et al that in 2021 “non-Hispanic Black youths accounted for two-thirds (62.9%) of homicide victims aged 10 to 19 years.” And: “… the homicide rate among non-Hispanic Black youths aged 10 to 19 years was 6 times that of Hispanic youths and 20 times that of Asian/Pacific Islander non-Hispanic youth and White youths.”
Fatalities related to child maltreatment
According to National Child Abuse and Neglect Data System (NCANDS) contained in annual Child Maltreatment reports, child maltreatment (CM) fatalities, which had declined from 2009-13, increased from an estimated 1520 fatalities during FFY 2013 to an estimated 2000 fatalities in FFY 2023. However, the percentage of CM fatalities in which physical abuse was present (41.6% during 2013) decreased rather than increased, probably because the increase in CM fatalities occurred during an opioid epidemic during which many children died from fentanyl overdoses or unsafe sleep practices rather than physical abuse.
The rate of infant (from birth to 12 months of age) CM fatalities was more than three times the rate of any other age group; two-thirds of child fatalities during 2023 were 0-2 years of age. The male/female ratio in CM fatalities in 2023 was 58.7% - 40.9%. A third of child fatalities in both 2013 and 2023 were Black; 36.3% were White,14.8% were Hispanic. The NCANDS CM fatality rate increased from 2.04 per 100,000 during FFY 2013 to 2.73 per 100,000 in FFY 2023.
The increase in youth suicide
Given the alarming increase in youth suicide during the decade following the widespread use of smartphones, I have asserted in several Sounding Board commentaries that the social disconnection (e.g., much less in-person contact of adolescents with their friends) resulting from misuse of this technology was likely the main cause of this increase. However, after review of youth suicide statistics, I have concluded that misuse of smartphone technology is only a partial explanation.
In 2019, the Congressional Black Caucus’ Emergency Task Force on Black Youth Suicide issued a report, “Ring the Alarm: The Crisis of Black Youth Suicide in America.” The report asserts that the rate of suicide for Black youth, 10-19, almost doubled from 2.55 per 100,000 in 2007 to 4.82 per 100,000 in 2017. While the overall rate of Black youth suicide remained lower than the White youth suicide rate, “Black youth under 13 years (were) twice as likely to die as their White counterparts.” The authors comment that the alarming increase in Black youth suicide “challenges the public perception that Black youth do not commit suicide.”
“Ring the Alarm” does not offer a cogent explanation for the near doubling of the Black youth suicide rate from 2007-17. It lists possible causal factors such as experiences of trauma and bullying, along with socioeconomic conditions that were no different (and possibly less extreme) than during preceding decades, and acknowledges the need for further research on the subject. The report’s main goal appears to be to raise an alarm that would support more and better mental health resources for Black children and youth, and to reduce the stigma of seeking out these services.
A study just as alarming and more discerning regarding possible causes of youth suicide is “Suicidal Thoughts and Behaviors on American Indian and Alaska Native Adolescents” by Price and Khubchandani, published in the Journal of Community Health (2025). These authors “conducted a cross- sectional descriptive analysis of the suicide-related data from years 2015, 2017, 2019 and 2021” based on data from the national Youth Risk Behavior Surveys and Web-Based Injury Statistics Query and Reporting System.
This study reports that the suicide rate for American Indian/Alaskan Native (AI/AN) adolescents,14-18, in 2021 was 18.95 per 100,000, 1.7 to 3 times higher than rate for any other racial/ethnic group. Most alarming, the study found that during 2021 more than one-quarter of AI/AN (27.3%) adolescents considered attempting suicide, more than one-fifth (21.9%) planned suicide and one-sixth (16.0%) attempted suicide. The most common method used for suicide by AI/AN adolescents was suffocation (58.3%), followed by firearms (32.5%) and poisonings (3.8%).
