[Unnatural death due to child abuse--forensic autopsies 1996-2009]

To evaluate the number of cases of fatal child abuse in minors on whom forensic autopsy was carried out in the Netherlands during the period 1996-2009 and to compare the 1996 data with Dutch data published earlier by Kuyvenhoven et al. (a questionnaire study among general practitioners and paediatricians).

Descriptive retrospective study.

Cases of unnatural death from all forensic autopsies on fetuses, children and young adults (> 24 weeks and < 18 years; n = 688) over the past 14 years (1996-2009) were retrospectively analyzed for child abuse. By means of death certificates and suspected cause of death, the actual outcomes of the 1996 data were compared with those of the study of Kuyvenhoven et al.

Over the past 14 years, in 445 of 688 forensic cases (65%) in this study population, cause of death was demonstrated to be unnatural. Of these deaths, 54% (n = 239/445) were unnatural and non-accidental due to child abuse. This corresponded with an annual average of 15 (30%) 'proven' and 2 (5%) 'highly probable' cases of fatal child abuse. The total number of abandoned babies, foundlings and otherwise, was on average 4 per year. In 1996 57% (13/23) of fatal child abuse cases were not represented in the data published by Kuyvenhoven et al.

Of the 49 foetuses, children and young adults on whom forensic autopsy was carried out in the Netherlands each year, 17 (35%) died due to proven or highly probable child abuse. In 1996 more than half of the number of fatal cases of child abuse of the Netherlands Forensic Institute were not represented in the study of Kuyvenhoven et al. In both this study and in the one of Kuyvenhoven underreporting is highly probable.