SEVENTEENTH ANNUAL REPORT
NOVEMBER 2010

Arizona Department of Health Services
Public Health Prevention Services
Bureau of Women’s and Children’s Health

ARIZONA CHILD FATALITY REVIEW TEAM

SEVENTEENTH ANNUAL REPORT

NOVEMBER 2010

MISSION:
To reduce preventable child fatalities through systematic, multidisciplinary, multiagency, and multi-modality review of child fatalities in Arizona, through interdisciplinary
training and community-based prevention education, and through data-driven
recommendations for legislation and public policy
Submitted to:
The Honorable Janice K. Brewer, Governor, State of Arizona
The Honorable Robert Burns, President, Arizona State Senate
The Honorable Kirk Adams, Speaker, Arizona State House of Representatives

This report is provided as required by A.R.S. §36-3501(C) (3)

Leadership for a Healthy Arizona

Janice K. Brewer, Governor
State of Arizona
Will Humble, Director
Arizona Department of Health Services

MISSION:
Setting the standard for personal and community health through direct care delivery,
science, public policy, and leadership

Arizona Department of Health Services
Public Health Prevention Services
Bureau of Women’s and Children’s Health
Child Fatality Review Program
150 North 18th Avenue, Suite 320
Phoenix, AZ 85007
(602) 364-1400
Prepared by: Alana J. Shacter, MPH
Injury and Child Fatality Epidemiologist

This publication can be made available in alternative formats. Please contact the Child
Fatality Review Program at (602) 364-1400 (voice) or call 1-800-367-8939 (TDD).
Permission to quote from or reproduce materials from this publication is granted when
acknowledgment is made.

TABLE OF CONTENTS
ACKNOWLEDGMENTS .................................................................................................. 1
EXECUTIVE SUMMARY................................................................................................. 2
RECOMMENDATIONS ................................................................................................... 5
INTRODUCTION ............................................................................................................. 8
2009 DEMOGRAPHICS ................................................................................................ 12
CHILD FATALITY REVIEW FINDINGS......................................................................... 17
SUBSTANCE USE ........................................................................................................ 24
PREMATURITY ............................................................................................................ 28
INFLUENZA-RELATED FATALITIES............................................................................ 31
SUDDEN UNEXPECTED INFANT DEATHS ................................................................ 33
MOTOR VEHICLE CRASH FATALITIES ...................................................................... 36
DROWNINGS ............................................................................................................... 42
HOME SAFETY-RELATED DEATHS ........................................................................... 45
SUICIDES ..................................................................................................................... 47
HOMICIDES .................................................................................................................. 52
FIREARM-RELATED FATALITIES ............................................................................... 56
MALTREATMENT FATALITIES .................................................................................... 60
APPENDIX A: CHILD DEATHS BY AGE GROUP ....................................................... 65
APPENDIX B: POPULATION DENOMINATORS FOR ARIZONA CHILDREN ............. 71
APPENDIX C: DATA ANALYSIS METHODOLOGY ..................................................... 72
APPENDIX D: ARIZONA CHILD FATALITY REVIEW TEAMS AND ARIZONA
DEPARTMENT OF HEALTH SERVICES STAFF ......................................................... 73
State Child Fatality Review Team .............................................................................. 73
Apache County Child Fatality Review Team .............................................................. 74
Cochise County Child Fatality Review Team ............................................................. 75
Coconino County Child Fatality Review Team ........................................................... 76
Gila County Child Fatality Review Team ................................................................... 77
Graham County and Greenlee County Child Fatality Review Team .......................... 78
Maricopa County Child Fatality Review Team ........................................................... 79
Mohave County and La Paz County Child Fatality Review Team .............................. 81
Navajo County Child Fatality Review Team ............................................................... 82
Pima County and Santa Cruz County Child Fatality Review Team............................ 83
Pinal County Child Fatality Review Team .................................................................. 85
Yavapai County Child Fatality Review Team ............................................................. 86
Yuma County Child Fatality Review Team ................................................................ 87
Arizona Department of Health Services Bureau of Women’s and Children’s Health . 88

ACKNOWLEDGMENTS
We wish to acknowledge the 210 volunteers who contributed more than 4,000 hours of
their time to review child deaths during 2009. It is through their hard work that we were
able to learn about the causes of child fatalities and what we, as individuals and as a
society, can do to reduce preventable deaths of children.

1

EXECUTIVE SUMMARY
The Arizona Child Fatality Review Program was created in 1993 (A.R.S. § 36-342, 363501-4) and data collection began in 1994. Reviews of child deaths are completed by
12 local child fatality teams located throughout Arizona. The state team provides
oversight to the local teams, produces an annual report summarizing review findings,
and makes recommendations regarding the prevention of child deaths. These
recommendations have been used to educate communities, initiate legislative action,
and develop prevention programs. The Arizona Department of Health Services
provides professional and administrative support to the state and local teams and
analyzes data from all death reviews.
In 2009, 947 children younger than 18 years of age died in Arizona. This was a
decline from 2008, despite the fact that the population of children increased slightly in
Arizona during 2009.
The rate of child fatalities decreased 23 percent in the five years from 2005
through 2009, from 71.7 deaths per 100,000 children in 2005 to 58.1 deaths per
100,000 children in 2009.
Arizona Child Fatality Review Teams reviewed 100 percent of child deaths and
determined that 33 percent of these deaths could have been prevented (n=315).
• 94 percent of homicides were preventable (n=48).
• 100 percent of drownings were preventable (n=35).
• 93 percent of deaths from motor vehicle crashes were preventable (n=76).
• 91 percent of maltreatment deaths were preventable (n=58). For three percent of
maltreatment deaths, local review teams were not able to determine
preventability (n=2).
• 95 percent of deaths from accidents (unintentional injuries) were preventable
(n=157).
• 89 percent of suicides were preventable (n=24). For 11 percent of suicides, local
review teams were not able to determine preventability (n=3).
The number of deaths among all age groups declined in 2009 except for children ages
one through four years. The percentage of children ages one through four years who
died increased from 12 percent of all child deaths in 2008 (n=126) to 14 percent of all
child deaths in 2009 (n=130).
Deaths were disproportionately high among most minority children in Arizona
during 2009. African American children comprised five percent of the population in
Arizona, but 10 percent of the fatalities. American Indian children comprised seven
percent of the population and nine percent of deaths. Hispanic children accounted for
39 percent of the population and 44 percent of fatalities. Though the numbers of deaths
decreased in 2009, these proportions remain nearly identical to previous years.

2

Deaths due to prematurity remained high among some minority groups during
2009. African American infants accounted for eight percent of deaths due to
prematurity in 2007 (n=26), 14 percent of deaths due to prematurity in 2008 (n=39), and
14 percent of deaths due to prematurity in 2009 (n=33). Hispanic infants comprised 46
percent of deaths due to prematurity in 2008 (n=125) and 47 percent of deaths due to
prematurity in 2009 (n=113).
Deaths involving substance use (illegal drugs, prescription drugs, and/or alcohol)
declined in 2009. Nineteen percent of all child deaths involved substance use (n=182),
a decrease from 2008 when substance use was involved in 20 percent of all child
deaths (n=209).
The rate of motor vehicle fatalities declined from 9.9 deaths per 100,000 children
in 2006 to 4.7 deaths per 100,000 children in 2009, but the rate remained stable
between 2008 and 2009. Motor vehicle crashes claimed 82 children’s lives in 2009,
the same number of deaths as in 2008. Six children died in off-highway vehicle (OHV)
crashes in 2009. Ninety-three percent of motor vehicle-related deaths were determined
to have been preventable (n=76). Lack of vehicle restraints was identified as a
preventable factor for 41 percent of motor vehicle crash fatalities (n=34).
In 2009, motor vehicle crashes were the leading non-medical cause of death for
children ages 15 through 17 years (23 percent, n=30). This is a departure from
previous years in which firearm injuries were the leading overall cause of death for this
age group.
The rate of drowning fatalities increased from 1.7 deaths per 100,000 children in
2008 to 2.0 deaths per 100,000 children in 2009. Thirty-five children died due to
drowning during 2009, and 100 percent of these deaths were determined to have been
preventable. The highest numbers of pool drownings were among children ages one
through four years.
Thirteen percent of all child deaths occurred in or around the home, and 87
percent of these deaths were determined to have been preventable (n=106). In
2009, 122 children died in or around the home, due to causes such as drownings,
sleep-related suffocations, poisonings, falls, and fires. Eighty-seven percent of these
deaths were among children younger than five years of age (n=106).
Ninety-one infants died in unsafe sleep environments in 2009, including 43 infants
who were placed to sleep in adult beds and three who were placed to sleep in car seats
or strollers. Thirty-six infants were placed to sleep on their sides or stomachs. Thirtyfour infants were bed sharing with adults and/or other children, and 21 of the adults who
bed shared were using illegal drugs, prescription drugs, and/or alcohol.
The child suicide rate continued to decrease in 2009, from 2.2 deaths per 100,000
children in 2005 to 1.6 deaths per 100,000 children in 2009. Twenty-seven children
took their own lives during 2009, and 89 percent of these deaths were determined to
3

have been preventable (n=24). For 11 percent of suicides, local review teams were not
able to determine preventability (n=3). The majority of suicides were among children
ages 15 through 17 years (89 percent, n=24), and 11 percent were among children 14
years of age and younger (n=3).
Deaths due to maltreatment increased from five percent of all deaths in 2008
(n=51) to seven percent of deaths in 2009 (n=64). For 22 maltreatment deaths,
mandatory reporters did not notify Arizona Child Protective Services that the deaths
were suspected to have been due to maltreatment even after investigation. Substance
use was involved in more than half of the child maltreatment deaths during 2009 (55
percent, n=35). Ninety-one percent of maltreatment deaths were determined to have
been preventable (n=58). For three percent of maltreatment deaths, local review teams
were unable to determine preventability (n=2).
Successes Related to Previous Recommendations
Deaths due to prematurity
The Arizona Department of Health Services launched a preconception health
awareness campaign that included culturally appropriate messaging to African
Americans in Arizona. The LiveItChangeIt campaign included media messaging,
community based presentations through faith-based organizations, and education for
barbers and beauticians who have a significant African American clientele.
The Arizona Department of Health Services partnered with March of Dimes to hold the
first annual Preconception Health Summit: “A Life Course Perspective”. All
presentations from the event were recorded and made available on DVD to maternal
and child health partners throughout Arizona.
The Arizona Department of Health Services joined with maternal and child health
partners and the Florida Department of Health to update preconception health materials
for use by healthcare providers and the public. The Every Woman Arizona packet is
used by healthcare providers as a reminder to screen for preconception health topics,
and individual pages can be used as informational sheets for the public.
Deaths due to motor vehicle crashes
The Arizona Game and Fish Department increased enforcement of existing laws
regarding children riding or driving all terrain/off-highway vehicles including helmet use,
double riding, and licensing.
The Arizona Injury Prevention Advisory Council in partnership with the Arizona Game
and Fish Department convened two statewide stakeholders’ meetings to raise
awareness of the various entities promoting safe all terrain/off-highway vehicle use
among Arizona residents.

4

Deaths due to poisoning
The Arizona Parents Commission on Drug Education and Prevention approved $16,012
in funding to support the printing of a brochure in English and Spanish that informs
adults of the potential dangers of prescription drugs and provides tips for safeguarding
prescription drugs around children, along with information on proper drug disposal. The
Commission and the Governor’s Office for Child, Youth and Families partnered with
Target to include the brochure with prescriptions distributed by Target stores in the state
of Arizona.
Deaths due to injuries
The Arizona Injury Prevention Program provided local child death and injury data to
Regional First Things First Councils so they could utilize this information to develop
regional grants targeting injury prevention.
Deaths due to suicide
The Arizona Department of Health Services Division of Behavioral Health developed a
taskforce to explore the development and implementation of a Suicide Investigation
Checklist for use by law enforcement when investigating suicides.
Unexpected infant deaths
The Arizona Unexplained Infant Death Council sent a letter to all law enforcement
agencies in Arizona reminding them of the statutory obligation to complete an Infant
Death Investigation Checklist whenever a child younger than one year of age dies
unexpectedly (A.R.S. § 36-2293). The letter instructed law enforcement officers to
promptly email or fax all completed Infant Death Investigation Checklists to the medical
examiner’s office where the autopsy will be conducted and the Arizona Department of
Health Services Unexplained Infant Death Council.

RECOMMENDATIONS
Based on its review of child deaths that occurred during 2009 and in previous years, the
State Child Fatality Review Team recommends specific actions to prevent future child
deaths in Arizona:
To Prevent Deaths due to Substance Use
Substance abuse (including illegal drugs, prescription drugs, and/or alcohol) was
involved in 182 child deaths during 2009, accounting for 19 percent of all child deaths.
According to the CFR teams, a history of drug and/or alcohol abuse played a role in 30
percent of all youth who died by suicide in this same year. Additionally, drugs and/or
alcohol contributed to 55 percent of the deaths listed under maltreatment (n=35).
Findings from the Center for Substance Abuse Treatment demonstrated that the
implementation of a Screening Brief Intervention and Referral to Treatment (SBIRT)
model in Washington State Emergency Departments resulted in Medicare savings of
5

$185 per member, per month, primarily due to declines in costs associated with
inpatient hospital admissions. Utilization of SBIRT has demonstrated a successful
reduction of substance abuse in various health care populations, including primary care,
emergency department, and trauma centers, in both adults and adolescents.
Recommendation to Arizona Department of Health:
Initiate outreach to hospitals and emergency departments across the state in efforts to
incorporate the SBIRT model into policy and protocol and educate about the availability
of the Substance Abuse Prevention and Treatment Block Grant funds, under which
women and children are priority populations for substance abuse treatment.
To Prevent Deaths due to Motor Vehicle Crashes
Primary seatbelt laws are important not only for raising adult safety belt use, but also for
increasing the number of children who are protected by occupant restraints. Research
also shows that when adults buckle up, 87% of children get buckled up too. In 2009, the
largest percentage of motor vehicle deaths was among children 15 through 17 years of
age; one third of victims were improperly restrained. Arizona’s secondary seat belt law
does not allow law enforcement officers to stop and ticket a driver for non-use of a seat
belt unless the driver has committed another offense.
Recommendation to the Arizona Legislature: Enact a primary seat belt law to allow law
enforcement officers to ticket a driver for not wearing a seat belt. This has already been
enacted in four Arizona Tribal Nations.
Children aged 4 to 7 years in states with booster seat laws were 39 percent more likely
to be reported as appropriately restrained than were children in other states (Children's
Hospital of Philadelphia). Booster seats are for older children who have outgrown their
forward-facing car safety seats. Children should stay in a booster seat until adult belts fit
correctly, usually when a child reaches 4' 9" in height and is between 8 and 12 years of
age. Arizona is one of only three states that do not have a booster seat law.
Recommendation to the Arizona Legislature: Enact legislation that requires the use of
booster seats for children who are between five and nine years of age and are less than
four feet, nine inches in height.
To Prevent Injury-Related Deaths among Children
In 2009, 122 children died in or around the home. Lack of supervision was a
preventable factor that was identified in sixty-six percent of the deaths. Supervision
may be direct and constant, intermittent or focused on an area of play space. The type
of supervision is dependent upon the activity and location as well as the age and skill of
the child. As an example, proper supervision of a young non-swimmer requires the
supervising adult to be within an arm's length to provide "touch supervision."

6

Recommendation to Arizona Drowning Prevention Programs: Drowning prevention
programs should emphasize “touch supervision” to prevent child drowning.
Recommendation to Arizona Legislature: Strengthen current legislation regarding pool
fencing to require four-sided fencing with appropriate gates for all backyard pools where
children live or play.
Storing firearms locked and unloaded, with ammunition locked separately, can reduce
the risk of injuries, deaths, and suicides involving children and teens. There were 32
firearm deaths in 2009, with a majority of these among children 15 through 17. Only
one death involved a gun that was in a locked cabinet. The safe storage of firearms is
associated with a significant decrease in firearm injuries in homes with children and
teenagers, according to a study by researchers from the Harborview Injury Prevention
and Research Center of the University of Washington.
Recommendation to Gun Owners: Families with children should store all firearms
unloaded, in a secure locked location. Firearms should be removed from homes in
which children or adolescents exhibiting signs or symptoms of mental illness reside or
visit.
To Prevent Deaths due to Maltreatment
When Arizona Child Protective Services (CPS) is not notified of a death of a child where
abuse or neglect is suspected because there were no other children living in the home,
this results in information not being investigated by CPS. CPS would not have a record
should the parents have future children and a new report of suspected abuse or neglect
be received on the parents. The death of a child is critical information for subsequent
CPS investigation.
Recommendation to all Arizona Law Enforcement Officers and Medical Examiners:
Report every child death where child abuse or neglect is suspected to the Child
Protective Services' Child Abuse Hotline promptly (1-888-SOS-CHILD), even if there are
no other children living in the home.
Recommendation to Arizona Department of Economic Security Division of
Developmental Disabilities and its providers: Notify Child Protective Services’ Child
Abuse Hotline (1-888-SOS-CHILD) promptly whenever there is a suspicion of neglect of
a child’s medical or developmental condition.
Arizona caseload standards are 10 investigations, 19 in-home cases, or 16 children in
out of home care per CPS Specialist. As of October 2010, Arizona CPS Specialists are
presently working at 64 percent above caseload standards. If all CPS Specialist
positions were filled, CPS Specialists would be working at 24 percent above caseload
standards.

