NINETEENTH ANNUAL REPORT
NOVEMBER, 2012

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 1 of 101

November 15, 2012
Dear Friends of Arizona’s Children:
The death of a child is a tragedy, not only for his or her family, but also for our communities.
The child fatality review process provides a critical opportunity to learn about the causes and
circumstances of children’s deaths in order to prevent future deaths as well as disabilities and
injuries. A multidisciplinary team from the child’s community reviews each death to determine
not only the cause of death but also its preventability. In 2011, a total of 837 children younger
than 18 years of age died in Arizona and the teams determined that 35 percent of these deaths
could have been prevented. The number of deaths in 2011 was less than in 2010, when 862
children died.
Deaths due to motor vehicle crashes and other types of transportation have steadily declined
from 164 in 2007 to 70 in 2011. The rate of motor vehicle crash fatalities in 2011 was 3.7 deaths
per 100,000 children, a slight increase from 2010 when the rate was 3.6 per 100,000 children.
Lack of or improper use of vehicle restraint was identified as a preventable factor for 33 of the
motor vehicle crash deaths and drugs and/or alcohol was a factor in 15 of the deaths.
In 2011, 122 of the child deaths occurred in or around the home. Thirteen of these deaths were
due to drowning. More than half of the children who died in and around the home were less than
one year old. Seventy-six percent of these deaths were deemed to have been preventable and the
most common preventable factor was lack of supervision (56 percent).
The number of maltreatment deaths increased from 2010 to 2011. The Child Fatality Review
Program determined that 71 children died as a result of maltreatment in 2011. By comparison,
there were 70 children who died as a result of maltreatment in 2010. Over half of these children
were less than one year old. Drugs and/or alcohol contributed to 72 percent of these deaths
(n=49). Additionally, more than 1 in 4 children who died from maltreatment were known to have
had a physical, mental, and/or sensory disability.
The Arizona Child Fatality Review Team includes in this report many recommendations to
prevent future child deaths. We hope that families, communities and policy makers will adopt
these recommendations in order to prevent future child deaths.
Sincerely,

Mary Ellen Rimsza, MD
Chair, Arizona Child Fatality Review Program
Arizona Chapter, American Academy of Pediatrics
University of Arizona College of Medicine

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 2 of 101

ARIZONA CHILD FATALITY REVIEW TEAM

NINETEENTH ANNUAL REPORT

NOVEMBER, 2012

MISSION:
To reduce preventable child fatalities through systematic, multidisciplinary, multi-agency
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 Andy Biggs, President, Arizona State Senate
The Honorable Andy Tobin, Speaker, Arizona State House of Representatives

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

Prepared by: Marla D. Dedrick, BSW, M.Ed., MA
Child Fatality Review Program Manager
Brenna V. Rabel, MPH
Injury Epidemiologist
Arizona Department of Health Services

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. Resources for the development of this report were provided
in part through funding to the Arizona Department of Health Services from the Centers
for Disease Control and Prevention, Cooperative Agreement 5U17CE002023, Core
Violence and Injury Prevention Program.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 3 of 101

TABLE OF CONTENTS
ACKNOWLEDGMENTS .................................................................................................. 5
EXECUTIVE SUMMARY ................................................................................................ 6
RECOMMENDATIONS ................................................................................................. 13
INTRODUCTION. ..…………………………………………………………………….…..….20
2011 DEMOGRAPHICS ................................................................................................ 22
PREVENTABILITY ........................................................................................................ 33
SUBSTANCE ABUSE ................................................................................................... 36
PREMATURITY ............................................................................................................ 40
SUDDEN UNEXPECTED INFANT DEATHS ................................................................ 43
MOTOR VEHICLE CRASHES AND OTHER TRANSPORT FATALITIES .................... 46
DROWNINGS ............................................................................................................... 51
HOME SAFETY-RELATED DEATHS ........................................................................... 56
SUICIDES ..................................................................................................................... 58
HOMICIDES .................................................................................................................. 62
FIREARM-RELATED FATALITIES ............................................................................... 66
MALTREATMENT FATALITIES .................................................................................... 70
APPENDIX A: CHILD DEATHS BY AGE GROUP ........................................................ 76
The Neonatal Period, Birth Through 27 Days ............................................................ 76
The Post-Neonatal Period, 28 Days Through 365 Days ............................................ 77
Children, One Through Four Years of Age ................................................................ 78
Children, Five Through Nine Years of Age ................................................................ 79
Children, 10 Through 14 Years of Age ...................................................................... 80
Children, 15 Through 17 Years of Age ...................................................................... 81
APPENDIX B: POPULATION DENOMINATORS FOR ARIZONA CHILDREN ............. 82
APPENDIX C: DATA ANALYSIS METHODOLOGY ..................................................... 83
APPENDIX D: ARIZONA CHILD FATALITY REVIEW TEAMS AND ARIZONA
DEPARTMENT OF HEALTH SERVICES STAFF ......................................................... 84
State Child Fatality Review Team .............................................................................. 84
Apache County Child Fatality Review Team .............................................................. 85
Cochise County Child Fatality Review Team ............................................................. 86
Coconino County Child Fatality Review Team ........................................................... 87
Gila County Child Fatality Review Team ................................................................... 88
Graham County and Greenlee County Child Fatality Review Team .......................... 89
Maricopa County Child Fatality Review Team ........................................................... 90
Mohave County and La Paz County Child Fatality Review Team .............................. 93
Navajo County Child Fatality Review Team............................................................... 94
Pima County and Santa Cruz County Child Fatality Review Team ........................... 95
Pinal County Child Fatality Review Team .................................................................. 97
Yavapai County Child Fatality Review Team ............................................................. 98
Yuma County Child Fatality Review Team ................................................................ 99
Arizona Department of Health Services Bureau of Women’s and Children’s Health 100

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 4 of 101

ACKNOWLEDGMENTS
We wish to acknowledge the following individuals, businesses, and/or organizations for
their efforts to reduce child deaths in our communities and their dedication to improving
safety for all Arizona residents.


The more than 300 volunteers who contributed more than 5,900 hours of their
time to review child deaths which occurred during 2011. 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 the number of preventable
deaths of children in Arizona.



Carol Punske who has served children and her community through her work with
Arizona Child Protective Services. Carol has served on the Pima County Fatality
Review Team since its inception in 1993 and her knowledge has proven to be
invaluable to the team. After a career of more than 20 years, she is moving on to
a well-deserved retirement.



Jean Oliver and her commitment to develop a better awareness of domestic
violence. Additionally, Jean has been a driving force in the Child Fatality Review
Process in Gila County. She has assembled volunteers and many professionals
from all service organizations in Payson. Jean taught the committee how to
conduct child death reviews and ensure quality data. Jean recently retired from
Time Out, Inc, where she served as a volunteer, board member, advocate and
education coordinator. In doing so, she also retires from her duties as the child
fatality review coordinator. Her support, direction and dedication will be dearly
missed.