The authors comment that the suicide rate for non-Hispanic AI/AN females increased 139% between 1999 and 2017 and by 71% for male adolescents. AI/AN adolescent males have a much higher suicide rate than females, which is also true for other racial/ethnic groups.
The authors assert that adverse childhood experiences (ACEs) such as physical abuse, sexual abuse, emotional abuse, neglect, parental substance abuse or mental illness, incarceration of family members, race-based discrimination, divorce and witnessing neighborhood violence have been shown to be associated with poor mental health outcomes. They state: “Research has also found that youth with four or more ACEs are more likely than other races to be AI/AN.” And: “each additional ACE has been found to increase the odds of suicide attempts by 37%, depression (57%), PTSD symptoms (55%) and polydrug use (51%).” They comment: “The aforementioned ACEs are layered on top of a mental substate of AI/AN historical intergenerational trauma (e.g., colonization and modern structural racism). … Such actions have negatively impacted tribes by reducing employment opportunities, and social connections, creating areas of concentrated poverty, establishing lower-quality schools … creating a social environment of limited resources.”
Both “Ring the Alarm” and this study of AI/AN adolescent suicide emphasize the importance of strengthening protective factors such as connectedness to families, communities and schools, as well as strengthening the capacity of youth to cope with mental and emotional distress. In addition, the quality of AI/AN youths’ school experiences appear to have a large impact on their mental health. Price and Khubchandani state: “research indicates that adolescents who attend “high poverty schools … were twice as likely to have attempted suicide as adolescents from “low poverty schools…” Positive school experiences strengthen a realistic hope of a decent and rewarding future. School failure, especially the failure to graduate from high school, is a common pathway to involvement with the criminal justice system for youth from oppressed minorities. In Poverty, by America (2023) Matthew Desmond asserts that 70% of Black youth who do not graduate from high school end up spending time in prison.
The Social Context and its Effects on Children’s Health and Mortality
I question whether the decline in children’s health and increase in all-cause child mortality from 2007-2023 can be understood without considering trends in American adults’ health and early mortality. A couple of years after the Great Recession of 2008-2009 an opioid epidemic began which, from 2011- 2021, led to the deaths of almost 650,000 adults aged 18-64. “An estimated 321,566 children lost a parent from a drug overdose,” two-thirds of whom were males. In “Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021,” (JAMA, May 2024), Jones, et al, state that “The rate of community dwelling children who lost a parent to drug overdose … increased from 27 per 100,000 in 2011 to 63.1 per 100,000 in 2021.The highest rates were found among children of non-Hispanic AI/AN individuals who had a rate of 187.1 per 100,000 in 2021, almost double the rate among non-Hispanic Whites (76.5 per 100,000) and non-Hispanic Blacks (73.2 per 100,000).
Jones, et al, comment: “… children who experience parental loss are at increased risk of a range of health and social challenges, including future substance use and mental health challenges.” And: our findings are consistent with previous research that shows significant increase in overdose among AI/AN and Black persons in recent years.” The authors call attention to inequities in access to and use of evidence-based treatments and by the huge effect of social determinants of health such as discrimination, unsafe neighborhoods, unstable housing and multigenerational poverty on AI/AN and Black families.
In addition to the loss of parents who died due to drug overdoses, the National Institute of Health (NIH) estimates that 140,000 children had a parent or secondary caregiver, e.g., a custodial grandparent, who died from April 1, 2020 to June 30, 2021 due to COVID-19. More than 460,000 American children lost a parent or secondary caregiver from 2011-2021 due to a drug overdose or COVID-19, a statistic that does not account for children of parents who were murdered or committed suicide.
Deaths of Despair
Drug overdose death is one of three “deaths of despair” discussed by Anne Case and Angus Deaton in Deaths of Despair (2020). The other two are suicide and alcoholic liver disease. Taken together, deaths of despair reduced average lifespan in the US before the COVID-19 pandemic, which further exacerbated this trend. The increase of rates of early mortality among middle aged (45-54) American adults has been particularly striking.