7

Recommendation to the Arizona Legislature: Increase funding to the Arizona
Department of Economic Security Division of Youth, Children, and Families in order to
reinstate child maltreatment prevention programs and reduce the caseload of Child
Protective Services Specialists to meet the existing Arizona Caseload Standards.
To Prevent Deaths due to Pneumonia/Influenza
The Arizona Child Fatality Review Teams identified 52 child deaths resulting from
pneumonia/influenza in 2009. This is a sharp increase from 2008 when 21 child deaths
were due to pneumonia/influenza.
Recommendation to Arizona parents: Obtain influenza immunization for yourself and all
children six months of age and older. Urge other household contacts and out of home
care providers of your child to obtain influenza immunization if your child is less than
five years of age or has a high-risk medical condition.
To Prevent Sudden Unexpected Infant Deaths
There has been a major decrease in the incidence of sudden infant death syndrome
(SIDS) since the American Academy of Pediatrics (AAP) released its recommendation
in 1992 that infants be placed on their back to sleep. For more than a decade, SIDS
has been defined as the sudden death of an infant younger than 1 year that remains
unexplained after thorough case investigation, including performance of a complete
autopsy, examination of the death scene, and review of the clinical history. In 2009,
CFR teams reviewed 123 sudden unexpected infant deaths and 74 percent occurred in
sleep environments (n=91). Seventy-seven of these sleep environments were
determined to have been unsafe (63 percent). Suffocation was the cause of 17 unsafe
sleep-related deaths, and 20 sudden expected infant deaths were identified as SIDS.
Recommendation to Arizona Safe Kids Coalitions: Include safe sleep information as
part of the child passenger safety and education materials distributed to families.
The Arizona Perinatal Trust is a private-public partnership among hospitals, health care
professionals, and state agencies throughout Arizona, committed to an effective
regionalized perinatal health care system. This organization designates hospitals based
on the maternal and neonatal care the facility is capable of delivering. Parents watch
how nurses and health care professionals handle their newborn so it is important that
health care staff model the right behaviors. This can be ensured by having safe sleep
policies in place.
Recommendation to the Arizona Perinatal Trust: Continue to evaluate the safe sleep
practices and safe sleep education programs for parents in reviews and site visits of all
Arizona birthing hospitals.
The American Academy of Pediatrics and the National Association of Medical
Examiners (NAME) endorse universal performance of autopsies by forensic
8

pathologists experienced in the diagnosis of SIDS whenever an infant dies suddenly
and unexpectedly. In 2009, only eighty-eight percent of the sudden unexpected infant
deaths were referred to medical examiner’s offices (n=108). One hundred one of these
cases were autopsied and ninety-nine had toxicology tests performed.
Recommendation to Arizona Medical Examiners: The determination of the manner and
cause of a sudden unexpected infant death should be made after review of the Sudden
Unexplained Infant Death Investigation Checklist, medical records, and an autopsy
which includes radiographs, appropriate toxicology testing and appropriate metabolic
and histologic studies.
The Arizona Teratogen Information Program
The Arizona Pregnancy Riskline provides toll-free, evidence based information to health
care providers and consumers throughout the state who have concerns about
potentially toxic exposures during pregnancy and breastfeeding. Information necessary
to counsel women about these exposures is not readily available to health care
providers due to the difficulties in obtaining and interpreting the available medical
literature. Inappropriate medical care, even in one pregnancy, can lead to complications
in the mother or baby that are likely to have significant costs to Arizona.
Arizona Pregnancy Riskline had been funded by the Arizona Legislature since 1999.
Funding was cut by half in January 2009 and eliminated in July 2009. Current funding
has been “cobbled together” since that time and is unlikely to be sustainable. The
Riskline receives approximately 1,200 calls annually (down from 3,000 in 2008) from
providers and patients. Employees of Arizona Teratogen Information Program (ATIP)
provide 25-35 educational sessions annually to medical students, residents, attending
physicians, other health care providers (such as CPS workers, Catholic Social Services
staff, etc.) and consumers throughout Arizona.
Recommendation to the Arizona Legislature: Restore funding to the Riskline at the
Arizona Poison Center so that pregnant and nursing women can receive timely
information about the risks associated with drug and medication exposures, as well as
the risk of influenza during pregnancy.

9

INTRODUCTION
The Arizona Child Fatality Review Program was created in 1993 (A.R.S. § 36-342, 363501-4) and data collection began in 1994. The state team is mandated by statute to
produce an annual report summarizing the findings. The state team is also authorized
to study the adequacy of existing statutes, ordinances, rules, training, and services to
determine what changes are needed to decrease the number of preventable child
fatalities. Further, the state team is charged with educating the public regarding the
number and causes of child fatalities. By statute, the state team includes
representatives from:
•
Attorney General’s Office
•
Bureau of Women’s and Children’s Health in the Department of Health Services
•
Division of Behavioral Health in the Department of Health Services
•
Division of Developmental Disabilities in the Department of Economic Security
•
Governor’s Office for Children
•
Administrative Office of the Courts
•
Arizona Chapter of the American Academy of Pediatrics
•
Medical Examiner’s Office
•
Maternal Child Health Specialist who works with members of Tribal Nations
•
Private nonprofit organization of Tribal Governments
•
The Navajo Nation
•
United States Military Family Advocacy Program
•
Unexplained Infant Death Council
•
Prosecuting Attorney’s Advisory Council
•
Law Enforcement Officer’s Advisory Council with experience in child homicide
•
Association of County Health Officers
•
Child Advocate not employed by the state or a political subdivision of the state
•
A member of the public
Actual reviews of child deaths are conducted by 12 local child fatality review teams.
These teams are located throughout the state and must include local representatives
from Child Protective Services, a county medical examiner’s office, a county health
department, law enforcement, and a county prosecuting attorney’s office. Membership
also includes a pediatrician or family physician, a psychiatrist or psychologist, a
domestic violence specialist, and a parent. Additional members representing a wide
range of disciplines may also participate.
Child Fatality Review Process
When a child younger than 18 years of age dies in Arizona, a copy of the death
certificate is sent to the appropriate Local Child Fatality Review Team. The local team
coordinator or chairperson then requests relevant documents which may include the
child’s autopsy report, hospital records, Child Protective Services records, law
enforcement reports, and any other information that may provide insight into the death.
If the child was younger than one year of age at the time of death, the birth certificate is
also reviewed. Legislation requires that hospitals and state agencies release this
10

information to the Arizona Child Fatality Review Program’s local teams. Team
members are required to maintain confidentiality and are prohibited from contacting the
child’s family.
According to the National Center for Child Death Review (www.childdeathreview.org),
there are six steps to a quality review of a child’s death:
1. Share, question, and clarify all case information.
2. Discuss the investigation that occurred.
3. Discuss the delivery of services (to family, friends, schoolmates, community).
4. Identify risk factors (preventable factors or contributing factors).
5. Recommend systems improvements (based on any identified gaps in policy or
procedure).
6. Identify and take action to implement prevention recommendations.
Next, the local team completes a standardized Child Death Review Case Report
(version 2.1) that includes extensive information regarding the circumstances
surrounding the death. The Case Report was created by the National Center for Child
Death Review.
Local Child Fatality Review Teams review deaths throughout the year and submit all
reviews to the Child Fatality Review Program by August 15th for inclusion in the annual
report published each November. If a team has not completed a review by the August
15th deadline, the death will not be included in the published report. Staff members
within the Arizona Department of Health Services Bureau of Women’s and Children’s
Health enter all submitted Case Reports into a confidential database created by the
National Center for Child Death Review. The Arizona Department of Health Services
provides professional and administrative support for the teams, and analyses of the
data are completed by staff within the Bureau of Women’s and Children’s Health.
This is the seventeenth annual report issued by the Arizona Child Fatality Review
Program. Each year, the state team has made recommendations regarding the
prevention of child deaths. These recommendations are evidence-based and have
been used to educate communities, initiate legislative action, and develop prevention
programs. Because these reviews are completed by a multidisciplinary team of wellrespected professionals, the team’s recommendations are often adopted.

11

2009 DEMOGRAPHICS
During 2009, there were 947 fatalities among children younger than 18 years in Arizona.
This was a decline from 2008 when 1,038 children died, despite the fact that the
population of children increased by 0.5 percent in Arizona during 2009. Males
accounted for 58 percent of deaths (n=546) and females accounted for 42 percent
(n=401). More males died in each age group, a trend that has been observed in
previous years. Figure 1 shows deaths among children by age group and sex.
Figure 1. Deaths Among Children by Age Group and Sex, Arizona 2009 (n=947)
250
Males (n=546)
200

Females (n=401)

197
169

150
100

100

94
83

68 62
47

40

50

27

26

34

0
Birth‐27 Days

28‐365 Days

1‐4 Years

5‐9 Years

10‐14 Years

15‐17 Years

The largest percentage of deaths was among infants younger than 28 days (39 percent,
n=366). Figure 2 shows deaths among children by age group.

12

Figure 2. Deaths Among Children by Age Group, Arizona 2009 (n=947)
15‐17 Years
13% (n=128)
Birth‐27 Days
39% (n=366)

10‐14 Years
8% (n=73)

5‐9 Years
7% (n=67)

1‐4 Years
14% (n=130)

28‐365 Days
19% (n=183)

Compared to 2008, there was a decrease in the percentage of child deaths among
children less than one year of age and an increase in the percentage of deaths among
children ages one through seventeen years in 2009. Table 1 shows the number and
percentage deaths among children by age group for 2005 through 2009.
Age Group
0-27 Days
28-365 Days
1-4 Years
5-9 Years
10-14 Years
15-17 Years
Total

Table 1. Deaths Among Children by Age Group, Arizona 2005-2009
2005
2006
2007
2008
434
38%
440
37%
485
42%
423
42%
233
20%
206
18%
225
20%
211
20%
130
11%
153
13%
113
10%
126
12%
85
7%
64
6%
67
6%
67
6%
86
8%
92
8%
92
8%
74
7%
180
16%
206
18%
161
14%
137
13%
1,148
1,161
1,143
1,038

2009
366
183
130
67
73
128
947

39%
19%
14%
7%
8%
14%

Mortality rates among all children declined 23 percent from 2005 through 2009, but rate
decreases varied by age group. The declining mortality rate was largest among children
15 through 17 years (70.8 deaths per 100,000 population in 2005 to 45.0 deaths per
100,000 population in 2009). Table 2 shows the mortality rate among children in Arizona
per 100,000 population by age group.

13

Table 2. Mortality Rates per 100,000 Population Among Children
by Age Group, Arizona 2005-2009
Age Group
2005
2006
2007
2008
2009
<1 Year*
738.7
665.2
692.1
640.4
595.0
1-4 Years
36.5
39.7
28.5
31.3
32.0
5-9 Years
18.6
14.2
14.6
14.4
14.3
10-14 Years
19.4
20.1
20.2
16.0
15.6
15-17 Years
70.8
76.6
58.0
48.6
45.0
Total
71.7
70.0
67.6
60.7
55.1
*Because population denominators are only available for children younger than
one year of age, deaths in the neonatal and post-neonatal periods have been
combined.

Forty-four percent of child deaths in 2009 were among Hispanics (n=420), 35 percent
were among Non-Hispanic Whites (n=327), 10 percent were among African Americans
(n=93), nine percent were among American Indians (n=85), and two percent were
among Asians (n=22). Figure 3 shows deaths among children by race/ethnicity.
Figure 3. Deaths Among Children by Race/Ethnicity, Arizona 2009 (n=947)
White, Non‐
Hispanic
35% (n=327)

African American
10% (n=93)

American Indian
9% (n=85)
Asian
2% (n=22)

Hispanic
44% (n=420)

Deaths were over-represented among three racial/ethnic groups in 2009. African
American children comprised five percent of the population in Arizona, but 10 percent of
fatalities. American Indian children comprised seven percent of the population and nine
percent of deaths. Hispanic children accounted for 39 percent of the population and 44
percent of child fatalities in 2009. Figure 4 shows deaths among children by
race/ethnicity compared to population percentages.

14

Figure 4. Deaths Among Children by Race/Ethnicity Compared to Population,
Arizona 2009
50%
45%

46%

44%

2009 Fatalities
2009 Population

39%

40%

35%

35%
30%
25%
20%
15%
10%

10%

9%
5%

7%

5%

3%
2%

0%
African American American Indian

Asian

Hispanic

White, Non‐
Hispanic

Compared to 2008, the percentages of deaths among American Indian and White, NonHispanic children increased during 2009. For all other races/ethnicities, the percentage
of child deaths by race/ethnicity declined or remained the same compared to 2008.
Table 3 shows deaths among children by race/ethnicity for 2006 through 2009.
Table 3. Deaths Among Children by Race/Ethnicity, Arizona 2006-2009
Race/Ethnicity
2006
2007
2008
2009
African American
102
9%
75
7%
102
10%
93
10%
American Indian
111
10%
104
9%
86
8%
85
9%
Asian
19
2%
26
2%
41
4%
22
2%
Hispanic
505
42%
529
46%
456
44%
420
44%
White, Non-Hispanic
424
37%
409
36%
353
34%
327
35%
Total
1,161
1,143
1,038
947

Table 4 shows deaths among children by county of residence. There were increases in
the percentages of deaths among children who resided in Apache, Maricopa, Mohave,
and Pinal Counties in 2009. The population of children increased slightly in each of
these counties from 2008 to 2009 except for Mohave County. The percentage of
children who died in 2009 declined in Pima, Navajo, and Yuma Counties, even though
the population of children in those counties increased slightly (less than one percent
each). For more information on the population of children in Arizona, see Appendix B.

15

Table 4. Deaths Among Children by County of Residence Arizona 2007-2009
2007
2008
2009
County
Number Percent Number Percent Number Percent
Apache
13
1%
21
2%
26
3%
Cochise
27
2%
24
2%
21
2%
Coconino
25
2%
25
2%
18
2%
Gila
17
1%
15
1%
9
1%
Graham
12
1%
11
1%
5
<1%
Greenlee
0
-1
<1%
0
-La Paz
1
<1%
5
<1%
5
<1%
Maricopa
648
57%
575
55%
542
57%
Mohave
27
2%
12
1%
21
2%
Navajo
39
3%
31
3%
22
2%
Pima
148
13%
165
16%
130
14%
Pinal
64
6%
52
5%
60
6%
Santa Cruz
6
<1%
6
<1%
7
1%
Yavapai
28
2%
17
2%
20
2%
Yuma
35
3%
40
4%
28
3%
Outside Arizona
53
5%
38
4%
33
3%
Total
1,143
1,038
947

16

CHILD FATALITY REVIEW FINDINGS
Cause and Manner of Child Fatalities
Cause of death refers to the injury or medical condition that resulted in death (e.g.
firearm-related injury, pneumonia, cancer). Manner of death is not the same as cause
of death, but specifically refers to the intentionality of the cause. For example, if the
cause of death was a firearm-related injury, then the manner of death may have been
intentional or unintentional. If it was intentional, then the manner of death was suicide
or homicide. If it was unintentional, then the manner of death was an accident
(unintentional injury). In some cases, there was insufficient information to determine the
manner of death, even though the cause was known. It may not have been clear that a
firearm death was due to an accident (unintentional injury), suicide, or homicide, and in
these cases, the manner of death was listed as undetermined. Manners of death
include:
•
•
•
•
•

natural (e.g., cancer)
accident (unintentional injury) (e.g., unintentional car crash)
homicide (e.g., intentional assault)
suicide (e.g., self-inflicted intentional firearm injury)
undetermined.