All individuals and entities who have responded promptly and efficiently to
records requests. Adequate reviews are only possible if the teams have accurate
and current information to review. This includes entities such as medical
examiner’s offices, local hospitals, law enforcement and private practice facilities.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 5 of 101

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 statistical 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
review data.
In 2011, 837 children younger than 18 years of age died in Arizona. This was a
three percent decline from 2010 when 862 children died. This is especially significant
considering the population of children younger than 18 increased from 2010 to 2011 by
0.74 percent (1,629,014 in 2010 to 1,641,114) in 2011. It should also be noted that the
statewide birth rate declined from 13.6 births per 1,000 population in 2010 to 13.2 births
per 1,000 population in 2011.
Arizona Child Fatality Review Teams reviewed 100 percent of child deaths and
determined that 35 percent of these deaths could have been prevented.
 100 percent of homicides were preventable.
 96 percent of maltreatment deaths were preventable.
 96 percent of firearm-related deaths were preventable.
 94 percent of drowning deaths were preventable.
 91 percent of motor vehicle crash deaths were preventable.
 89 percent of accidental deaths were preventable.
 87 percent of suicides were preventable; and
 79 percent of home and safety-related deaths were preventable.
In 2011, the number of deaths among all age groups either declined or remained the
same from 2010 with the exception of children ages 10 through 14 years of age and 15
through 17 years of age. The number of child deaths of children ages 10 through 14
increased from 66 in 2010 to 72 in 2011. The number of child deaths of children ages
15 through 17 years of age increased from 93 in 2010 to 96 in 2011.
Deaths continued to be disproportionately high among most minority children in
Arizona during 2011. African American children comprised five percent of the
population in Arizona, but eight percent of the fatalities. American Indian children
comprised five percent of the population and nine percent of deaths. Hispanic children
accounted for 43 percent of the population and 45 percent of child fatalities.
The percentage of deaths associated with substance use (illegal drugs,
prescription drugs, and/or alcohol) continued to increase in 2011. Twenty-six
percent of all child deaths were associated with substance use (n=215), an increase

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 6 of 101

from 2010 when substance use was associated with 20 percent of all child deaths
(n=175).
The rate of motor vehicle fatalities increased slightly from 2010 when 3.6 children
per 100,000 children died. In 2011, 3.7 children per 100,000 children died. There
were a total of 70 children in 2011 whose deaths were attributed to motor vehicle
crashes and other transportation incidents. Motor vehicle crashes claimed the lives of
63 children in 2011, an increase from 2010 when 58 children died in motor vehicle
crashes. Ninety-one percent of transportation-related deaths were determined to have
been preventable (n=64). Lack of vehicle restraint was identified as a preventable factor
for 46 percent of motor vehicle crash fatalities (n=33). This does not include 3 children
who died during air transport or one incident involving a train.
The rate of drowning fatalities declined from 2.0 per 100,000 children in 2010 to
1.9 per 100,000 children in 2011. Thirty-two children died due to drowning during
2011, and 94 percent of these deaths were determined to have been preventable. The
highest number of drowning deaths were among children one through four years of age.
The child suicide rate increased dramatically from 1.5 deaths per 100,000 children
in 2010 to 2.6 deaths per 100,000 children in 2011. Thirty-nine children took their own
lives during 2011, and 87 percent of these deaths were determined to have been
preventable (n=34). The use of drugs and/or alcohol was the most commonly identified
preventable factor in child suicides during 2011 (51 percent, n=20). The majority of
suicides were among children ages 15 through 17 years (64 percent, n=25), and the
youngest child to have completed suicide in 2011 was seven years old.
The number of deaths due to maltreatment increased from 70 in 2010, 8 percent
of all child deaths to 71 in 2011, also 8 percent of all child deaths that year. Blunt
force trauma was the leading cause of maltreatment-related deaths among children in
Arizona during 2011. Ninety-six percent of maltreatment deaths were determined to
have been preventable (n=68). Among the maltreatment deaths, 34 had prior
involvement with Child Protective Services and 15 of these had open cases at the time
of death.
Sixty-four infants died in unsafe sleep environments in 2011, including 42 infants
who were placed to sleep in adult beds and two who were placed to sleep on couches.
This was a decline from 2010 when 77 children died in unsafe sleep environments.
Thirty-six infants were placed to sleep on their sides or stomachs. Thirty-six infants were
bed sharing with adults and/or other children, and 6 of the adults who were sharing a
bed with an infant were known to have been impaired by drugs and/or alcohol.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 7 of 101

OUTCOMES RELATED TO PREVIOUS RECOMENDATIONS
Deaths due to substance abuse
The Division of Behavioral Health Services (DBHS) conducted a statewide needs
assessment and key informant interviews to create an online training for Emergency
Department medical staff. The training incorporates both screening and assessment for
suicide and substance abuse. Additionally, DBHS created a decision tree regarding
accessing and paying for behavioral health services, including the utilization of the
Substance Abuse Prevention and Treatment block grant. DBHS has initiated statewide
outreach to hospitals to incorporate these into their current practices.
The Governor’s Office for Children, Youth, and Families and ADHS received a new $7.5
million federal grant which will allow Arizona to identify substance abuse problems and
begin intervention in primary care offices and the emergency room. The Screening,
Brief Intervention and Referral to Treatment (SBIRT) grant will help primary care
providers identify patients who are at risk for or who have underlying substance abuse
problems that might otherwise go unnoticed and untreated. The grant will help reduce
the number of substance use related deaths and the prevalence of substance abuse
disorders in the five northern Arizona counties: Apache, Coconino, Mohave, Navajo,
and Yavapai using the SBIRT model. Integration of behavioral health services into
primary care centers and the hospital emergency rooms provides opportunities for early
intervention with at-risk substance users before more severe consequences occur.
Unexplained infant deaths, including unsafe sleep environments
Two of Arizona’s Safe Kids Coalitions (Coconino County and Maricopa County) have
included safe sleep information as part of their child passenger safety education
materials distributed to families at all car seat safety check-up events.
The Arizona Perinatal Trust (APT) is a private-public partnership among hospitals,
health care professionals, and state agencies throughout Arizona committed to an
effective regionalized perinatal health care system. The APT has developed
Recommendations and Guidelines for Perinatal Care and designates hospitals based
on the maternal and neonatal care the facility is capable of delivering. Some of these
guidelines include requirements for parent education on safe sleep environments and
preventing sudden unexpected infant deaths.
The Arizona Perinatal Trust continues to monitor certified hospitals for safe sleep
education during certification site visits. The APT shared recommendations from
previous Child Fatality Review Program reports and its findings on the alarming number
of child fatalities due to unsafe sleep environments and issued a call to action for safe
sleep education program and modeling of safe sleep practices in the hospital. The APT
provided safe sleep education information consistent with recommendations from the
American Academy of Pediatrics and the Back to Sleep Campaign from the National
Institute of Child Health and Human Development to all hospitals providing obstetrical
services in Arizona.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 8 of 101

Deaths due to prematurity
The Arizona Department of Health Services continues to serve on the Centers for
Disease Control (CDC) Preconception Health Consumer Workgroup and screened
preconception health materials designed for consumers prior to them being posted on
the CDC Preconception Health Resource Center. In addition, Arizona Department of
Health Services/Bureau of Women’s and Children’s Heath (ADHS/BWCH) has
committed to distributing the preconception health social marketing campaign when it is
launched in February 2013 and working with other partners across the state to assist
with increasing the campaign’s reach around the state.
Following completion of the Arizona Preconception Health Strategic Plan, the Bureau
convened a Preconception Health Implementation Task Force which meets quarterly to
ensure that selected strategies and activities contained in the strategic plan are being
accomplished. One activity completed is a report on the health status of women in
Arizona which will serve as a baseline for assessing whether various prevention efforts
are having the desired impact over time. The Bureau provided community health grant
funding to 7 county health departments and 6 of the agencies are working on
preconception health activities that are unique to their local populations. These grant
activities include working with schools on educating youth about healthy living,
educating local health care providers on preconception health care and designing life
plans for youth to complete and discuss with the school nurse.
The Arizona Perinatal Trust (APT) has worked with their member hospitals to eliminate
non-medically indicated deliveries before 39 weeks. With the help of the local March of
Dimes Chapter, the APT distributed the March of Dimes 39 week toolkit to each certified
hospital (40 of Arizona’s 46 birthing hospitals) in 2011 and then requested that each
hospital develop a written policy of how they will eliminate elective inductions before 39
weeks. These plans are reviewed during site visits. To date, 90 percent of all certified
hospitals have a hard stop in place. In addition, the March of Dimes launched a Healthy
Babies are Worth the Wait campaign to help couples understand the potential
complications of preterm births and the benefits of delivering at 39 weeks or later.
ADHS, the APT, and March of Dimes pledged to work together on this prematurity
awareness campaign and set a goal of reducing prematurity by 8 percent by 2014.
Deaths due to motor vehicle crashes
The Arizona Legislature enacted legislation that requires the use of booster seats for
children who are between five and eight years of age and are less than four feet, nine
inches in height.
The Arizona Game and Fish Department (AZGFD) provided public outreach,
information, education, and enforcement efforts to the public statewide. Through
multiple collaborative group efforts that promoted safe Off Highway Vehicle (OHV)
riding, which included attending outreach events with the All-Terrain Vehicle Simulator
and giving children and their families access to safe riding information. The AZGFD
worked with all state and federal law enforcement agencies, Division of Motor Vehicles,
natural resource agencies and the general public with the “OHV laws and places to ride”