Case and Deaton comment: “The increase in deaths of despair was almost all among those without a bachelor’s degree. … The widening gap between those with and without a bachelor’s degree is not only in death but also in quality of life; those without a degree are seeing increases in their level of pain, ill health, and serious mental distress, and declines in their ability to work and socialize. The gap is widening in earnings, family stability and community. A four-year degree has become the key marker of social status …”.
Case and Deaton discuss the negative effects of health and mortality of an educational system whose outcomes are greatly influenced by the social class of parents, as explained brilliantly in Robert Putnam’s Our Kids. In low poverty schools, students are expected to attend college and prepared to succeed when they do. In high poverty schools, students are not expected to attend college and often unprepared when they manage to overcome the odds. Putnam notes that the effect of parents’ social class on education extend beyond the classroom to participation in athletics, which in many schools requires “pay to play.” Even during elementary school, athletics (such as soccer) is commonly organized into leagues that charge admission fees and often involve expensive travel and special coaching.
Deaths of despair accurately describes many child and adolescent fatalities of youth who are failing in the educational meritocracy that has taken on caste like features. However, there is another likely response other than despair among youth unable to access the economic and social benefits of higher education: rage. Social exclusion is easily transformed into gang violence that offers an alternative pathway (other than education) to collective agency, social regard and income.
Summary
The increase in child mortality from injury since 2007 has three main causes:
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Increased levels of social disconnection resulting from widespread misuse of smartphones by American youth of all social classes.
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The deaths of parents and secondary caregivers due to drug overdoses, COVID-19, homicide and suicide, losses which have had (by far) the largest effects on AI/AN and Black children and adolescents.
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Social exclusion and the loss of hope in a desirable future resulting from a hardening of educational meritocracy, the outcomes of which are greatly influenced by the social class of parents and multiple social determinants of health.
It seems common sense that a mental health crisis among children and adolescents requires a mental health response; but the emphasis on improving access to mental health services also reflects a distinct reluctance to regulate smartphone use among younger adolescents, and reconsider a “winners/losers” social ethos that has done severe harm to Americans of all ages. ©
References
Case, A. & Deaton, A., Deaths of Despair and the Future of Capitalism (2020), Princeton University Press, Princeton, NJ and Oxford, England.
Child Maltreatment 2013 and Child Maltreatment 2023, Administration for Children, Youth and Families, U.S. Department of Health and Human Services, Washington, D.C.
Desmond, M. Poverty, By America (2023), Random House, New York City.
Jones, C., Zhang, K., Han, B., Guy, G., Losby, J., Einstein, E., Delphin- Rittmon, M., Volkow, N. & Compton, W., “Estimated Number of Children Who Lost a Parent to Drug Overdose in the US From 2011 to 2021,” (2024), JAMA Psychiatry, published online, May 8, 2024.
Forrest, C., Koenigsberg, L., Harvey, F., Maltenfort, M. & Halfon, N., “Trends in US Children’s Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms,” (2025) JAMA, 334 (6), published online July 7, 2025.
“More than 140,000 US Children Lost a Primary or Secondary Caregiver Due to the COVID 19 Pandemic,”, National Institute of Health, October 7, 2021, available online.
Price, J. & Khubchandani, “Suicidal Thoughts and Behaviors in American Indian and Alaskan Native Adolescents,” (2025), Journal of Community Health, published online October 15, 2024.
Putnam, R., Our Kids: The American Dream in Crisis (2015), Simon and Schuster, New York, NY.
“Ring the Alarm: The Crisis of Black Youth Suicide in America,” (2019), Congressional Black Caucus Emergency Taskforce on Black Youth Suicide and Mental Health, Washington D. C.
Woolf, S., Woolf, E. & Rivera, F., “The New Crisis of Increasing All-Cause Mortality in US Children and Adolescents,” (2023), JAMA, published online March 13, 2023.
See past Sounding Board commentaries
©Dee Wilson