In addition to reviewing medical examiner reports, Child Fatality Review Teams also
review records from hospitals, emergency departments, law enforcement, Child
Protective Services, and other sources. As a result of this comprehensive,
multidisciplinary approach, the teams’ determinations of cause and manner sometimes
differ from those recorded on the death certificates. In the sections that follow, deaths
are counted once for each applicable section based upon the team’s determination of
the cause and manner of death. For example, a homicide involving a firearm injury
perpetrated by an intoxicated caregiver would be counted in the sections addressing
firearm injuries, homicides, substance use, and maltreatment fatalities.
Natural deaths accounted for 68 percent of all child deaths during 2009 (n=641), 17
percent of child deaths were accidents (unintentional injuries) (n=165), five percent were
homicides (n=51), three percent were suicides (n=27), and seven percent were of
undetermined manner (n=63). Figure 5 shows deaths among children by manner.

17

Figure 5. Deaths Among Children by Manner, Arizona 2009 (n=947)
Accident
17% (n=165)
Homicide
5% (n=51)
Suicide
3% (n=27)
Undetermined
7% (n=63)

Natural
68% (n=641)

The distribution of manner of death varied by age group. Deaths among infants were
primarily due to natural causes, while accidental (unintentional injury) deaths were more
common among older children. Suicide occurred only among the two oldest age
groups, and homicide occurred in all age groups. Figure 6 shows manner of child
deaths by age group.

18

Figure 6. Percentage of Child Deaths by Age Group and Manner,
Arizona 2009 (n=947)
100%
90%

2%
2%

1%
23%

80%

4%
10%

70%
60%
50%

6%
9%

8%
28%

4%
6%

3%

3%
19%

23%
16%

43%
Undetermined

95%

37%

40%

Suicide
Homicide

64%

63%

30%

64%

Accident

42%

20%

Natural
25%

10%
0%
<28
Days
(n=366)

28‐365
Days
(n=183)

1‐4
Years
(n=130)

5‐9
Years
(n=67)

10‐14
Years
(n=73)

15‐17
Years
(n=128)

The percentage of deaths due to homicides declined slightly from 2008 to 2009, and the
percentages of accidental (unintentional injury) deaths increased. Table 4 shows
deaths among children by manner for 2006 through 2009.
Table 4. Deaths Among Children Birth Through 17 Years by Manner of Death,
Arizona 2006-2009
Manner
2006
2007
2008
2009
Natural
743
64%
769
67%
702
68%
641
68%
Accident (Unint. Injury)
270
23%
227
20%
168
16%
165
17%
Undetermined
37
3%
53
5%
73
7%
63
7%
Homicide
63
5%
66
6%
60
6%
51
5%
Suicide
48
4%
28
2%
35
3%
27
3%
Total
1,161
1,143
1,038
947

There were 241 deaths due to prematurity, 28 deaths due to Sudden Infant Death
Syndrome (SIDS), and 372 deaths due to other medical conditions in 2009. There were
82 motor vehicle-related deaths and 35 drownings. There were seven deaths due to
exposure in 2009. Four of these children died of hyperthermia while crossing the
Mexico-United States border, and one child died of hyperthermia during a recreational
hike. Two children died of hypothermia; alcohol consumption was involved in both
cases. Table 5 shows deaths among children by cause and manner.

19

Table 5. Deaths among Children Birth Through 17 Years by
Cause and Manner, Arizona 2009 (n=947)
Cause
Accident
Homicide
Suicide
Natural
Undetermined
(Unint. Injury)
Medical*
0
1
0
371
0
Prematurity
0
0
0
241
0
Motor vehicle crash
81
1
0
0
0
Undetermined
1
1
0
9
46
Firearm injury
1
21
9
0
1
Drowning
33
0
0
0
2
Suffocation
12
2
0
0
3
Hanging
5
0
15
0
0
SIDS
0
0
0
20
8
Blunt force trauma
0
12
0
0
1
Other
4
11
0
0
1
Poisoning
12
1
3
0
1
Fall/crush
6
1
0
0
0
Exposure
7
0
0
0
0
Fire/burn
3
0
0
0
0
Total
165
51
27
641
63
*Excluding SIDS and prematurity

Total
372
241
82
57
32
35
17
20
28
13
16
17
7
7
3
947

The percentages of deaths due to motor vehicle crashes, drownings, and SIDS
increased, and the percentages of child deaths due to medical conditions, firearm
injuries, and prematurity declined. Table 6 shows deaths among children by cause for
2007 through 2009.
Table 6. Deaths Among Children Birth Through 17 Years by Cause,
Arizona 2007-2009
Cause
2007
2008
2009
Medical*
420
37%
420
40%
372
Prematurity
321
28%
271
26%
241
Motor vehicle crash
122
11%
82
8%
82
Undetermined
34
3%
59
6%
57
Firearm injury
48
4%
49
5%
32
Drowning
23
2%
29
3%
35
SIDS
37
3%
20
2%
28
Suffocation
27
2%
21
2%
17
Hanging
13
1%
21
2%
20
Other
33
3%
14
1%
16
Poisoning
24
2%
14
1%
17
Blunt force trauma
18
1%
16
1%
13
Fall/crush
9
1%
9
1%
7
Exposure
8
1%
9
1%
7
Fire/burn
6
1%
4
1%
3
Total
1,143
1,038
947
*Excluding SIDS and prematurity

39%
25%
9%
6%
3%
4%
3%
2%
2%
2%
2%
1%
1%
1%
<1%

20

Preventability of Child Fatalities
In Arizona, the child fatality review process is grounded in the principles of public health
and is focused on the prevention of all child deaths. Child Fatality Review Teams
consider a child’s death preventable if something could have been done (by an
individual such as the caregiver or supervisor, or by the community) that could have
prevented the death. Child Fatality Review Teams determined that 315 child deaths in
2009 were preventable (33 percent). This percentage remained the same from 2008,
when 33 percent of deaths were determined to have been preventable (n=343). Figure
7 shows deaths among children by preventability.
Figure 7. Deaths Among Children by Preventability, Arizona 2009 (n=947)
Probably Not
Preventable
58% (n=546)
Undetermined
9% (n=86)

Probably
Preventable
33% (n=315)

Ninety-five percent of accidental (unintentional injury) deaths were preventable (n=157),
94 percent of homicides were preventable (n=48), and 89 percent of suicides were
preventable (n=24). Six percent of natural deaths were determined to have been
preventable (n=40). For 11 percent of suicides and 10 percent of natural deaths, local
teams did not have enough information to determine preventability (n=3 and n=62
respectively). Seventy-three percent of deaths of undetermined manner were
considered preventable. Examples of preventable deaths of undetermined manner
include deaths due to poisoning or firearm-related injuries in which the team could not
determine whether or not the child was intentionally injured but was able to determine
that the death could have been prevented. Figure 8 shows preventable deaths by
manner.

21

Figure 8. Percentage of Preventable Deaths Among Children by Manner of Death,
Arizona 2009 (n=315)
100%
89%

90%
80%

95%

94%

Accident
(n=157)

Homicide
(n=48)

73%

70%
60%
50%
40%
30%
20%
10%

6%

0%
Natural
(n=40)

Undetermined
(n=46)

Suicide
(n=24)

Preventability also varied by age group. Neonates had the lowest percentage of
preventable deaths (7 percent, n=25). The highest percentage of preventable deaths
was among children ages 15 through 17 years (70 percent, n=90). Figure 9 shows
preventable deaths among children by age group.
Figure 9. Percentage of Preventable Deaths Among Children by Age Group,
Arizona 2009 (n=315)
100%
90%
80%

70%

70%
58%

60%
50%

39%

40%

39%

38%

5‐9 Years
(n=26)

10‐14 Years
(n=28)

30%
20%
10%

7%

0%
<28 Days
(n=25)

28‐365 Days
(n=71)

1‐4 Years
(n=75)

15‐17 Years
(n=90)

During the review of each child’s death, teams identify factors believed to have
contributed to the death. Although the presence of a contributing factor typically led to
22

the determination that a death was preventable, this was not always the case. For
example, the team might have concluded that an unsafe sleep environment (e.g. infant
left sleeping on a couch) was a contributing factor in an unexpected infant death.
However, the team may not have had sufficient information (e.g. autopsy report,
adequate scene investigation) to determine that the death could have been prevented.

23

SUBSTANCE USE
Substance use (including illegal drugs, prescription drugs, and/or alcohol) was involved
in 182 child deaths in Arizona during 2009, which accounted for 19 percent of all child
deaths. In 2008, substance use was involved in 20 percent of all child deaths (n=209).
In 2009, 29 percent of deaths involving substance use were natural (n=52), 25 percent
were accidents (unintentional injuries) (n=46), 22 percent were deaths of undetermined
manner (n=41), 16 percent were homicides (n=29), and eight percent were suicides
(n=14). Figure 10 shows child deaths involving drugs and/or alcohol by manner.
Figure 10. Child Deaths Involving Drugs and/or Alcohol by Manner,
Arizona 2009 (n=182)
Suicide
8% (n=14)
Natural
29% (n=52)

Undetermined
22% (n=41)

Homicide
16% (n=29)

Accident
25% (n=46)

Among the substance abuse-related deaths, firearms accounted for 9 percent (n=17) of
deaths involving drugs and/or alcohol, and motor vehicle crashes accounted for 10
percent of child deaths (n=19), including seven children who died in crashes involving
substance-impaired drivers. Sixteen deaths were due to prematurity (typically
substance exposed preterm newborns). Table 7 shows child deaths involving drugs
and/or alcohol by cause and manner in 2009.

24

Cause

Table 7. Child Deaths Involving Drugs and/or Alcohol by Cause and Manner,
Arizona 2009 (n=182)
Accident
Homicide
Suicide
Natural
Undetermined
(Unint. Injury)
0
0
0
29
0
0
0
0
16
0
0
1
0
2
30
18
1
0
0
0

Medical*
Prematurity
Undetermined
Motor vehicle
crash
Firearm injury
0
Poisoning
12
Suffocation
7
SIDS
0
Other injury
0
Blunt force trauma
0
Hanging
0
Drowning
3
Exposure
2
Fire/burn
2
Fall/crush
2
Total
46
*Excluding SIDS and prematurity

11
1
2
0
7
6
0
0
0
0
0
29

5
3
0
0
0
0
6
0
0
0
0
14

0
0
0
5
0
0
0
0
0
0
0
52

1
1
3
4
1
0
0
1
0
0
0
41

Total
29
16
33
19
17
17
12
9
8
6
6
4
2
2
2
182

Alcohol was involved in 51 child deaths in 2009, 76 child deaths in 2008, and 80 deaths
in 2007; marijuana was involved in 67 deaths in 2009; methamphetamine was involved
in 53 deaths in 2009; cocaine was involved in 17 deaths in 2009; and opiates were
involved in 24 deaths in 2009. More than one substance may have been involved in a
single death. Table 8 shows substances involved in child deaths from 2007 through
2009.
Table 8. Substances Involved in Deaths Among Children,
Arizona 2007-2009
Substance*
2007
2008
2009
Alcohol
80
7%
76
7%
51
5%
Marijuana
76
7%
57
5%
67
7%
Methamphetamine
48
4%
39
4%
53
6%
Cocaine
31
3%
21
2%
17
2%
Opiates
16
1%
18
2%
24
3%
*More than one substance could have been involved in a single death

Drugs and/or alcohol were determined to have been involved in child deaths among
males and females in all age groups. Males of all age groups accounted for 63 percent
of all substance use-related deaths (n=115). Figure 11 shows child deaths involving
substance use by sex and age group.

25

Figure 11. Child Deaths Involving Substance Use by Sex and Age Group,
Arizona 2009 (n=182)
40

38

Females (n=67)
35

Males (n=115)

30

27 27

25
21
20
16
15

12

11
10

10

7

8

5

2

3

0
<28 Days

28‐365 Days

1‐4 Years

5‐9 Years

10‐14 Years

15‐17 Years

The individual who used the substance may have been the parent, child, an
acquaintance of the child or family, a relative, or a stranger. For example, if the child
was a passenger in a car hit by the intoxicated driver of another car, then the individual
who used the substance was classified as “stranger.” In some deaths, more than one
individual may have been using drugs and/or alcohol. For 64 deaths in 2009, the user
was the parent, and for 34 deaths, the user was the child. In some deaths, more than
one individual may have been using drugs and/or alcohol. Figure 12 shows child
deaths involving drugs and/or alcohol by substance user for 2006 through 2009.

26

Figure 12. Child Deaths Involving Drugs and/or Alcohol by Substance User,
Arizona 2006-2009
90

85

80

2006

60

2008

64
58

2009
51

50

43

40
30

2007

73

70

29

34
22
16

20

11

10

5

7 10

8
4 2 4

8 10

8
6

3

5

0
Child

Parent

Acquaintance
of child

Acquaintance
of parent

Stranger

Other relative

27

PREMATURITY
Local teams consider a child’s cause of death to be prematurity if the infant was less
than 38 weeks gestation and factors directly related to prematurity caused the death.
Infants born prematurely who had congenital anomalies incompatible with survival after
birth are not included in the prematurity category. In 2009, there were 241 deaths due
to prematurity, which accounted for 25 percent of all child deaths. There were 271
deaths due to prematurity in 2008 (26 percent of all deaths). The rate of deaths due to
prematurity in 2009 was 2.6 deaths per 1,000 live births. This was a 13 percent decline
from 2005 when the rate was 3.0 deaths per 1,000 live births. Figure 13 shows the
rates of child deaths due to prematurity from 2005 through 2009.
Figure 13. Rate of Child Deaths due to Prematurity (per 1,000 live births),
Arizona 2005-2009
3.2
3.1
3.1
3.0
3.0
2.9
2.9
2.8
2.7

2.7

2.6
2.6
2.5
2.4
2.3
2005

2006

2007

2008

2009

In 2009, 55 percent of the premature infants who died were males (n=132) and 45
percent were females (n=109). Nearly half of the premature infants who died were
Hispanic (47 percent, n=113), 32 percent were White, Non-Hispanic (n=77), 14 percent
were African American (n=33), two percent were Asian (n=6), and five percent were
American Indian (n=12). In 80 cases, at least one of the parents was a first generation
immigrant, including four families from European countries and five from Asian
countries. In a majority of cases in which a parent of a deceased child was a first
generation immigrant, the parent was from Mexico (65 percent, n=52).
While the percentage of African American infants who died of prematurity increased
from eight percent in 2007 (n=26) to 14 percent in 2008 (n=39), the percentage
remained stable in 2009 (14 percent, n=33). Figure 14 shows deaths due to prematurity
by race/ethnicity from 2007 through 2009.
28

Figure 14. Child Deaths due to Prematurity by Race/Ethnicity, Arizona 2007-2009
60%
2007 (n=321)
50%

50%

2008 (n=271)

47%
46%

2009 (n=241)
40%

33%
32%
29%

30%
20%
10%

14% 14%
8%

5% 4% 5%

3% 6%

2%

0%
African American American Indian

Asian

Hispanic

White, Non‐
Hispanic

In 2009, over half of the deaths due to prematurity were among infants who were 21
through 24 weeks gestational age (52 percent, n=126), followed by infants who were 20
weeks gestational age or less (24 percent, n=59). There were 52 infants who were 25
through 37 weeks gestational age (22 percent). For four infants, gestational age was
unknown. There were 42 deaths due to prematurity among infants in multiple births (35
were twins, 3 were triplets, and four were quintuplets).
For two percent of deaths due to prematurity, prenatal care information was unknown to
review teams (n=6). For 10 percent of the deaths, the mother reported that she did not
receive any prenatal care (n=24). Seventy-eight percent of mothers started prenatal
care within the first trimester (n=189). For over half of the prematurity deaths, the
mother was 20 through 29 years of age at the time of the birth (52 percent, n=125).
Twelve percent of the mothers were 19 years of age and younger (n=28), 33 percent
were 30 through 39 years of age (n=79), and two percent of mothers were 40 years of
age and older (n=4). There were five cases in which the mother’s age was unknown.
Forty-nine percent of mothers whose infants died of prematurity were insured by the
Arizona Health Care Cost Containment System (AHCCCS) (n=117). Thirteen percent
of mothers had less than a high school education (n=31), 46 percent completed high
school (n=111), and 37 percent completed at least some college (n=89). For four
percent of mothers, educational status was unknown (n=10).
For 85 percent of deaths due to prematurity, the mothers experienced pregnancy- or
birth-related complications which may have contributed to the death (n=206). Twenty-six
mothers were known to have had a chronic illness, including seven women who had
29

non-gestational diabetes, and ten mothers were known to be obese. Five percent of
mothers reported using illegal drugs or heavy alcohol use during pregnancy (n=11).
Seven percent of mothers reported smoking during pregnancy (n=17). Table 9 shows
risk factors for prematurity deaths.
Table 9. Risk Factors for Prematurity Deaths, Arizona 2009
Factor*
Number
Percent
Mother had pregnancy or birth complications
206
85%
Multiple birth
42
17%
Mother had chronic illness (e.g. diabetes)
26
11%
Smoking during pregnancy
17
7%
Drugs and/or alcohol during pregnancy
11
5%
*More than one factor may have been identified for each death

30

INFLUENZA-RELATED FATALITIES
Infections resulting from the influenza virus claim the lives of children each year, and
2009 saw the pandemic spread of the H1N1 influenza virus. While the H1N1 strain of
influenza did not cause the rates of morbidity and mortality originally predicted by public
health officials, the virus remains particularly deadly to children and pregnant women,
especially those with underlying medical conditions.
The Arizona Department of Health Services Office of Infectious Disease Services
(ADHS-OIDS) identified 12,580 pediatric cases of influenza during 2009, and 4,524 of
these cases were confirmed by a laboratory to be the H1N1 strain of the virus. The
ADHS-OIDS confirmed 25 pediatric deaths associated with influenza in 2009, and 20 of
these deaths were associated with the H1N1 strain of the influenza virus. The Arizona
Child Fatality Review Teams identified 19 child deaths in 2009 resulting from an
influenza infection; 17 of these deaths were from the H1N1 strain of influenza. Local
Child Fatality Review Teams identified four additional cases in which influenza played a
role but was not the primary cause of death.
Influenza is a serious respiratory disease and a common cause of pneumonia in
children. The Arizona Child Fatality Review Teams identified 52 child deaths resulting
from pneumonia/influenza, with 19 of these deaths known to be due to influenza (two
percent of all child deaths in 2009). This is a sharp increase in pneumonia/ influenza
deaths from 2008, in which 21 deaths resulted from pneumonia/ influenza, and 2007, in
which 17 deaths were due to pneumonia/ influenza.
Sixty-eight percent of the 19 deaths resulting from influenza in 2009 were among males
(n=13) and 32 percent were among females (n=6). Thirty-seven percent of the children
who died in 2009 due to influenza were White, non-Hispanic (n=7), 37 percent were
Hispanic (n=7), 11 percent were African American (n=2), 11 percent were American
Indian (n=2), and five percent were Asian (n=1).
Over half of the influenza deaths in 2009 were among children ten through 17 years of
age (52 percent, n=10). Figure 15 shows influenza deaths among children by age
group.