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 9 of 101

brochure. The AZGFD issued 698 citations regarding off highway vehicle violations as
well as an unrecorded amount of written and verbal warnings.
Motor vehicle safety courses including child seat safety with an emphasis on booster
seats was provided by the Navajo County Public Health Services District. Adolescent
education in the school setting was provided regarding seatbelt use and motor vehicle
safety, specifically addressing the dangers of alcohol and driving under the influence.
The American Automobile Association (AAA) Arizona began a new safety program
entitled Permit Prep 101 that prepares teens for their written permit test and educates
families on what they need to know before their new driver takes the wheel. Safe Ways
to School workshops were completed covering the basics regarding pedestrian, school
bus and bike safety for elementary-aged children. AAA recognized school Crossing
Guards of the Year in Pima and Maricopa Counties and donated hundreds of safety
vests to be worn by school crossing guards.
Deaths due to injuries
The Arizona Injury Prevention Program provided local child death and injury data to
First Things First Regional Councils so they could utilize this information to develop
regional grants targeting injury prevention.
Coconino County Public Health Services District Injury Prevention Programs started a
Cribs 4 Kids program in Coconino County and made a video on safe sleep for the local
healthcare centers. They assisted the Hualapai and Supai Nations with child passenger
safety check-ups and distribution events. More than twenty Child Passenger Safety
Technicians were certified in Northern Arizona. Input and guidance was given to the
City of Flagstaff regarding two ordinances recently passed regarding helmet laws as
they pertain to minors and no consumption of alcohol in two public parks without a
permit. Two hundred and ninety five car seats and 365 helmets were distributed in
Coconino County and 321 seats were checked for proper installation.
The Injury Prevention Program at Cardon Children’s Medical Center provided health
and safety programs and education to schools, community groups, parents, health fairs
and safety fairs. The events have primarily been based in the East Valley though
portions of the programs reached throughout the state. One of the most important
community programs has been the Annual Walk for Water Safety a drowning prevention
program that provides lifeguard wrist tags and safety information to thousands of
families throughout the state. This program continues to operate in collaboration with
the community fire departments, businesses and coalitions throughout the state. During
2011, the Injury Prevention Program at Cardon Children’s Medical Center educated
over 1800 children on various injury prevention topics. Sixty thousand individuals were
impacted by water safety information provided to children and their families. Four
hundred and ninety seven helmets were distributed throughout the school year and
education on helmet safety was taught to over 2,000 children. Twenty-four car seat
classes were taught and 68 seats were distributed during these classes. In partnership
with Safe Kids and the Governor’s Office for Highway Safety, an additional 100 seats
were checked for safety and 71 were distributed to families in need.
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 10 of 101

The Injury Prevention Center at Phoenix Children’s Hospital (PCH) provided varied
interventions aimed at reducing childhood injuries and deaths by promoting safe and
healthy children, families and communities. Five key areas were addressed during
2011: 1) child passenger safety; 2) bike and pedestrian safety; 3) child abuse
prevention; 4) home safety; and 5) water safety. The Injury Prevention Center
distributed 1,200 car seats and performed 395 car seat checks. Six thousand clings and
safety information were distributed promoting safety in and around cars. The application
titled Car Seat Helper was created for iPhone, iPad and Android mobile devices with
over 5,000 downloads. Darkness to Light – Stewards of Children, Child Sexual Abuse
Prevention provided training to over 400 individuals. Phoenix Children’s Hospital
distributed over 2,000 helmets and presented information on safety while walking to
school to 45 schools. One thousand and fifteen parents were educated on home safety
and PCH distributed 115 cribs to parents to promote safe sleeping environments for
infants.
Many of the First Things First Regional Councils throughout the state have chosen to
support Child Care Health Consultants (CCHC). Consultants have used a strengthsbased approach with 497 child care centers and homes to achieve best practice goals
in all areas of early childhood development. Areas of focus included health and safety
issues related to growth and development, caregiving and parenting, physical activity,
nutrition, medication, oral health, abuse and neglect, and mental health. Child Care
Health Consultants provide training based on the curriculum from the National Training
Institute, University of North Carolina at Chapel Hill. CCHCs provide health and safety
education and support based on the individual needs of a child care provider. Training
topics include: playground safety, safe sleep, medication administration, and emergency
preparedness.
The Arizona Adverse Childhood Experiences (ACE) Consortium has worked to enhance
public awareness of the impact childhood trauma can have on adult disease and early
death. The ACE Consortium is a collaboration among community leaders to promote
safe, stable and nurturing communities and thereby reduce incidents of childhood
trauma. The ACE Study suggests that traumatic experiences in childhood are major risk
factors for the leading causes of illness and death as well as poor quality of life. To
combat childhood trauma the ACE Consortium brings together partners from health
care, public health, behavioral health, education, media, child welfare, community
service providers, child advocacy organizations and others. With the collaboration of
these diverse individuals and agencies, the ACE Consortium is helping Arizona
strengthen families and communities by getting the word out so that “Strong
Communities Raise Strong Kids”. By promoting healing from the effects of abuse and
ways to prevent it from occurring in the first place, the ACE Consortium is helping
Arizona create safe, stable and nurturing families and communities.
During 2011, the Never Shake a Baby Arizona education project educated 34,709
parents out of the 39,085 births at participating facilities for an overall education rate of
88 percent, statewide. This grant funded parent education program reaches across

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 11 of 101

Arizona to provide information on coping with crying and prevention of accidental head
trauma for our state's most vulnerable children.
Deaths due to suicide
The Central Arizona Suicide Prevention Project has changed the mindset about suicide
prevention in Arizona and around the country. The Arizona Department of Health
Services and The Department of Behavioral Health Services partnered with Magellan
Health of Arizona to train over 2,400 behavioral health employees in an innovative and
successful approach to suicide prevention and intervention. The heart of this approach
is to train any and all staff who may encounter a suicidal individual on how to engage
the individual in a sincere and caring conversation rather than simply referring them on
to an “expert” as quickly as possible. The project has also created survivor support
groups, family engagement groups and the opportunity for survivors to actively assist
others to make it through a painful time in their lives. There have been substantial drops
in the suicide rates for all behavioral health members including children (67%) between
FY2007 and FY2012.
The Arizona Department of Health Services Division of Behavioral Health developed a
taskforce and has continued to explore the development and implementation of a
Suicide Investigation Checklist for use by law enforcement when investigating child
suicides. They have also included suicide prevention in the Children and Adult System
of Care Strategic Plan, provided gatekeeper trainings and online early identification
training for emergency department personnel.
Deaths due to drowning
Since 2002, the Drowning Prevention Coalition of Arizona has promoted a threepronged approach to water safety. This includes: 1) promoting barriers; 2) supervision;
and 3) classes in CPR and swim lessons at the appropriate age. With the approval of
the American Academy of Pediatrics, DPCA included water safety classes as a layer of
protection for drowning prevention. DPCA has increasingly stressed the importance of
both children and their caregivers knowing how to swim. This has led to the introduction
of the Water SMART Babies program that involves the healthcare provider in
prescribing water safety classes for their patient’s families.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 12 of 101

