Deaths of children in NSW in 2015: Injury

In 2015, 504 children aged from birth to 17 years died in NSW in 2015; a mortality rate¹ of 29.61 deaths per 100,000 children.

At the time of writing, a cause of death was known for 458 children. One in five of the children (88; 19%) died as a result of injury, a mortality rate of 5.17 per 100,000 children.

Almost two-thirds (54) of the 88 injury-related deaths were de to unintentional injury, including transport fatalities and drowning. The deaths of 34 children were intentional, either due to suicide (26) or related to abuse or assault (8).

The causes of injury-related death varied by age. Fifteen to 17 year olds were the age group represented most in injury-related deaths in 2015; over half of these young people died as a result of suicide. Most drowning deaths in 2015 occurred in children aged under five years

Trends in injury-related deaths 2001–2015

Over the past five years, injury-related causes have accounted for the death of around one in every six children who die in NSW. However, as shown in the table below, there has been a continual and significant decline in the injury-related mortality rate over the 151 years to 2015. This decline relates to males rather than females, and while the rate for males is still higher than for females, the gap has narrowed since 2001. Males are also hospitalised more often than females (2:1) as a result of injury.²

The injury-related mortality rate for Indigenous children is consistently higher than that of non-Indigenous children. The rate has remained relatively constant over the last 15 years, in contrast to nonIndigenous children where the mortality rate has halved over the same time period.

Figure 1: Deaths due to external (injury-related) causes: children under 18 years by gender, 2001-2015

Leading causes of injury-related deaths of children: 2015

Transport fatalities

Thirty-three children died in 31 transport incidents in 2015, a rate of 1.94. This included 29 incidents that occurred on road-related areas, and four deaths on off-road areas.

In 2015, transport fatalities were the leading injury-related cause of death of children aged five to 14, and the second leading injury-related cause for children under five and young people aged 15-17. The mortality rate for children in transport fatalities has however declined by almost half between 2001 (4.43) and 2015 (1.94).

The majority (28) of the 33 fatalities were children travelling in or on a vehicle: 16 children were passengers; 12 were in control of a vehicle, including two children riding a quad bike. Five children were pedestrians who died after being struck by a vehicle.

Main observations: transport fatalities

• Unsafe driver behaviours remain the key contributing factors in transport deaths of children. Consistent with previous years, speed, driver drug and alcohol use, and driver fatigue were identified as contributing factors in transport-related deaths of children in 2015. Unsafe driver behaviours were rarely seen in isolation; multiple risk factors were identified as contributing to most crashes.
• Over half of at-fault drivers were novice drivers. NSW has a Graduated Licensing Scheme. From 2016, NSW will introduce changes to the Graduated Licensing Scheme; the Centre for Road Safety reports that these changes will better prepare drivers for real-world road hazards and reduce deaths on the road.
• The majority of deaths involved older, less safe vehicles. All six teenage drivers who died were driving an older, less safe vehicle. Younger drivers tend to drive older and inexpensive cars.
• Adult quad bikes and side-by-side vehicles are inherently dangerous and should not be ridden by children under the age of 16. However, quad bikes and side-by-side vehicles on private property and recreational areas are not subject to direct regulation in regard to rider age. The Team has proposed that:
  The NSW Attorney General refer to the NSW Law Reform Commission for review, the introduction of legislation to prohibit any child under 16 years from using an adult sized quad bike or side-by-side vehicle on private property or in recreational  vehicle areas.

Drowning deaths

In 2015, the deaths of nine children were a result of drowning, a rate of 0.53. While the rate of drowning deaths overall in 2015 was one of the lowest rates since 2001, drowning was the leading cause of unintentional injury-related death of children aged 1-4 years in NSW.

Seven of the nine children who drowned in 2015 drowned in private swimming pools; one child drowned in a bath and one child in a lake. Most (7) of the children who drowned were under five years of age. As has consistently been the case, drowning incidents in recreational circumstances in 2015 occurred in the context of the child having ready access to water at a time they were unsupervised.

The mortality rate of children from drowning declined overall between 2001 and 2015. However, the rate of drowning in private swimming pools in 2015 (0.41 per 100,000 children) was the highest since 2009.

Main observations: Drowning deaths

• Children under five are most at risk of drowning in backyard pools. Reviews underscored the critical link between lack of direct supervision of young children, even for very short periods of time, and inadequate child resistant safety barriers.
• Faulty gate latch mechanisms were the most common barrier defect through which young children accessed the pool. Gate latches are common weak points in pool barriers as they comprise moveable parts which must align for effective operation.
• Portable swimming pools are often unfenced and a particular risk. Over a ten-year period, one in five swimming pools in which children drowned were portable.
• Exemptions and variations to regulatory requirements are complex, and provide pool owners with little clarity.