31

Figure 15. Influenza Deaths Among Children by Age Group, Arizona 2009 (n=19)

15‐17 Years
26% (n=5)

<1 Year
16% (n=3)

1‐4 Years
16% (n=3)

10‐14 Years
26% (n=5)

5‐9 Years
16% (n=3)

Children with chronic medical conditions are more likely to experience medical severe
complications, including death, from influenza infection than healthy children. Seventynine percent of the influenza deaths in 2009 were among children with one or more
underlying medical conditions (n=15). Six of the children had cerebral palsy, two
children had chronic lung disease, and one child was born extremely prematurely as a
result of maternal influenza infection.
Deaths due to influenza infection can be prevention by immunization and prompt
medical care. Though each death is reviewed individually, local review teams generally
considered influenza deaths to be unpreventable if the family sought timely and
appropriate medical care for the ill child, and if the medical treatment provided was
clinically appropriate. While influenza vaccination is a preventable factor for these
deaths, the vaccine was not widely available throughout Arizona before the end of 2009.
Given the limited availability of the vaccine, local review teams often did not know if
influenza vaccine was available when reviewing individual cases, and therefore could
not assess this preventable factor in most cases. Eleven percent of the child influenza
deaths in 2009 were determined to have been preventable (n=2). For 32 percent of
influenza deaths, local review teams were not able to determine preventability (n=6).

32

SUDDEN UNEXPECTED INFANT DEATHS
Local review teams define sudden unexpected infant deaths as deaths that occur
suddenly and unexpectedly in children younger than one year of age while not in the
care of a medical professional. For these deaths, manner and cause of death may not
be immediately obvious prior to investigation. Sudden infant death syndrome (SIDS) is
a type of sudden unexpected infant death (SUID). Other types of SUID include infant
deaths due to suffocation, asphyxia, poisoning, undetected metabolic or cardiac
disorders, hypothermia and hyperthermia, as well as some abuse and neglect cases.
Although the number of sudden unexpected infant deaths declined in 2009, these
deaths comprised the same percentage of total deaths compared to 2008. There were
123 unexpected infant deaths in Arizona in 2009 (13 percent of all deaths that year). In
2008, there were 140 unexpected infant deaths in Arizona, which accounted for 13
percent of all child deaths. Fifty-two percent of unexpected infant deaths in 2009 were
among males (n=64), and 48 percent were among females (n=59).
Hispanic infants accounted for 37 percent of sudden unexpected infant deaths (n=45),
non-Hispanic Whites accounted for 31 percent (n=38), African Americans accounted for
18 percent (n=22), American Indians accounted for 14 percent (n=17), and one percent
were among Asian children (n=1).
Nearly half of the deaths were among infants younger than three months of age (49
percent, n=60). Forty-six deaths were among infants between three and six months of
age (37 percent), and 17 infants who died unexpectedly were older than six months of
age (14 percent).
For 40 deaths, teams were unable to determine the cause of death (33 percent). Thirtyfour deaths were due to medical causes (28 percent), including 14 deaths due to
pneumonia/influenza. Seventeen sudden unexpected infant deaths were due to
suffocation (14 percent) and 28 sudden unexpected infant deaths were due to SIDS (23
percent). Table 10 shows sudden unexpected infant deaths by cause.
Table 10. Sudden Unexpected Infant Deaths by Cause,
Arizona 2009 (n=123)
Cause
Number
Percent
Undetermined
40
33%
SIDS
28
23%
Suffocation
17
14%
Pneumonia/influenza
14
11%
Cardiovascular
10
8%
Other medical
10
8%
Other injury
4
3%
Total
123

33

Investigation
Law enforcement conducted scene investigations in 72 percent of sudden unexpected
infant deaths (n=89). Eighty-eight percent of sudden unexpected infant deaths were
referred to medical examiners’ offices (n=108), and 101 of those cases received an
autopsy. For the 15 deaths that were not referred to medical examiners, most were
deaths due to medical causes (n=14).
Ninety-one children were known to have had toxicology tests performed. Three children
tested positive for cough/cold medication, two tested positive for anti-anxiety
medications, one tested positive for caffeine, and one tested positive for a non-toxic
level of acetaminophen. Eighty-five children were known to have had radiographs.
Unsafe Sleep Environments
Of the 123 sudden unexpected infant deaths, 74 percent occurred in sleep
environments (n=91). Seventy-seven of these sleep environments were determined to
have been unsafe (63 percent). Suffocation was the cause of 17 unsafe sleep-related
deaths, and 20 deaths in unsafe sleep environments were identified as SIDS. For 32
deaths that occurred in unsafe sleep environments, the review teams could not
determine the cause of death.
Thirty-four infants were bed sharing with adults and/or other children. Twenty-one of
the adults who were bed sharing with infants were known to have been using illegal
drugs, prescription drugs, and/or alcohol. Forty-three infants were sleeping in adult
beds, two were sleeping on couches or chairs, and three were sleeping in car seats or
strollers. Thirty-six infants were put to sleep on their sides or stomachs.
More than half of the 123 sudden unexpected infant deaths were determined to have
been preventable (54 percent, n=67). Unsafe sleep environments was a contributing
factor in 74 of these deaths (60 percent), followed by lack of supervision (54 percent,
n=66). Table 11 shows preventable factors for sudden unexpected infant deaths.
Table 11. Preventable Factors for Sudden Unexpected Infant Deaths,
Arizona 2009
Factor*
Number
Percent
Unsafe sleep environment
77
63%
Lack of supervision
66
54%
Drugs and/or alcohol
50
41%
Infant exposure to smoking
29
24%
*More than one factor may have been identified for each death

Sudden Infant Death Syndrome (SIDS)
SIDS is the diagnosis given to the sudden death of an infant younger than one year of
age that remains unexplained after a complete postmortem investigation, including
34

autopsy, death scene investigation, and review of the child’s medical history. There
were 28 deaths identified by local review teams as SIDS in 2009, compared to 20 in
2008.
Forty-six percent of the children who died of SIDS were male (n=13) and 54 percent
were female (n=15). Four of the infants who died of SIDS had been born prematurely
(all were singleton births). Fifty-seven percent of the children who died of SIDS were
Hispanic (n=16), 25 percent were non-Hispanic Whites (n=7), 11 percent were
American Indian (n=3), and seven percent were African American (n=2).
Investigation
Twenty-six SIDS deaths were known to have had law enforcement investigations of the
death scenes. Twenty-seven SIDS deaths received autopsies, and 22 had the official
cause of death determined by a medical examiner. Twenty-three children who died of
SIDS were known to have had toxicology tests performed. One child tested positive for
an anti-anxiety medication and one tested positive for caffeine. Eighteen of the 28
children were known to have had x-rays.
All 28 SIDS deaths occurred in sleep environments. Thirteen of the deaths occurred
while the infant was sleeping in a crib or bassinette, and eight occurred while the infant
was sleeping in an adult bed. Nine of the infants who died of SIDS were bed sharing
with at least one adult or child. For eight infants, the sleep position was unknown to the
review teams. Seven infants were known to have been put on their backs to sleep, and
thirteen of the infants who died of SIDS were put to sleep on their stomachs or sides.
Three children who died of SIDS were sleeping in cribs on their backs. Of the 15 infants
who were not in cribs or bassinettes, scene investigations showed that four of these
families had a crib in the home.

35

MOTOR VEHICLE CRASH FATALITIES
In 2009, 82 children died as the result of motor vehicle crashes in Arizona (nine percent
of child fatalities). In 2008, 82 children died as the result of motor vehicle crashes in
Arizona (8 percent of child fatalities). The rate of motor vehicle fatalities in 2009 was
4.7 deaths per 100,000 children, a 44 percent decline from 2005 when the motor vehicle
fatality rate was 8.4 deaths per 100,000 children. Figure 16 shows the rates of child
deaths due to motor vehicle crashes from 2005 through 2009.
Figure 16. Rate of Child Deaths due to Motor Vehicle Crashes (per 100,000
children), Arizona 2005-2009
12.0
9.9

10.0
8.4
8.0

7.2

6.0

4.7

4.7

4.0
2.0
0.0
2005

2006

2007

2008

2009

The majority of motor vehicle-related deaths in 2009 were among males (65 percent,
n=53) and 35 percent were among females (n=29). Forty-five percent of the children
who died were Hispanic (n=37), 38 percent were Non-Hispanic White (n=31), 12
percent were American Indian (n=10), and five percent were other races/ethnicities
(n=4). Figure 17 shows motor vehicle-related deaths by race/ethnicity.

36

Figure 17. Motor Vehicle-Related Deaths Among Children by Race/Ethnicity,
Arizona 2009 (n=82)

White, Non‐
Hispanic
38% (n=31)

American Indian
12% (n=10)

Other
5% (n=4)

Hispanic
45% (n=37)

The distribution of motor vehicle-related deaths by race/ethnicity was different in 2008
when 18 percent of the deaths were among American Indian children, 44 percent of the
deaths were among Hispanics, 32 percent were among Non-Hispanic Whites, and six
percent were among other races/ethnicities. Table 12 shows motor vehicle-related
deaths among children by race/ethnicity for 2006 through 2009.
Table 12. Motor Vehicle-Related Deaths Among Children by Race/Ethnicity,
Arizona 2006-2009
Race/Ethnicity
2006
2007
2008
2009
American Indian
14
11%
20
12%
15
18%
10
12%
Hispanic
56
46%
69
42%
36
44%
37
45%
White, Non-Hispanic
45
37%
66
40%
26
32%
31
38%
Other
7
6%
9
5%
5
6%
4
5%
Total
122
164
82
82

The largest percentage of motor vehicle-related deaths was among children ages 15
through 17 years (36 percent, n=30), followed by children ages 1 through 4 years (25
percent, n=20). Figure 18 shows motor vehicle-related deaths by age group.

37

Figure 18. Motor Vehicle-Related Deaths Among Children by Age Group,
Arizona 2009 (n=82)
<1 Year
5% (n=4)
1‐4 Years
25% (n=20)
15‐17 Years
36% (n=30)

10‐14 Years
16% (n=13)

5‐9 Years
18% (n=15)

Of the 76 children who died in vehicle crashes, 45 were passengers of motor vehicles,
12 were drivers, 16 were pedestrians, and two were on bicycles. Six child pedestrians
were killed due to vehicle backovers. All of these children were struck by sport utility
vehicles or trucks, and all were two years of age and younger. Figure 19 shows motor
vehicle crashes by age group and location. This figure excludes deaths due to offhighway vehicle (OHV) crashes, such as those involving recreational use of an ATV or
dirt bike.

38

Figure 19. Motor Vehicle-Related Deaths Among Children by Age Group and
Location (Excluding OHV Crashes), Arizona 2009 (n=76)
14
12
10

Driver (n=12)
Passenger (n=45)
Pedestrian (n=16)
On bicycle (n=2)
Unknown (n=1)

12

12
11

11
9
8

8
6
4

3
2

2

2 2

1

2
1

0
<1 Year

1‐4 Years

5‐9 Years

10‐14 Years

15‐17 Years

Among the total 45 passengers, 23 were located in the back seat, 8 were in the front
seat, three were riding in truck beds, and 11 were in other or unknown locations. Of the
eight children who were in front seats, four were 13 years of age and younger. Two
children died as a result of in utero trauma during a motor vehicle crash. Four
unrestrained teen passengers died in a motor vehicle crash while being smuggled into
the United States from Mexico.
Sixty percent of children riding in vehicles were known to be improperly restrained
(n=34). Over one-third of all children who were not properly restrained were ages 15
through 17 years (35 percent, n=12), and all of these children were one year of age or
older. Figure 20 shows motor vehicle deaths associated with improperly restrained
occupants by age group.

39

Figure 20. Motor Vehicle Crash Deaths with Improperly Restrained Occupants by
Age Group, Arizona 2009 (n=34)
1‐4 Years
18% (n=6)
15‐17 Years
35% (n=12)

5‐9 Years
26% (n=9)

10‐14 Years
21% (n=7)

Ninety-three percent of all motor vehicle crash fatalities during 2009 were determined to
have been preventable (n=76). Lack of vehicle restraints was identified as a
preventable factor for 34 motor vehicle crash fatalities among children (41 percent).
Eleven children died in crashes involving drugs and alcohol, and seven deaths involved
substance-impaired drivers; for four of these deaths, the impaired driver was the child
who died. For 24 deaths, excessive speed was a contributing factor (29 percent).
Table 13 shows preventable factors for motor vehicle crash deaths among children.
This table includes factors that were identified for the six deaths due to OHV crashes.
Table 13. Preventable Factors for Motor Vehicle-Related Deaths
Among Children, Arizona 2009
Factor*
Number
Percent
Lack of vehicle restraint
34
41%
Excessive driving speed
24
29%
Driver inexperience
17
21%
Reckless driving
15
18%
Drugs and/or alcohol
11
13%
Red light running
7
9%
Driver distraction
6
7%
Lack of helmet
4
5%
*More than one factor may have been identified for each death

40

Off-Highway Vehicle Crashes
Six children died in off-highway vehicle (OHV) crashes; off-highway vehicles include any
vehicle designed to be operated on unpaved surfaces, including all-terrain vehicles
(ATVs) and dirt bikes. Five children were 10 years of age and older, and one child was
younger than ten years of age. Five of the children who died in OHV crashes were
drivers, and one child was a passenger. Three of the children who were driving were
less than 16 years of age. Four of the ATV crashes were single vehicle, and two
crashes involved collisions with other vehicles. Three of the single vehicle OHV
crashes were known to involve the driver hitting an object.
Two children who died in OHV crashes were not wearing helmets properly. One ATV
driver was known to have been travelling at excessive or unsafe speeds, and two were
known to have been riding with more occupants than the number for which the vehicle
was designed. In four cases, review teams identified drivers’ inexperience as
contributing to the deaths. None of the OHV crash deaths in 2009 involved drugs
and/or alcohol.