RECOMMENDATIONS
Based on its review of child deaths that occurred in 2011 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 Suicide
In 2011, 39 children took their own lives. This was a dramatic increase from 2010 when
24 children died by suicide. The primary mechanism by which a child completed suicide
was by hanging (n=24). Identification of children at risk for suicide can be difficult, and
warning signs are not always recognized or taken seriously. Improvements in the
investigations of child suicides may increase review teams’ abilities to identify risk
factors which may lead to improved methods for addressing a child’s despondency prior
to suicide, giving family members, schools, caregivers and the community opportunities
for intervention.
Recommendation to the Governor’s Office of Children, Youth and Families: Support the
Department of Health Services in examining methods to strengthen the investigation of
the circumstances surrounding child suicides in order to enhance statewide suicide
prevention strategies.
Recommendation to the Department of Health Services: Develop a Suicide
Investigation Checklist for use by law enforcement when investigating child suicides.
Recommendation to the Arizona Department of Health Services Division of Behavioral
Health Services: Incorporate guidance regarding the flow of information between the
Regional Behavioral Health Authorities, providers and local child fatality review teams
within existing contracts or policies to ensure timely coordination of information.
Recommendation to Parents: Become informed of the risk factors for suicide of your
children and their friends. Treat all suicidal talk and threats as if they are real. The
National Suicide Prevention Lifeline phone number is 1-800-273-8255. Program this
number into your mobile device and call for help if you have questions about suicidal
ideation.
Recommendation to Schools: Educate students on the signs of suicidal ideation,
including information where students may go for help either for themselves or a friend
thought to have displayed these signs. Educate students on bullying, cyber-bullying,
and other circumstances at school that may be risk factors for suicide.
To Prevent Deaths due to Substance Use
Substance use (including illegal drugs, prescription drugs, and/or alcohol) was
associated with 215 child deaths during 2011, accounting for 26 percent of all child
deaths.
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 13 of 101

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
$185 per member, per month, primarily due to decreased costs associated with
inpatient hospital admissions. Utilization of SBIRT model has been shown in both adults
and adolescents to reduce substance abuse in various health care settings, including
primary care, emergency department and trauma centers.
Recommendation to the Arizona Department of Health Services: Continue to work with
the Arizona Home Visiting Taskforce to integrate standards for screening of substance
abuse for families participating in home visiting programs.
Recommendation to the Arizona Department of Health Services: Continue outreach to
hospitals and emergency departments across the state in an effort to incorporate the
SBIRT model into policy and protocol and educate about the availability of the
Substance Abuse Prevention and Treatment (SAPT) Block Grant funds, under which
women and children are priority populations for substance abuse treatment.
Additionally, expand education and outreach regarding the availability of the SAPT
Block Grant Funds to federally qualified community health centers, educators, health
care providers, Indian Health Service, and the Veteran’s Administration.
Recommendation to Parents: Any kind of medicine and vitamin, even ones bought
without a prescription, can cause harm including death to children. All medicines,
vitamins and household cleaning supplies should always be kept up and away and out
of your child’s reach and sight.
Recommendation to Clinicians: Screen adults, including young adults and pregnant
women, for alcohol misuse and provide persons engaged in risky or hazardous drinking
with brief behavioral counseling interventions to reduce alcohol misuse.
To Prevent Deaths due to Infectious Diseases
Outbreaks of vaccine preventable diseases are increasingly common due to decreased
immunization rates. In 2011, pneumonia and influenza claimed the lives of 20 children
in Arizona.
Recommendation to Parents and Caregivers: Obtain appropriate age-related
immunizations for all family members in order to protect children from vaccine
preventable diseases and the community from outbreaks of vaccine preventable
diseases. Encourage others who have contact with children such as home care
providers, child care center staff, and baby sitters to obtain appropriate immunizations.
Recommendation to Health Care Providers: Adopt and enforce policies and procedures
for health care staff to receive proper immunizations.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 14 of 101

To Prevent Unexplained Infant Deaths
Sudden infant death syndrome (SIDS) is the sudden death of an infant younger than
one year of age that cannot be explained after a thorough investigation has been
conducted, including a complete autopsy, an examination of the death scene, and a
review of the clinical history. 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. This is the case definition that local review teams use
to determine if an infant’s death occurred 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.
The American Academy of Pediatrics recommendations ensuring safe sleep
environments for infants include:
1. Encouraging mothers to breastfeed their infant at least until the infant is 6 months
old, which may lower the risk of unexpected infant deaths.
2. Ensure that baby receives all recommended vaccines, which evidence suggests
reduces the risk of sudden unexpected infant deaths.
3. Keep soft objects or loose bedding out of the crib, including bumper pads, pillows
and toys.
4. Have baby sleep in the same room as the parents, but not in the same bed.
5. Always place baby to sleep on his/her back for sleep. Additional information
regarding the updated recommendations can be found at
http://HealthyChildren.org.
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.
Recommendation to Professionals Who Have Contact With Infants: During health care
visits, ask parents about their infant's sleep environment, and provide information on
American Academy of Pediatrics’ recommendations for safe sleep practices.
Recommendation to Parents and Caregivers: Parents and caregivers of infants should
follow the recommendations on safe sleep from the American Academy of Pediatrics as
listed above.
Recommendation to Safe Kids Coalitions: Provide information to families on safe-sleep
recommendations at all car seat safety checks and other community events where
parents of infants may be available.
Recommendation to Arizona Hospitals Caring for Infants: Model safe-sleep practices,
using the recommendations from the American Academy of Pediatrics including placing
infants on their back to sleep and having cribs free of soft objects and loose bedding.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 15 of 101

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
shows that when adults buckle up, 87 percent of children buckle up too. Arizona’s
secondary seat belt law does not allow law enforcement officers to stop and cite a driver
for non-use of a seat belt unless the driver has committed another offense. Fifty-one
percent of the child deaths involved in motor vehicle crashes in 2011 involved a driver
or passenger old enough to have been wearing a seat belt and was known to have
been improperly or not restrained (when seating position of the child was known).
Recommendation to the Arizona Legislature: Enact a primary seat belt law to allow law
enforcement officers to cite a driver and occupants for not wearing a seat belt in the
absence of other traffic violations. This has already been enacted in four Arizona Tribal
Nations.
Recommendation to County and City Governments: Strengthen distracted driving laws
to include prohibition of mobile device usage while driving, as the cities of Phoenix and
Tucson have done.
Recommendation to Community Agencies: Educate parents, caregivers, schools and
child care providers on proper child safety seat installation, including education on new
booster seat law. Provide available safety seats to families in need.
Recommendation to Tribal Entities/Communities That Do Not Have Child Passenger
Safety Laws: Adopt Arizona Revised Statutes regarding the usage of child safety seats.
To Prevent Home Safety-Related Deaths
In 2011, 122 children died in or around the home. Lack of supervision was a
preventable factor that was identified in 56 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.”
Recommendation to Arizona Drowning Prevention Programs: Drowning prevention
programs should emphasize “touch supervision” to prevent child drowning.
Pool fencing is an important prevention strategy for decreasing the risk of drowning in
swimming pools when children are not supposed to have access to the water.
Compared with no fencing, installation of 4-sided fencing that isolates the pool from the
house and yard has been shown to decrease the number of pool-immersion injuries
among young children by more than 50 percent.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 16 of 101