In the context of an independent review of swimming pool safety barriers under consideration by the NSW government, the CDRT has proposed:

• Swimming pool inspections by local councils target properties where very young children reside or regularly visit.
• That government consider the need for:
  › removal of existing exemptions from swimming pool safety barrier requirements under the Swimming Pools Act
  › standards relating to tolerance and movement of self-closing gate latch mechanisms
  › the adoption of a single, accessible standard for child resistant safety barriers
  › introduction of requirements for additional controls on the sale and use of portable pools and spas.

Deaths by suicide

In 2015, the deaths of 26 young people were attributed to suicide, a rate of 1.53. This was the largest number and highest rate of suicide for young people in NSW since 1997. Over the 15 year period to 2015, the NSW child death register has recorded the deaths by suicide of 264 young people. Since 2001, there has been no statistically significant change in the suicide mortality rate of young people in NSW.

Most (21) of the 26 young people who died by suicide
in 2015 were aged 15 – 17 years, and suicide was the leading cause of death for this age group. Twelve of the young people were 17 years old, five were 16 and four were 15. Five children were younger than 15; the youngest was 13 years. Thirteen of the young people were male, and 13 female. Six of the young people were Aboriginal.

Main observations: suicide

• Coordination of care and treatment for young people in contact with health services was not always optimal. Around half of the young people who died by suicide in 2015 were receiving support and assistance through a number of avenues, including both public and private providers simultaneously. In some cases, service provision and support was at times fragmented.
• Some young people who died by suicide in 2015 did not present with suicidal behaviours or signs of intent. Consistent with what the Team has identified previously, a small number of young people showed no indication of suicidal behaviour or intent. This reinforces the importance of universal strategies such as the NSW Wellbeing Framework for Schools.
• Young people often told their friends about their thoughts of self harm or intent to suicide. There are a number of resources available to people supporting others who are at risk of suicide, however this does not appear to be the case in relation to resources specific to young people.
• There is no focused suicide prevention plan for young people in NSW. Most recent initiatives in suicide prevention focus on whole of community responses that are tailored to the local community. It will be important that these initiatives take into account the particular circumstances and needs of children and young people.

The CDRT has asked NSW Health to consider the observations made in the report, and advise the Team of existing or planned strategies to address them.

Fatal abuse

In 2015, eight children died as the result of abuse or alleged abuse in NSW, a rate of 0.47.

Half (4) of the children who died as a result of abuse were less than two years of age. Three children were aged between 8 and 12 years, and one was an older teenager.

The families of half (4) of the eight children who died in circumstances of abuse had a child protection history, including two children who were placed in care at the time of their death. Children with a child protection history have a much higher rate of death from fatal abuse than children from families with no such history.

Consistent with national and state trends, all but one of the eight deaths of children due to abuse in 2015 occurred within a familial context, with most children allegedly killed by a parent or other person with whom they resided. Two children died in separate incidents of apparent murder-suicide.

All deaths of children under the age of 18 years that are the result of abuse, or that occur in circumstances suspicious of abuse, are reviewable by the NSW Ombudsman. Reports of reviewable deaths

Other unintentional injury-related deaths

In NSW in 2015, 12 children died as a result of injury other than transport and drowning or intentional causes. The children died as a result of accidental suffocation and other threats to breathing, poisoning (drug toxicity), falls and house fire.

Notes

1. Crude mortality rate - deaths per 100,000 people under 18 years of age. For children aged less than 12 months, this report uses the Infant Mortality Rate, which is deaths of infants under 12 months per 1,000 live births.
2. Pointer S (2014). Hospitalised injury in children and young people 2011–12. Injury research and statistics series no. 91. Cat. no. INJCAT 167. Canberra: AIHW, p7.

Since 1996, the CDRT has been responsible for reviewing and reporting to the NSW Parliament on all deaths of children aged less than 18 years in NSW. The CDRT maintains a register of child deaths in NSW. The Team consists of experts in child health, child protection and related areas, and representatives of key government agencies. The Convenor of the Team is the NSW Ombudsman, and Ombudsman staff provide support and assistance to the Team.

This page is a summary of key information contained in the NSW Child Death Review Team (CDRT) Child Death Review Report 2015.

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© State of New South Wales, November 2016
This publication is released under a Creative Commons license CC BY 4.0.