41

DROWNINGS
In 2009, there were 35 child deaths due to drownings, which accounted for four percent
of all child deaths. In 2008, there were 29 drowning fatalities among children (three
percent of all child deaths). The rate of drowning fatalities in 2009 was 2.0 deaths per
100,000 children. While the mortality rate of child drowning decreased nine percent
from 2005 through 2009, the 2009 rate has increased 43 percent since 2007 when the
drowning rate was 1.4 deaths per 100,000 children. Figure 21 shows the rates of child
deaths due to drowning from 2005 through 2009.
Figure 21. Rate of Child Deaths due to Drowning (per 100,000 children),
Arizona 2005-2009
2.5
2.2
2.0
2.0

1.9

1.7

1.5
1.4
1.0

0.5

0.0
2005

2006

2007

2008

2009

Seventy-seven percent of drowning deaths in 2009 were among males (n=27), and 23
percent were among females (n=8). Forty-six percent of children who drowned were
White, Non-Hispanic (n=16), 43 percent of children who drowned were Hispanic (n=15),
six percent were Asian (n=2), and six percent were African American (n=2). There were
no drowning deaths among American Indian children in 2009.
Sixty-eight percent of drowning deaths in 2009 were among children ages one through
four years of age (n=24), 11 percent were among children ages 15 through 17 years
(n=4), nine percent were among children ages five through nine years (n=3), nine
percent were among infants younger than one year of age, and three percent were
among children ages 10 through 14 years (n=1). Figure 22 shows drowning deaths by
age group.

42

Figure 22. Drowning Deaths Among Children by Age Group, Arizona 2009 (n=35)
5‐9 Years
9% (n=3)
10‐14 Years
3% (n=1)
1‐4 Years
68% (n=24)
15‐17 Years
11% (n=4)

<1 Year
9% (n=3)

Consistently since 2005, the largest percentage of drownings has been among children
ages one through four years. The percentage of deaths in this age group decreased
from 87 percent in 2008 (n=25) to 68 percent in 2009 (n=24). Table 14 shows drowning
deaths among children by age from 2005 through 2009.
Table 14.
Age Group
0-27 Days
28-365 Days
1-4 Years
5-9 Years
10-14 Years
15-17 Years
Total

Drowning Deaths Among Children by Age Group, Arizona 2005-2009
2005
2006
2007
2008
2009
1
3%
0
0%
1
4%
0
0%
0
0%
1
3%
2
10%
5
22%
1
3%
3
9%
20
57%
16
51%
12
53%
25
87%
24
68%
6
17%
4
13%
4
17%
2
7%
3
9%
1
3%
3
10%
1
4%
0
0%
1
3%
6
17%
6
16%
0
0%
1
3%
4
11%
35
31
23
29
35

In 2009, 20 drowning fatalities occurred in pools (18 cases occurred in in-ground pools,
two cases were in above ground pools), seven fatalities occurred in open water, seven
occurred in bathtubs, and one occurred in hot tubs or spas. There were no deaths
occurring in buckets or other containers. Among the seven open water drownings, three
were in canals, two were in a lake, and two were in rivers. Table 15 shows drowning
fatalities by location.

43

Table 15. Location of Child Drowning Fatalities,
Arizona 2009 (n=35)
Location
Number
Percent
In ground pool
18
51%
Bathtub
7
20%
River/lake
4
11%
Canal
3
9%
Above ground swimming pool
2
6%
Hot tub/spa
1
1%
Total
35

The highest number of pool drownings were among children ages one through four
years (54 percent of all drownings, n=19), and three of the seven bathtub drownings
were also among children ages one through four years. Figure 23 shows drowning
location by age group.
Figure 23. Drowning Deaths Among Children by Age Group and Location,
Arizona 2009 (n=35)
20

Pool, hot tub, spa (n=21)
Bathtub (n=7)
Open water (n=4)
Canal (n=3)

19

18
16
14
12
10
8
6
4

3

3

3
1 1

2

2

1

1

1

0
<1 Year

1‐4 Years

5‐9 Years

10‐14 Years

15‐17 Years

One hundred percent of child drownings were identified as preventable (n=35). Lack of
supervision was the most commonly identified preventable factor in child drowning
fatalities (80 percent, n=28), followed by access to water (66 percent, n=23). Table 16
shows preventable factors for child drownings in Arizona during 2009.
Table 16. Preventable Factors for Child Drownings, Arizona 2009
Factor*
Number
Percent
Lack of supervision
28
80%
Access to water
23
66%
Drugs and/or alcohol
1
3%
*More than one factor may have been identified for each death

44

HOME SAFETY-RELATED DEATHS
Deaths included in this section occurred in or around home environments (e.g.
bedroom, driveway, or yard) and were due to accidents (unintentional injuries) or were
of undetermined manner. Suicides, homicides, and natural deaths were excluded. In
2009, 122 children died in or around the home (13 percent of all deaths that year). The
majority of these deaths occurred among males (61 percent, n=74), 39 percent of these
deaths were among females (n=48).
Thirty-nine percent of deaths that occurred in or around the home were among White,
Non-Hispanic children (n=48), 33 percent were among Hispanic children (n=40), 18
percent were among African Americans (n=21), seven percent were among American
Indians (n=9), and three percent were among Asian children (n=4).
More than half of the deaths that occurred in or around the home during 2009 were
among infants younger than one year of age (55 percent, n=67). Thirty-two percent
were among children ages one through four years (n=39). Figure 24 shows home
safety-related deaths by age group.
Figure 24. Home Safety-Related Deaths Among Children by Age Group,
Arizona 2009 (n=122)
10‐14 Years
1% (n=1)

15‐17 Years
11% (n=13)

5‐9 Years
1% (n=2)

<1 Year
55% (n=67)
1‐4 Years
32% (n=39)

For 36 percent of deaths, the cause of death was undetermined (n=44), and most of
these deaths were among infants in unsafe sleep environments (n=32). The second
most common cause of death was drowning (19 percent, n=23). Seventeen children
drowned in family pools or hot tubs and six children drowned in bathtubs. Three children
were crushed by heavy objects in the home, usually after climbing or pulling on these
objects. One child died as the results of a fall. Three children died in home fires and
45

each incident involved a barrier to an effective exit and emergency response. Table 17
shows child deaths that occurred in or around the home by cause.
Table 17. Child Deaths In or Around the Home by Cause,
Arizona 2009 (n=122)
Cause
Number
Percent
Undetermined
44
36%
Drowning
23
19%
Suffocation
14
11%
Poisoning
11
9%
SIDS
8
7%
Other
5
4%
Fall/crush
4
3%
Hanging
4
3%
Motor vehicle crashes
4
3%
Fire
3
2%
Firearm-related injury
2
2%
Total
122

Eighty-seven percent of home safety-related deaths were determined to have been
preventable (n=106) and for 11 percent, teams were not able to determine preventability
(n=14). The most commonly listed contributing factors were lack of supervision (66
percent, n=81) and drugs and/or alcohol (48 percent, n=59). Table 18 shows
preventable factors for home safety-related deaths.
Table 18. Preventable Factors for Child Deaths In or Around the Home,
Arizona 2009
Factor*
Number
Percent
Lack of supervision
81
66%
Drugs and/or alcohol
59
48%
Access to water
14
11%
*More than one factor may have been identified for each death

46

SUICIDES
In 2009, there were 27 suicides among children in Arizona, which accounted for three
percent of all child deaths. In 2008, suicide accounted for three percent of all child
deaths (n=35). The child suicide rate in 2009 was 1.6 deaths per 100,000 children.
This was a 27 percent decrease from 2005 when the suicide rate was 2.2 deaths per
100,000 children. Figure 25 shows the rates of child suicides from 2005 through 2009.
Figure 25. Rate of Child Deaths due to Suicide (per 100,000 children),
Arizona 2005-2009
3.5
3.0
2.5

2.9
2.2
2.0

2.0

1.7

1.6

1.5
1.0
0.5
0.0
2005

2006

2007

2008

2009

Seventy-eight percent of the children who died by suicide during 2009 were males
(n=21) and 22 percent were females (n=6). Forty-four percent of the children who died
by suicide were Hispanic (n=12), 33 percent were White, non-Hispanic (n=9), 19
percent were American Indian (n=5), and four percent were other races/ethnicities
(n=1).
The distribution of suicides by race/ethnicity was different from 2008 when the largest
percentage of suicides was among White, non-Hispanic children (51 percent, n=18).
Table 19 shows suicides among children by race/ethnicity for 2006 through 2009.
Table 19. Suicides Among Children by Race/Ethnicity, Arizona 2006-2009
Race/Ethnicity
2006
2007
2008
2009
American Indian
9
19%
4
14%
6
17%
5
19%
Hispanic
13
27%
15
54%
9
26%
12
44%
White, Non-Hispanic
24
50%
8
29%
18
51%
9
33%
Other
2
4%
1
3%
2
6%
1
4%
Total
48
28
35
27

47

In 2009, the majority of suicides were among children ages 15 through 17 years (89
percent, n=24), and 11 percent were among children 14 years of age and younger
(n=3). The youngest child who died by suicide in 2009 was 11 years old. Figure 26
shows suicides among children by age group.
Figure 26. Suicides Among Children by Age Group, Arizona 2009 (n=27)

10‐14 Years
11% (n=3)

15‐17 Years
89% (n=24)

The distribution of suicides by age group remained consistent from 2006 through 2008.
Table 20 shows suicides among children by age group for 2005 through 2009.
Table 20. Suicides Among Children by Age Group, Arizona 2005-2009
Age Group
2005
2006
2007
2008
2009
<10 Years
0
0%
1
2%
0
0%
0
0%
0
0%
10-14 Years
13
36%
11
23%
7
25%
9
26%
3
11%
15-17 Years
23
64%
36
75%
21
75%
26
74%
24
89%
Total
36
48
28
35
27

Hangings accounted for 56 percent of child suicides in Arizona during 2009 (n=15) and
firearm injuries accounted for 33 percent (n=9). The objects used in hanging suicides
included ropes, belts, and shoelaces. Eleven percent of child suicides were caused by
poisonings (n=3). Figure 27 shows suicides among children by cause of death and age
group.

48

Figure 27. Suicides Among Children by Cause of Death and Age Group,
Arizona 2009 (n=27)
14
Firearm (n=9)
12

12

Hanging (n=15)
Poisoning (n=3)

10

9

8
6
4

3

3

2
0
10‐14 Years (n=3)

15‐17 Years (n=24)

The distribution of cause of death varied by the sex of the child. As observed in
previous years, males were more likely to have used firearms to die by suicide. For
hangings and poisonings, the distributions between males and females were less
disparate. Figure 28 shows suicides among children by cause of death and sex.

49

Figure 28. Suicides Among Children by Cause of Death and Sex,
Arizona 2009 (n=27)
14
12

Females (n=6)
Males (n=21)

12

10
8

7

6
4
2

3
2

2
1

0
Firearm (n=9)

Hanging (n=15)

Poisoning (n=3)

Identification of children at risk for suicide can be difficult, and warning signs are not
always recognized or taken seriously. Eleven children who took their own lives in 2009
were known to have talked about suicide to others (41 percent), ten children were
known to have made prior suicide threats (37 percent), and three children had made
prior suicide attempts (11 percent). Only two children were known to have been on
medication for mental illness at the time of their deaths (7 percent). Six children who
died by suicide were known to have received prior mental health services (22 percent),
but only three children were known to have been receiving mental health services at the
time of their deaths (11 percent).
Review teams were able to identify several factors that may have contributed to the
children’s despondency prior to the suicides. The most commonly identified issue was
a history of drug or alcohol use, which was identified in eight suicides (30 percent).
Table 21 shows factors that may have contributed to the child’s despondency prior to
suicide.
For nearly half of all suicides, important information regarding risk factors was unknown
to review teams, even after review of law enforcement records. For example, in 37
percent of suicides, prior mental health services were unknown (n=10). For 41 percent
of suicides, it was unknown if the child was receiving mental health services at the time
of death (n=11). Improvements in the investigations of child suicides may increase
review teams’ abilities to identify risk factors and help us develop strategies for
preventing these deaths.

50

Table 21. Factors That May Have Contributed to the Child’s Despondency
Prior to Suicide, Arizona 2009
Factor*
Number
Percent
History of drug and/or alcohol use
8
30%
Family discord
7
26%
Recent breakup with boyfriend or girlfriend
6
22%
Failure at school
5
19%
Recent argument with parents/caregivers
4
15%
History of physical or sexual abuse/assault
3
11%
Pregnancy or possible pregnancy
2
7%
Recent argument with boyfriend or girlfriend
1
4%
Victim of bullying
1
4%
*More than one factor may have been identified for each death

Eighty-nine percent of child suicides were determined to have been preventable (n=24).
For 11 percent of suicides, local review teams were not able to determine preventability
(n=3). Lack of mental health treatment was the most commonly identified preventable
factor (48 percent, n=13), followed by access to firearms (33 percent, n=9). Table 22
shows preventable factors for child suicides.
Table 22. Preventable Factors for Child Suicides, Arizona 2009
Factor*
Number
Percent
Lack of mental health treatment**
13
48%
Access to firearms
9
33%
Drugs and/or alcohol
8
30%
*More than one factor may have been identified for each death
**For 37 percent of suicides, it was unknown if the child had ever received
mental health services (n=10). For 41 percent of suicides, it was unknown if the
child was receiving mental health services at the time of death (n=11).

51

HOMICIDES
Fifty-one children were victims of homicide in Arizona during 2009, compared to 60 in
2008. Homicide accounted for five percent of all child deaths in Arizona during 2009, a
decrease from six percent of all child deaths in 2008. The child homicide rate in 2009
was 3.0 deaths per 100,000 children. This was a 17 percent decline from 2005 when
the homicide rate was 3.6 deaths per 100,000 children. Figure 29 shows the rates of
child homicides from 2005 through 2009.
Figure 29. Rate of Child Deaths due to Homicide (per 100,000 children),
Arizona 2005-2009
4.5
4.0
3.6
3.5

3.8

3.9

3.5
3.0

3.0
2.5
2.0
1.5
1.0
0.5
0.0
2005

2006

2007

2008

2009

Fifty-one percent of homicide victims in 2009 were males (n=26) and 49 percent were
females (n=25). Nearly half of child homicides were among Hispanics (47 percent,
n=24), 33 percent were among White Non-Hispanics (n=17), 14 percent were among
African Americans (n=7), and six percent were among American Indians (n=3).
Children ages 15 through 17 years accounted for 39 percent of homicides (n=20).
Twenty percent of homicides were among children younger than one year of age
(n=10). Figure 30 shows homicides among children by age group.

52

Figure 30. Homicides Among Children by Age Group, Arizona 2009 (n=51)
<1 Year
20% (n=10)
15‐17 Years
39% (n=20)

1‐4 Years
23% (n=12)

10‐14 Years
8% (n=4)

5‐9 Years
10% (n=5)

Compared to 2008, the greatest increase in homicides in 2009 was observed among
children ages 1 through 4 years (from 12 percent in 2008 to 24 percent in 2009). Table
23 shows homicides among children by age group for 2005 through 2009.
Table 23. Homicides Among Children by Age Group, Arizona 2005-2009
Age Group
2005
2006
2007
2008
2009
0-27 Days
3
5%
4
6%
3
4%
1
2%
3
6%
28-365 Days
9
15%
12
19%
13
20%
14
23%
7
14%
1-4 Years
13
22%
11
17%
12
18%
7
12%
12
24%
5-9 Years
3
5%
0
0%
7
11%
2
3%
5
10%
10-14 Years
5
9%
7
11%
5
8%
6
10%
4
8%
15-17 Years
25
43%
29
47%
26
39%
30
50%
20
39%
Total
58
63
66
60
51

In 2009, firearms were the leading cause of death among child homicides (41 percent,
n=21), followed by blunt force trauma (25 percent, n=13). Figure 31 shows homicides
among children by cause of death.

53

Figure 31. Homicides Among Children by Cause of Death, Arizona 2009 (n=51)
Malnutrition or
dehydration
2% (n=1)

Firearm
41% (n=21)

Sharp force trauma
14% (n=7)

Asphyxia
4% (n=2)

Other injury
14% (n=7)
Blunt force trauma
25% (n=13)

For 47 percent of homicides, the perpetrator was a parent or step-parent of the child
(n=24), and in an additional eight percent of cases the perpetrator was the child’s
mother’s partner (n=4). In 16 percent, the perpetrator was someone that the child did
not know (n=8). Friends or acquaintances of the children accounted for an additional
six homicides. In three cases, the perpetrator was unknown to the review teams. Table
24 shows homicides among children by perpetrator.
Table 24. Homicides Among Children by Perpetrator,
Arizona 2009 (n=51)
Perpetrator
Number
Percent
Parent/step-parent
24
47%
Stranger
8
16%
Child’s friend/acquaintance
6
12%
Mother’s partner
4
8%
Unknown
3
6%
Rival gang member
2
4%
Other non-relative known to child
2
4%
Law enforcement officer
1
2%
Total
51

Ninety-eight percent of child homicides were determined to have been preventable
(n=50). In one homicide, the team did not have enough information to determine if the
death was preventable. Drugs and/or alcohol were the most commonly identified
preventable factors in child homicides (57 percent, n=29), followed by access to
firearms (41 percent, n=21). Gang conflict was a factor in four homicides (8 percent).
Table 25 shows preventable factors for child homicides in Arizona during 2009.