Recommendation to the Arizona Legislature: Strengthen current legislation regarding
pool fencing to require four-sided fencing with self-closing and self-latching gates for all
backyard pools where children live or play.
Recommendation City and County Governments: Strengthen and/or develop
ordinances regarding pool fencing to require four-sided fencing with self-closing and
self-latching gates for all backyard pools where children live or play.
In 2011, there were several drowning deaths during celebrations where family and
friends gathered near an outside pool area. These drowning deaths can happen when
an adult is distracted by preparing meals or otherwise leaves the pool area.
Recommendation to Parents: During celebrations where family and friends are
gathered, at least one responsible adult should be designated to monitor the pool area.
If a child is a non-swimmer and is in the pool, an adult must be in the pool with the child.
Do not rely upon floaties or inner tubes, as these are toys, not life-saving devices.
Always utilize “touch supervision.”
Storing firearms locked and unloaded, with ammunition locked separately, can reduce
the risk of injuries and deaths including suicides involving children and teens. There
were 23 firearm-related child deaths in 2011 (78 percent of these deaths were among
children 10 years of age or older). Only one death involved a gun that was in a locked
safe, however, the child did have access to the key. According to a study by
researchers from the Harborview Injury Prevention and Research Center at the
University of Washington, safe storage of firearms is associated with a significant
decrease in firearm injuries in home with children and teenagers.
Recommendation to Firearm Owners: Families with children should store all firearms
unloaded, in a secure locked location. Firearms should be removed from homes where
children, adolescents or caregivers have exhibited or are exhibiting signs or symptoms
of substance abuse or mental illness, including depression.
Recommendation to Health Care Providers: Continue to educate parents about gun
safety by asking whether or not there are firearms in the home, how those guns are
stored and the presence or absence of signs or symptoms of substance abuse or
mental illness, including depression, among children, adolescents and other family
members.
Recommendation to Parents: Ask how friends, neighbors and caregivers use and store
their firearms and ammunition where your children may play or be cared for.
To Prevent Deaths due to Maltreatment
Communities and families have a duty to report suspected child abuse or neglect. The
responsibility to protect Arizona’s most vulnerable population, our children, lies not only
with the immediate family of the child, social service agencies, or even medical
professionals, but with the community at large as well. Twenty percent of child
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 17 of 101

maltreatment deaths in 2011 were not reported to Arizona Child Protective Services,
even after a complete investigation, that there was suspected abuse or neglect. Prior to
the death event there were no reports by the child’s extended family, family friends or
community members. It is unlikely that abuse or neglect was present in a child’s life and
went unnoticed or suspected. When a community member, family member or family
friend has reason to believe that a child is being or has been abused or neglected,
he/she has a responsibility to report that suspicion.
Recommendation to Community Members: When abuse or neglect of a child is
suspected, report suspicions to Arizona’s Child Protective Services at 1-888-767-2445.
Numerous child abuse deaths were in families who had histories with child protective
service agencies in other states. In some deaths the abuse history was extensive. It can
be difficult for Arizona Child Protective Services to identify previous states of residence.
Recommendation to Arizona Lawmakers, Child Advocates and State Agencies:
Advocate for the development of a national child abuse registry which would provide
critical information when assessing a child’s safety.
Reviews have concluded that deaths of children due to abuse or neglect are not
consistently reported to Child Protective Services (CPS). Failure to report often occurs
when there were no other children in the home at the time of the death. Child Protective
Services' investigations of all child deaths in which there are suspicions of abuse or
neglect provide critical information in the event of future reports involving the family.
Arizona Revised Statute13-3620 requires a duty to report abuse, physical injury, neglect
and denial or deprivation of medical or surgical care or nourishment of minors. This
statute outlines responsibilities for mandated reporters. Section A states: Any person
who reasonably believes that a minor is or has been the victim of physical injury, abuse,
child abuse, a reportable offense or neglect that appears to have been inflicted on the
minor by other than accidental means or that is not explained by the available medical
history as being accidental in nature or who reasonably believes there has been a
denial or deprivation of necessary medical treatment or surgical care or nourishment
with the intent to cause or allow the death of an infant who is protected under section
36-2281 shall immediately report or cause reports to be made of this information to a
peace officer or to Child Protective Services in the Department of Economic Security,
except if the report concerns a person who does not have care, custody or control of the
minor, the report shall be made to a peace officer only.
Recommendation to all Arizona Law Enforcement Officers, Physicians and other
Mandated Reporters: Promptly report every child death where child abuse or neglect is
suspected to the Child Protective Services’ Child Abuse Hotline (1-888-SOS-CHILD).
Children with special health care needs are at increased risk for maltreatment. In 2011,
17 percent of maltreated children had special health care needs (n=12), this was an
increase from 2010 when 16 percent of maltreatment children had special health care
needs (n=11).
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 18 of 101

Recommendation to Those Caring for Vulnerable Children, Especially Those With
Special Health Care Needs: Promptly notify Child Protective Services’ Child Abuse
Hotline (1-888-SOS-CHILD) whenever there is suspicion of neglect of a child with a
chronic medical, developmental, physical, emotional or behavioral condition.
Recommendation to the Arizona Legislature: Ensure adequate funding to the Arizona
Department of Economic Security Division of Children, Youth and Families to support
the needs of Arizona’s vulnerable children in order to reduce the number of child deaths
due to maltreatment.
Recommendation to the Arizona Legislature: Increase funding to the Arizona
Department of Economic Security Division of Children, Youth 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.
Recommendation to the Arizona Department of Economic Security, Division of Children,
Youth and Families: Continue to explore methods of increased communication between
ADES and local child fatality review teams and its subcommittees.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 19 of 101

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
• Division of Children, Youth and Families in the Department of Economic Security
• Governor’s Office for Children, Youth and Families
• 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
• 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
Reviews of individual 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.
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
information to the Arizona Child Fatality Review Program’s local teams. Team members

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 20 of 101

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 2.2) 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 for inclusion in the annual report published
each November. Local team coordinators as well as 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.
Since 2005, the Arizona Child Fatality Review Program has reviewed the death of every
child who died in the state. By completing 100 percent of child death reviews, data can
be compared from year to year, and trends can be identified. Where possible
throughout this report, multiple years of data are presented. In cases where comparable
data were not available for a given year, that year has been omitted from the chart or
table.
This is the nineteenth annual report issued by the Arizona Child Fatality Review
Program. Each year, the state team makes recommendations regarding the prevention
of child deaths. These recommendations have been used to educate communities,
initiate legislative action, and develop prevention programs. Because these reviews are
completed by a multidisciplinary team of well-respected professionals, the team’s
recommendations are often adopted.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 21 of 101

2011 DEMOGRAPHICS
During 2011, there were 837 fatalities among children younger than 18 years of age in
Arizona. This was a three percent decrease from 2010 when 862 children died. Males
accounted for 57 percent of deaths (n=479) and females accounted for 43 percent
(n=358). 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, 2011 (n=837)

200
184

Male (n=479)

180
160

150

Female (n=358)

140
120
89
100

86
72

80

56

60
34

40

44

34

28

40

20

20
0
Birth-27 Days 28-365 Days
(n=334)
(n=175)

1-4 Years
(n=106)

5-9 Years
(n=54)

10-14 Years 15-17 Years
(n=72)
(n=96)

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 22 of 101

The largest percentage of deaths was among infants younger than 28 days (40 percent,
n=334). Figure 2 shows deaths among children by age group.
Figure 2. Deaths Among Children by Age Group, Arizona, 2011 (n=837)
15-17 Years
11% (n=96)

10-14 Years
9% (n=72)
Birth-27 Days
40% (n=334)
5-9 Years
6% (n=54)

1-4 Years
13% (106)

28-365 Days
21% (n=175)

