The 10 leading causes of death for US children, charted

Injury is the leading cause of death among U.S. children, and the injury-related death rates are far outpacing those of other developed countries, according to a study published in the New England Journal of Medicine (NEJM).

The case for improving coordination between behavioral health and pediatrics

Study finds car crashes, firearms are leading causes of death among US children

For the study, researchers sorted through CDC and World Health Organization data on 20,360 deaths of children and adolescents in the United States in 2016.

The researchers found that motor vehicle crashes were the leading cause of child deaths in the United States, comprising about 20% of all deaths among children in 2016. The chief reason for the crashes was cell phone use by drivers and pedestrians, the researchers found.

Firearms were the second leading cause of deaths among children and adolescents in 2016, according to the researchers. Overall, there was a 28% relative increase in the rate of firearm deaths among U.S. children, likely driven by a 32% increase in firearm homicides and a 26% increase in firearm suicides, the researchers said. They found that the odds of a child being killed by a firearm are 36 times higher in the United States than in other high-income countries.

The researchers also noted that recently-released 2017 data show firearm-related deaths among U.S. children are continuing to rise. "One in three U.S. homes with youth under 18 years of age has a firearm, with 43% of homes reporting that the firearm is kept unlocked and loaded, which increases the risk of firearm injuries," the researchers wrote.

Cancer was the third-highest cause of child deaths among U.S. children in 2016, though the rate of such cancer deaths declined by 32% from 1990 to 2016. Similarly, the rate of drowning deaths among U.S. children declined by 46%, and the rate of deaths from home fires declined almost 73% over that time.

'Shameful' numbers

In an editorial accompanying the study, Edward Campion, executive editor of NJEM, called the numbers in the study "shameful," and said the United States needs to do a better job of protecting its children.

"Children and adolescents in the United States were more than 36 times as likely to be killed by gunshots as their counterparts in other high-income countries," he wrote, adding, "The grim statistics include suicides, which occur mainly in adolescents and which accounted for 35% of firearm-related deaths and 13% of all deaths among children and adolescents in 2016."

Campion also argued against referring to motor vehicle and firearm deaths as accidents. "Car crashes and lethal gunshots are not random results of fate," Campion wrote. "Both individuals and the larger society need to understand that there is much that can be done to reduce the rate of fatal trauma," he argued.

Rebecca Cunningham of the University of Michigan, the study's lead author, said the results on firearm deaths likely will surprise most Americans. She said she doesn't think "it's acceptable for firearms to be a preventable cause of death and remain the second cause of death of children and teens." She said,

"We've invested billions of dollars to decrease motor vehicle crashes from the late 1990s to now. The same with cancer. The public accepts that as something we should be investing in to keep our children safe. But we've invested virtually nothing in firearm-related prevention. We've done virtually no research. Yet we can do things that do not affect our Second Amendment rights at all."

Deaths related to child labor are high, as well

Work-related injuries are also a noticeable cause of death among children, according to recent data from the Government Accountability Office (GAO).

The Department of Labor (DOL) allows children ages 16 and 17 to work, though they are not permitted to do hazardous work, such as mining coal or roofing. DOL permits children ages 14 and 15 to work limited hours in fairly safe jobs, such as food service jobs, while children ages 13 and younger are permitted to work only in a small number of exempt, regulated professions, like babysitting or acting in plays or movies.

However, the GAO data show around 452 children died as a result of workplace injuries between 2003 and 2016, including 73 deaths among children ages 12 or younger.

The vast majority of the deaths occurred in the agriculture industry, despite farmworkers making up less than a fifth of the child workforce in the United States.

Barbara Lee, director of the National Children's Center for Rural and Agricultural Health and Safety, said the number of work-related child deaths are unsurprising. "The news reports of these deaths and traumatic injuries cross my desk every day," she said. "They are not 'accidents' because that word implies they are out of our control. The truth is that each of these traumatic events is predictable and preventable. Adults bear responsibility for putting these kids at risk" (Emery, Reuters, 12/19; Silberner, "Goats and Soda," NPR, 12/19; Walker, MedPage Today, 12/19; Van Dam, "Wonkblog," Washington Post, 12/20).

The case for improving coordination between behavioral health and pediatrics

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The CDC estimates that nearly $247 billion is spent annually on the treatment and management of childhood mental disorders. Further, pediatric patients and caregivers often struggle to access high-quality behavioral health expertise due to a limited number of specialists and fragmented approaches to behavioral health services.

In this presentation, we review the case for improving coordination between behavioral health and pediatrics, and describe four successful models that increase access to behavioral health care.

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