54

Table 25. Preventable Factors for Child Homicides, Arizona 2009
Factor*
Number
Percent
Drugs and/or alcohol
29
57%
Access to firearms
21
41%
Lack of supervision
12
24%
Involvement in gang
4
8%
*More than one factor may have been identified for each death

55

FIREARM-RELATED FATALITIES
There were 32 firearm-related fatalities in 2009, compared to 49 in 2008. Firearms
accounted for three percent of all child deaths in 2009 and five percent in 2008.
Seventy-two percent of the firearm-related deaths in 2009 were among males (n=23)
and 28 percent were among females (n=9). Nearly half of firearm-related deaths were
among Hispanics (44 percent, n=14), 41 percent were among Non-Hispanic Whites
(n=13), nine percent were among African Americans (n=3), and six percent were among
American Indians (n=2).
Seventy-two percent of these deaths were among children ages 15 through 17 years
(n=23). There were nine deaths due to firearms among children 14 years of age and
younger. Figure 32 shows firearm-related fatalities among children by age group.
Figure 32. Firearm-Related Deaths Among Children by Age Group,
Arizona 2009 (n=32)
0‐4 Years
16% (n=5)

5‐9 Years
9% (n=3)

10‐14 Years
3% (n=1)

15‐17 Years
72% (n=23)

The age group distribution in 2009 was similar to what has been observed in previous
years for children 15 through 17 years of age. The age distribution in 2009 is shown
above, and in 2008, there were 37 firearm-related deaths among children ages 15
through 17 years (76 percent), seven among children ages 10 through 14 years (14
percent), and five among children younger than 10 years of age (10 percent). Table 26
shows firearm-related deaths among children by age group from 2005 through 2009.

56

Table 26.
Age Group
<10 Years
10-14 Years
15-17 Years
Total

Firearm-Related Deaths Among Children by Age Group, Arizona 2005-2009
2005
2006
2007
2008
2009
2
5%
1
2%
5
10%
5
10%
8
25%
7
16%
13
22%
7
15%
7
14%
1
3%
34
79%
46
76%
36
75%
37
76%
23
72%
43
60
48
49
32

In 2009, 66 percent of firearm-related deaths were homicides (n=21), 28 percent were
suicides (n=9), three percent were accidents (unintentional injuries) (n=1), and three
percent were of undetermined manner (n=1). These percentages were similar to those
from 2007, although there were 17 fewer deaths. Figure 33 shows firearm-related
deaths among children by manner.
Figure 33. Firearm-Related Deaths Among Children by Manner,
Arizona 2009 (n=32)
Accident
3% (n=1)
Undetermined
3% (n=1)

Homicide
66% (n=21)

Suicide
28% (n=9)

Handguns accounted for the majority of firearm-related fatalities among children in 2009
(78 percent, n=25), followed by shotguns and rifles (each nine percent, n=3). Table 27
shows types of firearms involved in child deaths during 2009.
Table 27. Types of Firearms Involved in Child
Deaths, Arizona 2009 (n=32)
Type
Number
Percent
Handgun
25
78%
Shotgun
3
9%
Rifle (hunting, assault)
3
9%
Unknown firearm
1
3%
Total
32

57

Among the 32 firearm-related deaths, 34 percent of firearms were stored with
ammunition (n=11), and nine percent of firearms were stored loaded (n=3). In 59
percent of cases the presence of ammunition was unknown to the review team (n=19),
and whether or not the firearm was stored loaded was unknown to the review team in
75 percent of cases (n=24). The largest percentage of firearms belonged to parents or
step-parents (47 percent, n=15). Figure 34 shows the owners of the firearms used in
child fatalities.
Figure 34. Owners of Firearms Involved in Child Deaths, Arizona 2009 (n=32)

Law enforcement
3% (n=1)

Self
6% (n=2)

Unknown
19% (n=6)

Friend or
acquaintance
9% (n=3)

Stranger
10% (n=3)

Other relative
6% (n=2)

Parent/Step‐parent
47% (n=15)

For a notable percentage of firearms, the storage location was unknown to the review
teams (44 percent, n=14). One firearm was stored in a locked cabinet, but the
remaining firearms were not stored in secured locations. Table 28 summarizes the
locations of the firearms involved in child deaths during 2009.
Table 28. Locations of Firearms Involved in Child Deaths, Arizona 2009 (n=32)
Location
Number
Percent
Unknown
14
44%
Other not stored (unsecured location)
6
19%
In or under furniture (e.g. in a drawer or under a bed)
6
19%
Closet
5
16%
Locked cabinet
1
3%
Total
32

Ninety-one percent of the firearm-related deaths in 2009 were determined by the review
teams to have been preventable. Drugs and/or alcohol were involved in 53 percent of
firearm-related deaths (n=17). Lack of supervision was a factor in 25 percent of the
deaths (n=8). While access to firearms was identified as a preventable factor for 53
percent of firearm-related fatalities among children (n=17), in 44 percent of firearm58

related fatalities the storage location and security of the firearm was unknown (n=14).
Table 29 shows preventable factors for firearm-related fatalities in Arizona during 2009.
Table 29. Preventable Factors for Firearm-Related Deaths Among
Children, Arizona 2009
Factor*
Number
Percent
Access to firearm
17
53%
Drugs and/or alcohol
17
53%
Lack of supervision
8
25%
Involvement in gang
2
6%
*More than one factor may have been identified for each death

59

MALTREATMENT FATALITIES
To gain greater understanding of the contribution of neglect and abuse to child mortality,
the Arizona Child Fatality Review Teams answered several questions regarding
maltreatment. In order for a death to be classified as a result of maltreatment, the
following three conditions must be met:
1. “An act or failure to act by a parent, caregiver, or other person as defined under
State law which results in physical abuse, neglect, medical neglect, sexual abuse,
emotional abuse, or an act or failure to act which presents an imminent risk of
serious harm to a child” applied to the circumstances surrounding the death (from
the U.S. Department of Health and Human Services definition of maltreatment).
2. The relationship of the individual accused of committing the maltreatment to the child
must be the child’s parent, guardian, or caretaker.
3. A team member, who is a mandated reporter, would be obligated to report a similar
incident to Child Protective Services.
Deaths classified as maltreatment are also reported in other categories by manner and
cause of death. For example, a death due to abusive head trauma would be classified
as a manner of homicide with a cause of blunt force trauma, and a maltreatment death.
An accidental (unintentional injury) or natural death might also be classified as a
maltreatment death if, in the opinion of the team, a caretaker’s negligence or actions
contributed to or caused the death. For example, it would be maltreatment if a child
died in a motor vehicle crash due to the parent driving while intoxicated with the child in
the car.
The number of child maltreatment deaths presented in this report is not comparable to
child maltreatment deaths reported by the Arizona Department of Economic Security
(AzDES) for the National Child Abuse and Neglect Data System (NCANDS). NCANDS
includes substantiated maltreatment deaths identified through Child Protective Services
investigations, and because some maltreatment deaths identified by Local Child Fatality
Review Teams may not have been reported to Child Protective Services, were unable
to have been substantiated after an investigation, or were within the jurisdiction of Tribal
Nations, these deaths would not be included in AzDES’s annual report to NCANDS.
However, when a Local Child Fatality Review team identifies a death due to
maltreatment that has not been previously reported to Child Protective Services, the
Local Child Fatality Review Program notifies Child Protective Services of the team’s
assessment so that an investigation can be initiated.
In 2009, there were 64 deaths classified as maltreatment, which was seven percent of
all child deaths. This was an increase from 51 child maltreatment deaths in 2008 (five
percent of all child deaths). A portion of this increase may be attributed to two major
factors: a change in the Arizona Revised Statutes and an increase in familial murdersuicides. A statutory change in 2009 included prenatal substance exposure in the
definition of neglect; there were seven such deaths involving substance exposed
newborns. Prior to the statutory change such deaths would not have been counted as
60

maltreatment deaths. In 2009, there were eight child deaths resulting from six familial
murder-suicide incidents by a child’s parent or caregiver.
In 2009, 52 percent of maltreatment deaths were among males (n=33) and 48 percent
were among females (n=31). Forty-two percent of the children who died due to
maltreatment were White, non-Hispanic (n=27), 31 percent were Hispanic (n=20), 14
percent were African American (n=9), 11 percent were American Indian (n=7), and two
percent were Asian (n=1).
In the past, the majority of maltreatment deaths were among children younger than one
year of age. In 2009, however, less than half of all maltreatment deaths were among
children younger than one year of age (42 percent, n=27). Part of this trend may be
attributed to the familial murder-suicide incidents, as none of the children murdered
were infants. Figure 35 shows maltreatment deaths among children by age group.
Figure 35. Maltreatment Deaths Among Children by Age Group,
Arizona 2009 (n=64)
15‐17 Years
9% (n=6)
10‐14 Years
10% (n=6)

<1 Year
42% (n=27)

5‐9 Years
8% (n=5)

1‐4 Years
31% (n=20)

In 2009, homicide comprised almost half of child maltreatment deaths in Arizona (47
percent, n=30). Fourteen percent of maltreatment deaths were due to accidents
(unintentional injuries) (n=9). Examples of maltreatment-related accidental
(unintentional injury) deaths included situations in which the child’s supervisor was
impaired, left the child unsupervised in a potentially dangerous environment, or failed to
take appropriate steps to seek medical care for the child after an injury occurred. For 19
percent of child maltreatment deaths the manner of death was deemed to be natural
(n=12). Examples of maltreatment deaths due to natural manner of death included
prenatal substance use associated with premature birth, neglect which resulted in an
illness, or failure to obtain medical care. Twenty percent of child maltreatment deaths
61

were of undetermined manner (n=13). Figure 36 shows maltreatment deaths by
manner.
Figure 36. Maltreatment Deaths Among Children by Manner, Arizona 2009 (n=64)
Accident
14% (n=9)

Undetermined
20% (n=13)

Natural
19% (n=12)

Homicide
47% (n=30)

The leading causes of child maltreatment deaths were blunt force trauma (23 percent,
n=15) and deaths resulting from undetermined causes (17 percent, n=11). Table 30
shows maltreatment deaths among children by cause and manner.
Table 30. Maltreatment Deaths Among Children by Cause and Manner, Arizona 2009 (n=64)
Cause
Accident
Homicide
Natural
Undetermined
Total
(Unint. Injury)
Blunt force trauma
0
14
0
1
15
Undetermined
0
2
0
9
11
Firearm injury
1
7
0
0
8
Medical
0
1
6
0
7
Drowning
4
0
0
2
6
Prematurity
0
0
6
0
6
Poisoning
2
1
0
0
3
Suffocation
0
2
0
1
3
Motor vehicle crash
2
0
0
0
2
Other injury
0
2
0
0
2
Fall/crush
0
1
0
0
1
Total
9
30
12
13
64

Twenty-eight percent of the maltreated children in Arizona during 2009 were known to
have had physical, mental, and/or sensory disabilities (n=18), including three children
with cerebral palsy.

62

For 81 percent of maltreatment deaths, the perpetrator was the child’s biological parent
(n=52), and for an additional eight percent, the perpetrator was the mother’s boyfriend
(n=5). While more than one perpetrator may have contributed to a child’s maltreatment,
only the primary person responsible for the child’s death is listed below. Because the
perpetrator in the case of substance exposed newborns is the child’s mother, the
number of mothers as perpetrators of maltreatment is higher than in previous years.
Table 31 shows maltreatment deaths among children by perpetrator.
Table 31. Maltreatment Deaths Among Children by Perpetrator,
Arizona 2009 (n=64)
Perpetrator
Number
Percent
Mother
29
45%
Father
23
36%
Mother’s boyfriend
5
8%
Other relative
3
5%
Child’s boyfriend/girlfriend*
1
2%
Foster parent
1
2%
Other relative’s boyfriend/girlfriend
1
2%
Unknown
1
2%
Total
64
*May not have been under the jurisdiction of Arizona Child Protective Services

There were 11 fatalities among children two years of age and younger due to abusive
head trauma during 2009. This was an increase from 2008, when seven children two
years of age and younger died as a result of abusive head trauma. Of the children who
died from abusive head trauma in 2009, seven of the children were known to have been
shaken.
Ninety-one percent of the child maltreatment deaths in 2009 were determined to have
been preventable (n=58). For three percent of maltreatment deaths, local review teams
were not able to determine preventability (n=2). Drugs and/or alcohol contributed to 55
percent of the deaths (n=35), partially impacted by the increase in cases of substance
exposed newborns. Lack of supervision contributed to 39 percent of maltreatment
deaths (n=25). Table 32 shows preventable factors for child maltreatment deaths.
Table 32. Preventable Factors for Maltreatment Deaths Among Children,
Arizona 2009
Factor*
Number
Percent
Drugs and/or alcohol
35
55%
Lack of supervision
25
39%
Unsafe sleep environment
11
17%
*More than one factor may have been identified for each death

Child Protective Services Involvement with Families of Children who Died due to
Maltreatment
Local Child Fatality Review Teams attempt to obtain records from child protective
services agencies, including Arizona Child Protective Services and child protective
63

agencies in other jurisdictions, such as tribal authorities and other states. If a child
protective agency investigated a report of maltreatment for the deceased child or any
child in the family prior to the incident leading to the child’s death, then the family was
considered to have had previous involvement with a child protective agency. This
includes reports in which the maltreatment was or was not substantiated.
In 2009, 36 percent of maltreated children were from families with prior child protective
services involvement (n=23), and four of these children had prior involvement with Tribal
Nation child protective services. Among these 23 families, five were open cases with
Arizona Child Protective Services at the time of the child’s death. Two open cases were
in the process of being closed at the time of the child’s death.
For 22 maltreatment deaths, mandatory reporters did not notify Arizona Child Protective
Services that the deaths were suspected to have been due to maltreatment even after
investigation. For an additional six cases resulting from familial murder-suicide, Arizona
Child Protective Services was not notified because the perpetrator and child to be
investigated were deceased. The number of maltreatments deaths that were not
reported to Arizona Child Protective Services declined from 23 in 2008 to 22 in 2009.
For one child maltreatment death during 2009, the child was abused by an individual
other than a parent, guardian, or custodian (as defined in A.R.S. § 8-201) and may not
have been under the investigative jurisdiction of Arizona Child Protective Services.
These deaths were investigated by law enforcement (as defined in A.R.S. § 13-3620).
For 23 maltreatment deaths in 2009 charges were filed or expected to be filed against
the perpetrator(s) of the abuse. In an additional six cases, charges were not filed
because the perpetrator was deceased. At the time of review, charges in one case have
been dismissed, six cases are awaiting completion of the criminal investigation, and 16
cases have had charges filed.

64

APPENDIX A: CHILD DEATHS BY AGE GROUP
The following section of the report provides information on the causes and manners of
child deaths by age group. The information provided for each age group can be used to
guide prevention efforts within each stage of development. For the past five years, 100
percent of child deaths in Arizona have been reviewed, and data from 2005 through
2009 are included in the following tables.