Compared to 2010, there was an increase in the percentage of deaths among children
ages 0 through 27 days and 10 through 14 years. Each of the other age groups
declined or remained at the same percentage of total deaths. Table 1 shows deaths
among children by age group for 2007 through 2011.
Table 1. Deaths Among Children by Age Group, Arizona, 2007-2011
Age Group
2007
2008
2009
2010
2011
0-27 Days
485
42%
423
42%
366
39%
334
38% 334 40%
28-365 Days
225
20%
211
20%
183
19%
192
22% 175 21%
1-4 Years
113
10%
126
12%
130
14%
119
14% 106 13%
5-9 Years
67
6%
67
6%
67
7%
58
7%
54
6%
10-14 Years
92
8%
74
7%
73
8%
66
8%
72
9%
15-17 Years
161
14%
137
13%
128
14%
93
11%
96
11%
Total
1,143
1,038
947
862
837

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 23 of 101

Mortality rates among all children declined 26.8 percent from 2007 through 2011, but
rate decreases varied by age group. The declining mortality rate was largest among
children 15-17 years of age (70.0 deaths per 100,000 population in 2006 to 35.2 deaths
per 100,000 population in 2011). Table 2 shows the mortality rate among children in
Arizona per 100,000 population by age group from 2007 through 2011.
Table 2. Mortality Rates per 100,000 Population Among
Children by Age Group, Arizona, 2007-2011
Age Group
2007
2008
2009
2010
2011
<1 Year*
692.1
640.0
595.0
600.8
577.0
1-4 Years
28.5
31.0
32.0
32.3
28.6
5-9 Years
14.6
14.4
14.3
12.8
11.8
10-14 Years
20.2
16.0
15.6
14.7
15.9
15-17 Years
58.0
48.6
45.0
34.3
35.2
Total
67.6
60.7
55.1
52.9
51.0
*As population denominators are only available for children younger than one year of age, deaths in the
neonatal and post-natal periods have been combined.

Forty-five percent of child deaths in 2011 were among Hispanics (n=374), 35 percent
were among White, non-Hispanics (n=293), ten percent were among American Indians
(n=80), eight percent were among African Americans (n=65), two percent were among
Asians (n=19), and 1 percent were among children with 2 or more races or their race
was unknown. Figure 3 shows deaths among children by race/ethnicity.
Figure 3. Deaths Among Children by Race/Ethnicity, Arizona, 2011 (n=862)
Asian
2% (n=19)
American Indian
10% (n=80)

2 or More Races or
Unknown
1% (n=6)

African American
8% (n=65)
Hispanic
45% (n=374)

White, NonHispanic
35% (n=293)

Deaths were over-represented among three of the four racial/ethnic groups in 2011
which is a similar distribution as in previous years. African American children comprised
five percent of the population in Arizona, but eight percent of fatalities. American Indian
children comprised five percent of the population and nine percent of deaths. Asian
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 24 of 101

children comprised three percent of the population and two percent of deaths. Hispanic
children accounted for 43 percent of the population and 45 percent of child fatalities in
2011. Figure 4 shows deaths among children by race/ethnicity compared to population
percentages.
Figure 4. Deaths Among Children by Race/Ethnicity Compared to Population,
Arizona, 2011 (n=831*)
50%
45%
40%

45% 43%

Fatalities

43%

Population
35%

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

8%
5%

5%

5%
2%

3%

0%
African
Americans

American Indian

Asian

Hispanic

White, NonHispanic

*Does not include categories for Unknown or 2 or more races

Compared to 2010, the percentages of child fatalities among American Indian and
White, non-Hispanic children increased during 2011. For all other races/ethnicities, the
percentage of child deaths by race/ethnicity declined or remained the same compared
to 2010. Table 3 shows deaths among children by race/ethnicity for 2007 through 2011.
Table 3. Deaths Among Children by Race/Ethnicity, Arizona, 2007-2011
Race/Ethnicity
2007
2008
2009
2010
2011
African American
75
7%
102
10%
93
10%
68
8%
65
8%
American Indian
104
9%
86
8%
85
9%
74
9%
80
10%
Asian
26
2%
41
4%
22
2%
32
4%
19
2%
Hispanic
529
46%
456
44%
420
44% 393 45% 374 45%
White, Non-Hispanic
409
36%
353
34%
327
35% 289 33% 293 35%
Total
1,143
1,038
947
856*
831*
*Does not include category for 2 or more races.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 25 of 101

Table 4 shows deaths among children by county of residence. There were increases in
the percentages of deaths among children who resided in Maricopa and Pinal counties
and those children who resided outside of Arizona in 2011. The percentages of children
who died in 2011 declined in Coconino and Pima Counties.

County
Apache
Cochise
Coconino
Gila
Graham
Greenlee
La Paz
Maricopa
Mohave
Navajo
Pima
Pinal
Santa
Cruz
Yavapai
Yuma
Outside
Arizona
Total

Table 4. Deaths Among Children by County of Residence, Arizona, 2007-2011
2007
2008
2009
2010
2011
Number Percent Number Percent Number Percent Number Percent Number Percent
13
1%
20
2%
26
3%
12
1%
15
2%
27
2%
24
2%
21
2%
20
2%
15
2%
25
2%
21
2%
18
2%
26
3%
19
2%
17
1%
15
1%
9
1%
12
1%
9
1%
12
1%
11
1%
5
<1%
6
<1%
4
<1%
0
-1
<1%
0
-2
<1%
5
<1%
1
<1%
5
<1%
5
<1%
2
<1%
3
<1%
648
57%
577
56%
542
57%
486
56%
478
57%
27
2%
11
1%
21
2%
22
3%
23
3%
39
3%
30
3%
22
2%
23
3%
26
3%
148
13%
165
16%
130
14%
130
15%
109
13%
64
6%
52
5%
60
6%
40
5%
51
6%
6
<1%
6
<1%
7
1%
9
1%
4
<1%
28
35
53
1,143

2%
3%
5%

17
39
44
1,038

2%
4%
4%

20
28
33
947

2%
3%
3%

20
31
21
862

2%
4%
2%

14
33
29
837

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 26 of 101

2%
4%
3%

Though Arizona’s more populous southern counties had the highest numbers of child
deaths in 2011, Arizona’s northern counties had the highest stable rates of child
fatalities. Coconino County had 59.9 deaths per 100,000 residents and Navajo County
had 81.5 deaths per 100,000 residents. Pinal County had the lowest stable rate of child
fatalities, with 50.0 deaths per 100,000 residents. Figure 5 shows child fatality rates per
100,000 residents by county; rates are unstable for counties with fewer than 20 deaths.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 27 of 101

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. 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, suicide, or homicide, and in these cases, the manner of death was listed as
undetermined. Manners of death include:






natural (e.g., cancer)
accident (e.g., unintentional car crash)
homicide (e.g., 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 teams’ 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 64 percent of all child deaths during 2011 (n=537); 20
percent of child deaths were accidents (n=167); five percent were homicides (n=42);
five percent were suicides (n=38); and six percent were of undetermined manner
(n=52). There was one death of an unknown manner in 2011. Deaths are listed as
having an undetermined manner or cause of death if a definitive manner or cause
cannot be determined by the review team following review of all available information
pertaining to the death. Deaths are listed as having an unknown manner if review
information was not available to the review team. Figure 6 shows deaths among
children by manner.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 28 of 101

Figure 6. Deaths Among Children by Manner, Arizona, 2011 (n=837)
Undetermined
6% (n=52)

Unknown
<1% (n=1)

Homicide
5% (n=42)
Suicide
5% (n=38)

Accident
20% (n=167)

Natural
64% (n=537)

The distribution of deaths by manner varied by age group, with the percentage of
natural deaths in each age group decreasing over the course of childhood. Deaths
among infants were due primarily to natural causes, while accidental deaths were more
common among older children. Suicides occurred only among the three older age
groups, and homicides occurred in all age groups. Figure 7 shows manner of child
deaths by age group.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 29 of 101

Figure 7. Percentage of Child Deaths by Age Group and Manner,
Arizona, 2011 (n=837)
100% 2%
90%

<1%

2%

1%

18%

7%

1%

2%

2%
7%

11%

3%

17%
26%

80%

3%

7%

70%

41%
22%

60%
50%

32%

44%

11%

Unknown
Undetermined
Suicide

95%
31%

40%

Homicide
Accident
Natural

30%
53%

20%

48%

47%

38%
28%

10%
0%
Birth-27
Days
(n=334)

28-365
Days
(n=175)

1-4
Years
(n=106)

5-9
Years
(n=54)

10-14
Years
(n=72)

15-17
Years
(n=96)

The most common causes of death in most age groups were medical causes.
Accidental death was the leading cause, however, for 15 through 17 year olds and 1
through 4 year olds. Table 5 shows the four most common causes of death for each age
group.

Rank

0-27 Days
40%, n=334

1

Prematurity
n=181, 22%

2

3

4

Congenital
Anomaly
n=65, 8%
Other
Medical
Condition
n=77, 9%
Suffocation
n=5, <1%

Table 5. Leading Causes of Death by Age Group, Arizona, 2011
10-14
15-17
28-365 Days
1-4 Years
5-9 Years
Years
Years
21%, n=175
13%, n=106
6%, n=54
9%, n=72
11%, n=96
Other
Other
Other
Other
Other Medical
Medical
Medical
Medical
Medical
Condition
Condition
Condition
Condition
Condition
n=49, 6%
n=37, 4%
n=25, 3%
n=30, 4%
n=25, 3%

All Deaths
100%,
n=837
Other
Medical
Condition
n=243, 29%

Suffocation
n=34, 4%

Drowning
n=18, 2%

Transport
n=13, 2%

Transport
n=17, 2%

Transport
n=21, 3%

Prematurity
n=199, 24%

Undetermined
n=30, 4%

Transport
n=15, 2%

Drowning
n=7, <1%

Hanging
n=10,1%

Firearm
n=15, 2%

Congenital
Anomaly
n=99, 12%

Congenital
Anomaly
n=26, 3%

Blunt Force
Trauma
n=10, 1%

Firearm
n=3, <1%

Firearm
n=3, <1%

Hanging
n=13, 2%

Transport
n=70, 8%

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 30 of 101

The percentage of deaths due to accidents, homicides and suicides increased during
2011, and the percentages of natural and undetermined deaths decreased. Table 6
shows deaths among children by manner for 2007 through 2011.
Table 6. Deaths Among Children Birth Through 17 Years by Manner,
Arizona, 2007-2011
Manner
2007
2008
2009
2010
2011
Natural
769
67%
702
68% 641 68% 565 66% 537 64%
Accident
227
20%
168
16% 165 17% 160 19% 167 20%
Undetermined
53
5%
73
7%
63
7%
74
9%
52
6%
Homicide
66
6%
60
6%
51
5%
36
4%
42
5%
Suicide
28
2%
35
3%
27
3%
24
3%
38
5%
Total
1,143
1,038
947
859*
836*
*Does not include deaths of unknown manner.

In 2011, there were 342 deaths due to medical conditions, 199 deaths due to
prematurity and 70 deaths due to motor vehicle crashes and other types of
transportation. There were 23 firearm-related deaths and 50 deaths due to suffocation.
There were 32 drowning deaths in 2011. There were no deaths due to exposure, and no
deaths of children died while crossing the Mexico-United States border. Improvements
in data collection in 2011, and positive changes made to the data collection tool used by
review teams has enabled the child fatality review program to classify deaths that were
previously placed in “other” categories. Table 7 shows deaths among children by cause
and manner.
Table 7. Deaths among Children Birth Through 17 Years by Cause and Manner,
Arizona, 2011 (n=837)
Cause
Natural
Accident
Suicide Homicide Undetermined
Unknown
Medical*
337
2
0
0
3
0
Prematurity
196
0
0
0
2
1
Transport
0
68
2
0
0
0
Firearm
0
1
9
12
1
0
Suffocation
0
45
0
3
2
0
Drowning
0
31
1
0
0
0
SIDS
1
0
0
0
1
0
Blunt Force Trauma
0
2
0
24
0
0
Hanging
0
3
24
0
0
0
Undetermined
3
0
0
2
41
0
Poisoning
0
7
3
0
0
0
Fire/Burn
0
5
0
0
1
0
Exposure
0
0
0
0
0
0
Fall/Crush
0
3
0
1
0
0
Total
537
167
39
42
51
1
*Excluding SIDS and prematurity.
** Other includes other medical and other non-medical causes of death.

Total
342
199
70
23
50
32
2
26
27
46
10
6
0
4
837

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 31 of 101

The percentages of deaths due to prematurity, transportation-related deaths,
suffocation, hanging and blunt force trauma increased in 2011, and the percentages of
child deaths due to medical causes, exposure and undetermined deaths declined. Table
8 shows deaths among children by cause for 2007 through 2011.
Table 8. Deaths Among Children Birth Through 17 Years by Cause,
Arizona, 2007-2011
Cause
2007
2008
2009
2010
Medical*
420
37%
420
40%
372
39%
359
42%
Prematurity
321
28%
271
26%
241
25%
197
23%
Transport
122
11%
82
8%
82
9%
61
7%
Undetermined
34
3%
59
6%
57
6%
74
9%
Firearm
48
4%
49
5%
32
3%
22
3%
Drowning
23
2%
29
3%
35
4%
33
4%
SIDS
37
3%
20
2%
28
3%
1
<1%
Suffocation
27
2%
21
2%
17
2%
25
3%
Hanging
13
1%
21
2%
20
2%
19
2%
Other
33
3%
14
1%
16
2%
21
2%
Poisoning
24
2%
14
1%
17
2%
18
2%
Blunt Force Trauma
18
1%
16
1%
13
1%
11
1%
Fall/crush
9
1%
9
1%
7
1%
4
<1%
Exposure
8
1%
9
1%
7
1%
11
1%
Fire/burn
6
1%
4
1%
3
<1%
6
<1%
Total
1,143
1,038
947
862
*Excluding SIDS and prematurity.

2011
342
41%
199
24%
70
8%
46
6%
23
3%
32
4%
2
<1%
50
6%
27
3%
0
0%
10
1%
26
3%
4
<1%
0
0%
6
1%
837

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 32 of 101

PREVENTABILITY
The child fatality review process in Arizona 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 reasonably been done by
an individual, or by the community as a whole to prevent the death. The determination
of preventability for an individual case is a consensus decision by the local team made
after discussing and reviewing all available data regarding the circumstances of a child’s
death. In some cases, there is insufficient information available to determine
preventability or the team cannot reach consensus on preventability. In 2011, Child
Fatality Review Teams determined that 292 child deaths were probably preventable (35
percent), 476 child deaths (57 percent) were probably not preventable, and in 8 percent
of the child deaths, the teams could not determine preventability (n=69).
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
the determination that a death was preventable, this was not always the case. For
example, the team may have concluded that an unsafe sleep environment (e.g., infant
sleeping on an adult bed) was a contributing factor in an unexpected infant death.
However, the team may not have had sufficient information (e.g., the child’s autopsy
report or an adequate death scene investigation) to determine that the death could have
been prevented. Figure 8 shows deaths among children in Arizona by preventability.
Figure 8. Deaths Among Children by Preventability, Arizona, 2011 (n=837)
Could Not
Determine
8% (n=69)

Probably
Preventable
35% (n=292)
Probably Not
Preventable
57% (n=476)