The Neonatal Period, Birth Through 27 Days
Table 33. Deaths Among Children Ages Birth Through 27 Days by Cause and Manner,
Arizona 2009 (n=366)
Cause
Accident
Homicide
Suicide
Natural
Undetermined
Total
(Unint. Injury)
Prematurity
0
0
0
221
0
221
Medical*
0
0
0
128
0
128
Undetermined
0
0
0
0
5
5
SIDS
0
0
0
0
1
1
Motor vehicle
2
0
0
0
0
2
crash
Suffocation
3
0
0
0
1
4
Other Injury
1
2
0
0
0
3
Firearm Injury
0
1
0
0
0
1
Poisoning
1
0
0
0
0
1
Total
7
3
0
349
7
366
*Excluding SIDS and prematurity
Table 34. Deaths Among Children Ages Birth Through 27 Days by Cause,
Arizona 2005-2009
Cause
2005
2006
2007
2008
Prematurity
263
61%
263
60%
281
58%
256
60%
Medical*
155
36%
168
38%
180
37%
155
37%
Undetermined
3
1%
2
0%
4
1%
6
1%
SIDS
3
1%
1
0%
4
1%
3
1%
Motor vehicle crash
4
1%
1
0%
5
1%
2
<1%
Other
1
0%
4
1%
5
1%
1
<1%
Suffocation
3
1%
1
0%
5
1%
0
0%
Exposure
1
0%
0
0%
0
0%
Drowning
1
0%
0
0%
1
0%
0
0%
Total
434
440
485
423
*Excluding SIDS and prematurity

2009
221
60%
128
35%
5
1%
1
<1%
2
<1%
5
1%
4
1%
0
0%
0
0%
366

65

Table 35. Deaths Among Children Ages Birth Through 27 Days by Manner,
Arizona 2005-2009
Manner
2005
2006
2007
2008
Natural
421
97%
432
98%
464
96%
414
98%
Undetermined
3
1%
2
0%
6
1%
6
1%
Accident (Unint. Injury)
7
2%
2
0%
12
2%
2
<1%
Homicide
3
1%
4
1%
3
1%
1
<1%
Suicide
0
0%
0
0%
0
0
0%
Total
434
440
485
423

2009
349
95%
7
2%
7
2%
3
1%
0
0%
366

The Post-Neonatal Period, 28 Days Through 365 Days
Table 36. Deaths Among Children Ages 28 Days Through 365 Days by Cause and Manner,
Arizona 2009 (n=183)
Cause
Accident
Homicide
Suicide
Natural
Undetermined
Total
(Unint. Injury)
Medical*
0
1
0
76
0
77
Undetermined
0
0
0
2
33
35
Suffocation
9
2
0
0
2
13
SIDS
0
0
0
20
7
27
Prematurity
0
0
0
18
0
18
Blunt force
0
3
0
0
0
3
trauma
Motor vehicle
2
0
0
0
0
2
crash
Other injury
1
0
0
0
0
1
Fall/crush
3
0
0
0
0
3
Poisoning
0
1
0
0
0
1
Drowning
3
0
0
0
0
3
Total
18
7
0
116
42
183
*Excluding SIDS and prematurity
Table 37. Deaths Among Children Ages 28 Days Through 365 Days by Cause,
Arizona 2005-2009
Cause
2005
2006
2007
2008
2009
Medical*
122
52%
89
43%
83
37%
91
43%
77
42%
Undetermined
17
7%
14
7%
25
11%
44
21%
35
19%
Suffocation
19
8%
24
12%
21
9%
21
10%
13
7%
SIDS
34
15%
27
13%
33
15%
17
8%
27
15%
Prematurity
21
9%
29
14%
35
15%
15
7%
18
10%
Blunt force trauma
7
3%
8
4%
8
3%
9
4%
3
2%
Other non-medical
5
2%
8
4%
5
2%
6
3%
3
2%
Motor vehicle crash
1
0%
2
1%
7
3%
6
3%
2
1%
Drowning
1
0%
2
1%
5
2%
1
<1%
3
2%
Exposure
1
0%
0
0%
2
1%
1
<1%
0
0%
Fire/burn
3
1%
1
0%
6
3%
0
0%
0
0%
Poisoning
1
0%
2
1%
1
0%
0
0%
1
<1%
Hanging
1
0%
0
0%
1
0%
0
0%
0
0%
Total
233
206
225
211
183
*Excluding SIDS and prematurity

66

Table 38. Deaths Among Children Ages 28 Days Through 365 Days by Manner,
Arizona 2005-2009
Manner
2005
2006
2007
2008
2009
Natural
178
76%
140
68%
147
65%
116
55%
116
63%
Undetermined
9
4%
12
6%
27
12%
52
25%
42
23%
Accident (Unint. Injury)
19
8%
25
12%
38
17%
29
14%
18
10%
Homicide
27
12%
29
14%
13
6%
14
7%
7
4%
Suicide
0
0%
0
0%
0
0%
0
0%
0
0%
Total
233
206
225
211
183

Children, One Through Four Years of Age
Table 39. Deaths Among Children Ages One Through Four Years by Cause and Manner,
Arizona 2009 (n=130)
Cause
Accident
Homicide
Suicide
Natural
Undetermined
Total
(Unint. Injury)
Medical*
0
0
0
50
0
50
Drowning
23
0
0
0
1
24
Motor vehicle
20
0
0
0
0
20
crash
Undetermined
0
1
0
3
6
10
Other injury
2
2
0
0
0
4
Blunt force
0
6
0
0
1
7
trauma
Prematurity
0
0
0
1
0
1
Firearm injury
1
3
0
0
0
4
Fire/burn
3
0
0
0
0
3
Fall/crush
2
0
0
0
0
2
Hanging
5
0
0
0
0
5
Total
56
12
0
54
8
130
*Excluding SIDS and prematurity
Table 40. Deaths Among Children Ages One Through Four Years by Cause,
Arizona 2005-2009
Cause
2005
2006
2007
2008
2009
Medical*
56
43%
74
48%
45
40%
67
53%
50
38%
Drowning
20
15%
16
10%
12
11%
25
20%
24
18%
Motor vehicle crash
19
15%
34
22%
21
18%
10
8%
20
15%
Other non-medical
5
4%
4
3%
11
10%
7
5%
11
8%
Undetermined
5
4%
7
4%
8
7%
7
5%
10
8%
Blunt force trauma
10
8%
6
4%
7
6%
4
3%
7
5%
Firearm injury
0
0%
1
1%
2
2%
2
2%
4
3%
Poisoning
4
3%
1
1%
2
2%
2
2%
0
0%
Exposure
3
2%
1
1%
1
1%
2
2%
0
0%
Fire/burn
5
4%
4
3%
2
2%
1
1%
3
2%
Prematurity
0
0%
0
0%
0
0%
0
0%
1
1%
Suffocation/choking
2
2%
5
3%
2
2%
0
0%
0
0%
Total
130
153
113
126
130
*Excluding SIDS and prematurity

67

Table 41. Deaths Among Children Ages One Through Four Years by Manner,
Arizona 2005-2009
Manner
2005
2006
2007
2008
Natural
56
43%
74
48%
49
43%
67
53%
Accident (Unint. Injury)
54
42%
64
42%
45
40%
43
34%
Undetermined
7
5%
4
3%
7
6%
9
7%
Homicide
13
10%
11
7%
12
11%
7
5%
Suicide
0
0%
0
0%
0
0%
0
0%
Total
130
153
113
126

54
56
8
12
0
130

2009
42%
43%
6%
9%
0%

Children, Five Through Nine Years of Age
Table 42. Deaths Among Children Ages Five Through Nine Years by Cause and Manner,
Arizona 2009 (n=67)
Cause
Accident
Homicide
Suicide
Natural
Undetermined
Total
(Unint. Injury)
Medical*
0
0
0
42
0
42
Prematurity
0
0
0
1
0
1
Motor vehicle
15
0
0
0
0
15
crash
Firearm injury
0
3
0
0
0
3
Drowning
3
0
0
0
0
3
Undetermined
1
0
0
0
0
1
Other injury
0
2
0
0
0
2
Total
19
5
0
43
0
67
*Excluding SIDS and prematurity
Table 43. Deaths Among Children Ages Five Through Nine Years by Cause,
Arizona 2005-2009
Cause
2005
2006
2007
2008
2009
Medical
43
51%
30
47%
37
55%
43
64%
42
63%
Prematurity
0
0%
0
0%
0
0%
0
0%
1
1%
Motor vehicle crash
23
27%
23
36%
13
19%
10
15%
15
22%
Other non-medical
2
2%
2
3%
7
10%
8
12%
6
9%
Drowning
6
7%
4
6%
4
6%
2
3%
3
4%
Fire/burn
6
7%
2
3%
1
1%
2
3%
0
0%
Hanging
0
0%
1
1%
1
1%
1
1%
0
0%
Blunt force trauma
2
2%
1
1%
1
1%
1
1%
0
0%
Suffocation
1
1%
0
0%
1
1%
0
0%
0
0%
Poisoning
1
1%
1
1%
2
3%
0
0%
0
0%
Total
85
64
67
67
67
*Excluding SIDS and prematurity
Table 44. Deaths Among Children Ages Five Through Nine Years by Manner,
Arizona 2005-2009
Manner
2005
2006
2007
2008
Natural
43
51%
30
47%
37
55%
42
63%
Accident (Unint. Injury)
39
46%
32
50%
23
34%
19
28%
Undetermined
0
0%
1
1%
0
0%
4
6%
Homicide
3
4%
0
0%
7
10%
2
3%
Suicide
0
0%
1
1%
0
0%
0
0%
Total
85
64
67
67

43
19
0
5
0
67

2009
64%
28%
0%
7%
0%

68

Children, 10 Through 14 Years of Age
Table 45. Deaths Among Children Ages 10 Through 14 Years by Cause and Manner,
Arizona 2009 (n=73)
Cause
Accident
Homicide
Suicide
Natural
Undetermined
Total
(Unint. Injury)
Medical*
0
0
0
43
0
43
Motor vehicle
13
0
0
0
0
13
crash
Firearm injury
0
1
0
0
0
1
Drowning
1
0
0
0
0
1
Hanging
0
0
3
0
0
3
Fall/crush
1
1
0
0
0
2
Undetermined
0
0
0
4
1
5
Exposure
2
0
0
0
0
2
Other injury
0
2
0
0
1
3
Total
17
4
3
47
2
73
*Excluding SIDS and prematurity
Table 46. Deaths Among Children Ages 10 Through 14 Years by Cause,
Arizona 2005-2009
Cause
2005
2006
2007
2008
Medical
32
37%
38
41%
40
43%
34
46%
Motor vehicle crash
21
24%
21
23%
27
29%
19
26%
Firearm injury
7
8%
13
14%
7
8%
7
9%
Hanging
7
8%
3
3%
6
6%
6
8%
Other non-medical
1
1%
0
0%
4
4%
2
3%
Fall/crush
0
0%
1
3%
3
3%
2
3%
Poisoning
4
5%
2
2%
2
2%
2
3%
Blunt force trauma
1
1%
3
3%
1
1%
1
1%
Exposure
4
5%
4
4%
1
1%
1
1%
Suffocation
3
3%
4
4%
0
0%
0
0%
Drowning
1
1%
3
3%
1
1%
0
0%
Total
86
92
92
74
*Excluding SIDS and prematurity
Table 47. Deaths Among Children Ages 10 Through 14 Years by Manner,
Arizona 2005-2009
Manner
2005
2006
2007
2008
Natural
32
37%
38
41%
40
43%
33
45%
Accident (Unint. Injury)
34
40%
34
37%
35
38%
26
35%
Suicide
13
15%
11
12%
7
8%
9
12%
Homicide
5
6%
7
8%
5
5%
6
8%
Undetermined
2
2%
2
2%
5
5%
0
0%
Total
86
92
92
74

43
13
1
3
8
2
0
0
2
0
1
73

2009
59%
18%
1%
4%
11%
3%
0%
0%
3%
0%
1%

47
17
3
4
2
73

2009
64%
23%
4%
5%
3%

69

Children, 15 Through 17 Years of Age
Table 48. Deaths Among Children Ages 15 Through 17 Years by Cause and Manner,
Arizona 2009 (n=128)
Cause
Accident
Homicide
Suicide
Natural
Undetermined
Total
(Unint. Injury)
Firearm injury
0
13
9
0
1
23
Motor vehicle
29
1
0
0
0
30
crash
Medical*
0
0
0
32
0
32
Hanging
0
0
12
0
0
12
Poisoning
11
0
3
0
1
15
Other
0
4
0
0
0
4
Exposure
5
0
0
0
0
5
Undetermined
0
0
0
0
1
1
Blunt force
0
2
0
0
0
2
trauma
Drowning
3
0
0
0
1
4
Total
48
20
24
32
4
128
*Excluding SIDS and prematurity
Table 49. Deaths Among Children Ages 15 Through 17 Years by Cause,
Arizona 2005-2009
Cause
2005
2006
2007
2008
Firearm injury
34
19%
46
22%
36
22%
37
27%
Motor vehicle crash
66
37%
83
40%
49
30%
35
25%
Medical
34
19%
29
14%
35
22%
30
22%
Hanging
10
6%
19
9%
6
4%
13
9%
Poisoning
9
5%
5
2%
17
11%
10
7%
Other
2
1%
4
2%
7
4%
4
3%
Exposure
10
6%
4
2%
4
2%
4
3%
Drowning
6
3%
6
3%
0
0%
1
1%
Undetermined
2
1%
1
0%
4
2%
1
1%
Fall/crush
4
2%
1
0%
0
0%
1
1%
Blunt force trauma
2
1%
6
3%
0
0%
1
1%
Fire/burn
1
1%
2
1%
3
2%
0
0%
Total
180
206
161
137
*Excluding SIDS and prematurity

2009
23
18%
30
23%
32
25%
12
9%
15
12%
4
3%
5
4%
4
3%
1
1%
0
0%
2
2%
0
0%
128

Table 50. Deaths Among Children Ages 15 Through 17 Years by Manner,
Arizona 2005-2009
Manner
2005
2006
2007
2008
Accident (Unint. Injury)
92
51%
109
53%
74
46%
49
36%
Natural
35
19%
29
14%
34
21%
30
22%
Homicide
25
14%
29
14%
26
16%
30
22%
Suicide
23
13%
36
18%
21
13%
26
19%
Undetermined
5
3%
3
1%
6
4%
2
1%
Total
180
206
161
137

2009
48
37%
32
25%
20
16%
24
19%
4
3%
128

70

APPENDIX B: POPULATION DENOMINATORS FOR ARIZONA
CHILDREN
The population denominators shown below were used in computing the rates presented
in this report. These denominators were provided by the Arizona Department of Health
Services Bureau of Public Health Statistics, available online at
http://www.azdhs.gov/plan/menu/info/pd.htm.
Table 51. Population of Children Ages 0 Through 17 Years by County of
Residence, Arizona 2005-2009
2005
2006
2007
2008
2009
Apache
28,451
26,177
25,708
25,713
25,888
Cochise
34,862
34,132
34,478
34,786
35,356
Coconino
37,476
35,979
35,867
35,840
36,439
Gila
13,626
13,436
13,130
13,545
14,002
Graham
10,574
9,987
9,833
10,536
10,819
Greenlee
2,585
2,359
2,355
2,551
2,495
La Paz
4,405
4,222
4,143
4,130
4,074
Maricopa
980,054 1,032,185 1,051,575 1,059,737 1,064,572
Mohave
43,266
43,954
45,146
45,589
45,296
Navajo
38,807
36,426
35,821
35,684
35,814
Pima
234,407
239,165
242,411
243,987
244,390
Pinal
61,497
67,010
72,802
80,600
81,414
Santa Cruz
14,764
14,475
14,624
14,880
14,898
Yavapai
42,936
42,682
43,925
44,725
44,969
Yuma
54,181
57,034
58,446
59,083
59,089
Total
1,601,891 1,659,223 1,690,264 1,711,386 1,719,515
Table 52. Population of Children Ages 0 Through 17 Years by Age Group,
Arizona 2005-2009
2005
2006
2007
2008
2009
<1 Year
90,288
97,113
102,587
98,995
92,263
1-4 Years
355,874
385,231
396,458
402,486
406,201
5-9 Years
457,483
450,576
457,956
465,088
469,372
10-14 Years
443,912
457,207
455,724
462,890
467,149
15-17 Years
254,334
269,096
277,539
281,927
284,530
Total
1,601,891 1,659,223 1,690,264 1,711,386 1,719,515

71

APPENDIX C: DATA ANALYSIS METHODOLOGY
Child fatality review data include a variety of data sources that may not be available to
other programs or research endeavors. Arizona statute facilitates data collection
among protected data sources, including health and law enforcement records (A.R.S.
§36-3503). Confidentiality of records is strictly enforced, and meetings at which
individual cases are reviewed are not open to the public. Case review records are
destroyed after publication of the annual report.
All reasonable efforts are made to obtain complete records for each death. However, if
records are unavailable, case reviews may be conducted without some information.
Records may be difficult to obtain for children who died in Arizona but lived in other
states or countries and for children whose families only recently moved to Arizona.
These cases may have had additional risk factors that were unknown to review teams.
The reliability of child fatality data is dependent upon the accuracy of the records
provided for review. Data presented in the Child Fatality Review Annual Report may
differ from other published sources.

72

APPENDIX D: ARIZONA CHILD FATALITY REVIEW TEAMS
AND ARIZONA DEPARTMENT OF HEALTH SERVICES STAFF
State Child Fatality Review Team
Chair
Mary Ellen Rimsza, MD, FAAP
University of Arizona College of Medicine
American Academy of Pediatrics
Members
Angela Andrews
Lori Eidemanis (proxy)
Maricopa County Attorney’s Office

Beth Rosenberg
Children’s Action Alliance

Kathryn Bowen, MD
University of Arizona College of Medicine

Sara Salek, MD
Markay Adams (proxy)
Arizona Department of Health Services
Division of Behavioral Health Services

David K. Byers
Leticia D’Amore (proxy)
Administrative Office of the Courts

Valerie Seitz, LCSW
Luke Air Force Base

Tim Flood, MD
Arizona Department of Health Services
Bureau of Public Health Statistics

Kim Simmons
Arizona Department of Economic Security
Division of Developmental Disabilities

Randy Force
Phoenix Police Department

Sheila Sjolander
Arizona Department of Health Services
Bureau of Women’s and Children’s Health

Wade Kartchner, MD
Navajo County Public Health Services
Janice Mickens
Arizona Department of Economic Security
Division of Children, Youth, and Families
Gaylene Morgan
Office of the Attorney General

Tomi St. Mars, RN, MSN, CEN, FAEN
Arizona Department of Health Services
Bureau of Women’s and Children’s Health
Roy Teramoto, MD
Indian Health Services
David Winston, MD, PhD
Forensic Pathologist
Pima County Office of the Medical Examiner

73

Apache County Child Fatality Review Team
Chair/Coordinator
Diana Ryan
Apache Youth Council

Members
Gladys Ambrose
Navajo Nation Division of Social Services
Commander Matrese Avila
Apache County Sheriff’s Office
Criss Candelaria
Apache County Attorney’s Office
Mike Downs
Little Colorado Behavioral Health Center
Lieutenant Fred Frazier
Eagar Police Department
Peggy Hart
Arizona Department of Economic Security
Division of Children, Youth, and Families
Chief Mike Hogan
Eagar Police Department
Michael Johnson
Apache County Public Health Services
District
Chief Donny Jones
St. Johns Police Department

Jim Pierson
New Hope Ranch
Brenda Plumb
Apache County Tobacco Youth Prevention
Program
Ann Russell
Arizona Department of Economic Security
Division of Children, Youth, and Families
Keli Sine-Shields
Apache County Public Health Services
District
James Sielski, DO
Medical Examiner
Jim Staffnik, PhD
St. Johns Schools
Cathy Taylor, MD
North Country Community Health Center
Sandra Thompson
Little Colorado Behavioral Health Center
Chief Steve West
Springerville Police Department

Elizabeth Kizer
Apache County Public Health Services
District

Michael Whiting
Apache County Attorney’s Office

Detective Mike Nuttall
Springerville Police Department

Chief Jim Zeiler
St. Johns Police Department

74

Cochise County Child Fatality Review Team
Chair/Coordinator
Hal Thomas, EdD
Committee for the Prevention of Child Abuse
Assistant Coordinator
Nilda Townsend
Recording Secretary
Paula Peters

Members
Joy Craig
Arizona Department of Public Safety
Parent Representative
Vincent Fero
Arizona Department of Public Safety
Guery Flores, MD
Cochise County Medical Examiner’s Office
Dee Foster
Community Representative
Tonianne Goebel
Domestic Violence Specialist
Angela Hillig
Sierra Vista Police Department

Maureen Kappler
Cochise County Health Department
Debbie Nishikida
Arizona Department of Economic Security
Division of Children, Youth, and Families
Judy Pike
Psychologist
Melodi Polach
Family Resource Specialist
Rebecca Reyes, MD
Pediatrician
Rodney Rothrock
Cochise County Sheriff’s Office
Mary Scott
Cochise County Prosecutor’s Office

75

Coconino County Child Fatality Review Team
Chair/Coordinator
Vacant
Members
Child deaths occurring to residents of Coconino County in 2009 were reviewed by the State
Team Chair and designees. A new team coordinator has been identified and a review team has
been formed for 2010.

76

Gila County Child Fatality Review Team
Chair/Coordinator
Jean M. Oliver
Time Out, Inc.

Members
Lucinda Campbell, RN, BSN
Gila County Health Department
Yvonne Harris
Arizona Department of Economic Security

Mary Ellen Rimsza, MD, FAAP
American Academy of Pediatrics
University of Arizona College of Medicine
Katrisha Stuler
CASA Coordinator
Detective Matt Van Camp
Payson Police Department

77

Graham County and Greenlee County Child Fatality Review Team
Chair/Coordinator
Vacant

Members
Child deaths occurring to residents of Graham or Greenlee Counties in 2009 were reviewed by
the State Team Chair and designees. A new team coordinator has been identified and a review
team is being formed for 2010.

78

Maricopa County Child Fatality Review Team
Chair
Mary Ellen Rimsza, MD, FAAP
American Academy of Pediatrics
University of Arizona College of Medicine
Coordinator
Susan Newberry, LBSW, MEd
Assistant Coordinator
Arielle Unger, BA
Members
Markay Adams
Arizona Department of Health Services
Division of Behavioral Health Services

Shawn Cox, LCSW
United States Attorney’s Office
Frances Baker Dickman, PhD, JD

Angela Andrews
Maricopa County Attorney’s Office
Elisha Au Franklin, MC
La Frontera Arizona
EMPACT-SPC
Nesanet Berhane, MPA
Arizona Department of Economic Security
Division of Children, Youth and Families
Wendy Bernatavicius, MD
Phoenix Children’s Hospital
Sergeant Jesse Boggs
Chandler Police Department
Detective Jennifer Borquez
Arizona Department of Public Safety
Kathryn Coffman, MD
St. Joseph's Hospital
Cindy Copp, MSW
Arizona Department of Economic Security
Division of Children, Youth, and Families
Kristen Covert, MD
Phoenix Children’s Hospital
Maricopa Medical Center

Paul S. Dickman, MD
Phoenix Children’s Hospital
University of Arizona College of Medicine
Frank DiModica
Retired Detective, Phoenix Police
Department
Ilene Dode, PhD, LPC
CEO Emeritus, EMPACT Suicide
Prevention Center
Michelle Fingerman, MS
Childhelp National Child Abuse Hotline
Rebecca Fitzpatrick, MSW
Arizona Department of Economic Security
Division of Children, Youth, and Families
Timothy Flood, MD
Arizona Department of Health Services
Bureau of Public Health Statistics
Minerva Gant, MBA
Arizona Department of Economic Security
Division of Children, Youth and Families
Sergeant Mike Hill
Tempe Police Department

79

Richard Johnson, MSW
Arizona Department of Economic Security
Division of Children, Youth, and Families

Susan Schmidt
Childhelp National Headquarters

Sharon Jones, RHIT
Hospice of the Valley

Michele F. Scott, MD
Phoenix Children’s Hospital

Karin Kline, MSW
Arizona Department of Economic Security
Division of Children, Youth, and Families

Alana Shacter, MPH
Arizona Department of Health Services
Bureau of Women’s and Children’s Health

Detective Chris Loeffler
Phoenix Police Department

Laurie Smith, MSN, PCNS-BC
Cardon Children’s Medical Center

Sergeant Eric Lumley
Phoenix Police Department

Connie Smyer
Retired Deputy County Attorney

Terence Mason, RN
Mesa Fire Department

Marilynn SoRelle, LPC
Arizona Department of Economic Security
Division of Children, Youth, and Families

Sergeant Dana McBride
Mesa Police Department
Sandra McNally, MA, LISAC
La Frontera Arizona
EMPACT Suicide Prevention Center

Katrina Taylor
Childhelp National Child Abuse Hotline
Jon Terpay, Director
Chandler/Gilbert Community College Law
Enforcement Training Academy

Sally Moffat
Phoenix Children’s Hospital
Injury Prevention Center

Amy Terreros MS, RN, CPNP
Phoenix Children’s Hospital

Christa Morgan
Arizona Department of Economic Security
Division of Children, Youth, and Families

Denis Thirion, MA
La Frontera Arizona
EMPACT Suicide Prevention Center

Ayrn O’Connor, MD
Banner Health, Good Samaritan Hospital

Zannie Weaver
U.S. Consumer Product Safety Commission

Sergeant Jennifer Pinnow
Arizona Department of Public Safety

Detective Sergeant David L. Wilson
El Mirage Police Department

Kindra Portillo, BA
Arizona Department of Economic Security
Division of Children, Youth, and Families

Joseph T. Zerella, MD
Pediatric Surgeon

Nancy Quay, MS, RN
Phoenix Children’s Hospital, Children’s
Neuroscience Institute

Stephanie Zimmerman, MD
Phoenix Children’s Hospital

80

Mohave County and La Paz County Child Fatality Review Team
Co-Chairs
Vic Oyas, MD
Havasu Rainbow Pediatrics
Daniel Wynkoop
Psychologist
Coordinator
Leslie DeSantis
Mohave County Sheriff’s Office

Members
B.W. (Bud) Brown
Mohave Mental Health Clinic

Jennifer McNally
Mohave County Health Department

Earl Chalfant
Lake Havasu City Police Department

Betty Munyon
Mohave County Victim/Witness Program

Kay Claborn
Parent Representative

Detective Steve Parker
Mohave County Sheriff’s Office

Craig Diehl, MD
Pediatrician

Angelica Pichardo
Mohave County Health Department

Detective Todd Foster
Kingman Police Department

Melissa Register
Mohave County Probation Department

Loria Gattis
Mohave County Medical Examiner

Detective Cindy Slack
Lake Havasu City Police Department

Detective Greg Kenyon
Mohave County Sheriff’s Office

Lieutenant Steve Smith
Bullhead City Police Department

Lieutenant Larry Kubacki
La Paz County Sheriff’s Office

Loralyn Staples
Mohave County Probation Department

Kosha Long
Arizona Department of Economic Security
Child Protective Services

Larry Tunforss
Bullhead City Fire Department

Patty Mead
Mohave County Health Department

Steve Wilson
Mohave County Attorney’s Office
Rexene Worrell, MD
Mohave County Medical Examiner

81

Navajo County Child Fatality Review Team
Chair/Coordinator
Janelle Virtue, RN
Navajo County Public Health Services
Co-chair
Susie Sandahl, RN
Navajo County Public Health Services

Members
Katy Aday
WMAT Social Services

Wade Kartchner, MD
Navajo County Public Health Services

Gladys Ambrose
Navajo Tribe Family Services

Jane McRitchie
Arizona Baptist Children’s Services

Brock Bevell
Lead Medical Examiner Investigator
ABMDI Certified
Navajo County Medical Examiner’s Office

Kateri Piecuch
Arizona Department of Economic Security
Division of Children, Youth, and Families

Greg Cardita
Assistant Medical Examiner Investigator
Navajo County Medical Examiner’s Office
Detective Sergeant Roger Conaster
Winslow Police Department
Detective Sergeant Tim Dixon
Holbrook Police Department
Sherry Herring
Navajo County Court Appointed Special
Advocate’s Office

Sylvia Pender
Foster Care Review Board
Amy Stradling
Navajo County Public Health Injury
Prevention
Andrea Tsatoke, MPH
Navajo County Community Outreach
Gordon Tsatoke, Jr
Indian Health Services Injury Prevention
C.J. Wischmann
Arizona Department of Economic Security
Child Protective Services

82

Pima County and Santa Cruz County Child Fatality Review Team
Chair
Kathryn Bowen, MD
Department of Pediatrics
University of Arizona
Coordinator
Becky Lowry
University of Arizona
Members
Albert Adler, MD
Indian Health Services
Norma Battaglia
Tucson Fire Department
Judith Becker, PhD
Psychiatrist
University of Arizona
Kathy Benson, RN
School Nurse
Captain Norm Carlton
Tucson Fire Department
Rachel Cramton, MD
University of Arizona
Sacha Cueto
University of Arizona
Detective Robert Dobell
Tucson Police Department
Lynn Edde, MD
University of Arizona
Department of Pediatrics
Detective Marty Fuentes
Tohono O’odam Police Department
Morgan Grygutis
Pima County Attorney’s Office

Sandy Guizetti
Foster Care Services
Karen Harper
Southern Arizona Children’s Advocacy
Center
Greg Hess, MD
Forensic Pathologist
Pima County Office of the Medical Examiner
Karen Ives
Pima County Juvenile Detention
Lisa Jacobs, RN
Casa de los Niños
Lynn Kallis
Pilot Parents of Southern Arizona
Patricia Kleiman
Special Needs Instructor
Sarah Long
Healthy Families
Kathleen Malkin, RN
Pima County Health Department
Stacey Meade
Epidemiologist
Community Representative
Joan Mendelson
Private Attorney

Lori Groenewold, MSW
Children’s Clinics for Rehabilitation Services

83

Brenda Neufeld, MD
Indian Health Services

Trish Tracy
Tucson Fire Department

Cindy Porterfield, DO
Forensic Pathologist
Pima County Office of the Medical Examiner

Deborah Weber, RN
Pima County Health Department

Carol Punske, MSW
Arizona Department of Economic Security
Division of Children, Youth, and Families
Barbra Quade
Jewish Family Services
Laurie San Angelo
Pima County Attorney General’s Office

Donald Williams, REHS, MPH
Indian Health Services
David Winston, MD, PhD
Forensic Pathologist
Pima County Office of the Medical Examiner
Dale Woolridge, MD
University of Arizona

84

Pinal County Child Fatality Review Team
Chair/Coordinator
Leah Lara
Against Abuse, Inc.

Members
Scott Bennett
Pinal County Attorney’s Office

Chuck Kerstell
Horizon Human Services

Detective Amy DeLeon
Casa Grande Police Department

Andrea Kipp
Pinal County Sheriff’s Office

Mark Dyrdahl
Arizona Department of Economic Security
Division of Children, Youth, and Families

Robert Kull, MD
Pediatrician (retired)

Vonnie Fuentes
Maricopa Integrated Health Systems
Rebecca Hsu
Pinal County Medical Examiner’s Office

Tom Schryer
Pinal County Health Department
Gerald Smith
Pinal County Attorney’s Office
Detective Gary Vance
Apache Junction Police Department

85

Yavapai County Child Fatality Review Team
Chair/Coordinator
Barbara Jorgensen, MSN, RN
Yavapai County Community Health Services
Secretary
Carol Espinosa
Members
Doug Brown
Yavapai County Attorney’s Office

B.J. Jordison
Yavapai Regional Medical Center

Esther Brohner
CASA

Dennis McGrane
Yavapai County Attorney’s Office

Sue Carlson
Licensed Counselor

Kathy McLaughlin
Yavapai Family Advocacy Center

Karen Dansby, MD
Pediatrician

LaRayne Ness
Yavapai Regional Medical Center

Pam Edgerton
Yavapai County Sheriff’s Office

Cynthia Ross
Yavapai County Medical Examiner’s Office

Bill Hobbs
Yavapai County Attorney’s Office

Becky Ruffner
Prevent Child Abuse Arizona

Dawn Kimsey
Arizona Department of Economic Security
Division of Children, Youth, and Families

Kathy Swope, RN
School Nurse
Yavapai County Education Services Agency

86

Yuma County Child Fatality Review Team
Chair
Patti Perry, MD
Pediatrician
Coordinator
Chip Schneider
Amberly’s Place

Members
Diana Gomez
Yuma County Health Department
Sonny Hixon
Yuma County Sheriff’s Office
Detective Debbie Machin
Yuma Police Department
Jim Miller
SAFE KIDS
Yuma County Health Department
Alice Nelson
Parent Representative

Maria Nunez
Yuma County Health Department
Maria Ortega
Arizona Department of Economic Security
Child Protective Services
Diane Umphress
Advocate
Amberly’s Place
Tom Varela
Yuma County Attorney’s Office
Robert Vigil
Medical Examiner’s Office

87

Arizona Department of Health Services Bureau of Women’s and
Children’s Health
Injury Prevention and Child Fatality Review Section
Tomi St. Mars, RN, MSN, CEN, FAEN, Section Manager
Alana Shacter, MPH, Injury and Child Fatality Epidemiologist
Teresa Garlington, Administrative Secretary

Office of Assessment and Evaluation
Khaleel Hussaini, PhD, Office Chief
Terri Baxter, Administrative Assistant III (Data Quality)
Tia Davis, Data Manager
Laurie Godinez, Data Manager
Marilyn Seiler, Data Manager
LaTonya VanDenburgh, Data Manager
Terry Williamson, Data Manager

88

To obtain further information, contact:
Arizona Department of Health Services
Public Health Prevention Services
Bureau of Women’s and Children’s Health
Child Fatality Review Program
150 North 18th Avenue, Suite 320
Phoenix, AZ 85007
Phone: (602) 364-1400
Fax: (602) 364-1496

Information about the Arizona Child Fatality Review Program may be found on the
Internet through the Arizona Department of Health Services at:
http://www.azdhs.gov/phs/owch/cfr.htm

Resources for the development of this report were provided through funding to the
Arizona Department of Health Services from the Centers for Disease Prevention and
Control Cooperative Agreement 5U17CE924770-04, Integrated Core Injury Prevention
and Control Program.