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 33 of 101

Child Fatality Review Teams deemed that 89 percent of accidents were preventable
(n=148), 100 percent of homicides were preventable (n=42), and 87 percent of suicides
were preventable (n=34). Eight percent of natural deaths were determined to have been
preventable (n=42). Figure 9 shows preventable deaths by manner.
Figure 9. Percentage of Preventable Deaths Among Children by Manner,
Arizona, 2011 (n=292)
100%
89%

90%

87%

100%

80%
70%
60%
51%
50%
40%
30%
20%
10%

8%

0%
Natural
(n=42)

Accident
(n=148)

Suicide
(n=34)

Homicide
(n=42)

Undetermined
(n=26)

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 34 of 101

Preventability also varied by age group. Children younger than one year of age had the
lowest percentage of preventable deaths (8 percent, n=27). The highest percentage of
preventable deaths was among children ages 15 through 17 years of age (67 percent,
n=64). Figure 10 shows preventable deaths among children by age group.
Figure 10. Percentage of Preventable Deaths Among Children by Age Group,
Arizona, 2011 (n=837)
80%
67%

70%
59%

60%
50%

46%

50%

5-9 Years
(n=25)

10-14 Years
(n=36)

44%

40%
30%
20%
10%

8%

0%
Birth-27 Days
(n=27)

28-365 Days
(n=77)

1-4 Years
(n=63)

15-17 Years
(n=64)

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 35 of 101

SUBSTANCE ABUSE
A child’s death would be considered “associated with substance use” if the child, the
child’s parent or caretaker, or the person responsible for the incident leading to the
death had abused substances at the time of the incident or had a history of substance
abuse including illegal substances, prescription drugs and/or alcohol. This could mean
that a child’s death may be associated with drugs and/or alcohol, even when the use of
the substance did not cause the death. Substance abuse (including illegal drugs,
prescription drugs, and/or alcohol) was associated with 215 child deaths in Arizona
during 2011, which accounted for 26 percent of all child deaths. In 2010, substance use
was associated with 20 percent of all child deaths (n=175). Among the 215 child deaths
associated with drugs and/or alcohol, 36 percent were determined to be of an accidental
manner (n=78) and 32 percent were due to a natural manner (n=69). Figure 11 shows
the distribution of child deaths involving drugs and/or alcohol by manner of death.
Figure 11. Deaths Among Children Associated with Drugs and/or Alcohol by
Manner Arizona, 2011 (n=215)
Suicide
7% (n=15)
Undetermined
12% (n=26)

Accident
36% (n=78)

Homicide
13% (n=27)

Natural
32%(n=69)

While 32 percent of deaths associated with substance use were determined to be
natural deaths, only 13 percent of all natural deaths involved substance use (n=69).
Similarly, substance use was associated with 47 percent of total accidents (n=78), 50
percent of deaths of undetermined manner (n=26), 64 percent of homicides (n=27), and
38 percent of suicides (n=15).

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 36 of 101

Eleven percent of prematurity deaths were associated with the use of drugs and/or
alcohol (n=23). Among transport deaths, 40 percent were associated with the use of
alcohol and/or drugs (n=28). Of the 10 poisoning deaths, 100 percent involved the use
of alcohol and/or drugs. Table 9 shows child deaths associated with drugs and/or
alcohol by cause and manner in 2011.
Table 9. Child Deaths Associated with Drugs and/or Alcohol by Cause and Manner,
Arizona, 2011 (n=215)
Cause
Accident
Homicide
Suicide
Natural
Undetermined
Medical*
2
0
0
45
1
Prematurity
0
0
0
22
1
Transport
28
0
0
0
0
Firearm Injury
0
8
4
0
1
Suffocation
22
2
0
0
1
Drowning
14
0
1
0
0
Blunt/Sharp force trauma
1
15
0
0
0
Hanging
0
0
7
0
0
Undetermined
0
1
0
2
22
Poisoning
7
0
3
0
0
Fire/Burn
3
0
0
0
0
Fall/Crush
1
1
0
0
0
Total
78
27
15
69
26
*Excluding SIDS and prematurity

Total
48
23
28
13
25
15
16
7
25
10
3
2
215

Alcohol was associated with 81 child deaths in 2011, which is an increase from 2010 at
which time alcohol was associated with 65 child deaths. Marijuana was associated with
95 child fatalities in 2011, an increase from 2010 when marijuana was associated with
70 deaths. Methamphetamine was associated with 33 deaths, 15 fatalities were
associated with cocaine and 22 associated with opiates. Table 10 shows substances
associated with child deaths for 2007 through 2011.
Table 10. Substances Involved in Deaths Among Children,
Arizona, 2007-2011
Substance*
2007
2008
2009
2010
Alcohol
80
7%
76
7%
51
5%
65
7%
Marijuana
76
7%
57
5%
67
7%
70
8%
Methamphetamine
48
4%
39
4%
53
6%
33
4%
Cocaine
31
3%
21
2%
17
2%
15
2%
Opiates
16
1%
18
2%
24
3%
22
3%
*More than one substance may have been associated with a single death

2011
81
10%
95
11%
34
4%
24
3%
17
2%

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 37 of 101

Drugs and/or alcohol were determined to have been associated with child deaths
among males and females in all age groups, with males being disproportionately higher
in ages greater than 27 days. Males of all ages accounted for 58 percent of all
substance use-related deaths (n=125). Figure 12 shows child deaths associated with
substance use by sex and age group.
Figure 12. Child Deaths Involving Substance Use by Sex and Age Group,
Arizona, 2011 (n=215)
40
Male (n=125)
35

34

Female (n=90)
29

30

28

23

25
21
20

16
15

14

15

14
11

10
6
5

4

0
Birth-27 Days

28-365 Days

1-4 Years

5-9 Years

10-14 Years

15-17 Years

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 38 of 101

For each child death associated with substance use, 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 an
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 74 deaths in 2011, the user was the parent, and for 33 deaths,
the user was the child. In some deaths, more than one individual may have been using
drugs and/or alcohol. Figure 13 shows child deaths associated with drugs and/or
alcohol by substance user for 2007 through 2011.
Figure 13. Child Deaths Involving Drugs and/or Alcohol by Substance User,
Arizona, 2007-2011
120
2007

101

100

2008
85

80

2009
73

74

2010

64

2011

60
43
39

40
29

34

33
22

20

11
5

8

5

7
4 2 4 5

10

6 8

2

6

8 10

5

8

12

0
Child

Parent

Acquaintance
of Child

Acquaintance
of Parent

Stranger

Other Relative

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 39 of 101

PREMATURITY
Local teams consider a child’s cause of death to be prematurity if the infant was born
prior to 37 weeks gestation and had no other underlying cause of death. Infants born
prior to 37 weeks gestation whose death was attributed to congenital anomalies or other
medical conditions were not included in the prematurity category. In 2011, there were
199 deaths due to prematurity, which accounted for 24 percent of all child deaths. There
were 197 deaths due to prematurity in 2010 (23 percent of all child deaths). The rate of
deaths due to prematurity in 2011 was 2.3 deaths per 1,000 live births. This was the
same rate as in 2010. Figure 14 shows the rates of child deaths due to prematurity from
2007 through 2011.
Figure 14. Rate of Child Deaths due to Prematurity (per 1,000 live births),
Arizona, 2007-2011
3.5
3.0
3

2.7

2.6

2.5
2

2.3

2.3

2010

2011

1.5
1
0.5
0
2007

2008

2009

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 40 of 101

In 2011, 57 percent of the premature infants who died were males (n=114) and 43
percent were females (n=85). Nearly half of the premature infants who died were
Hispanic (46 percent, n=92), 33 percent were White, non-Hispanic (n=65), 10 percent
were African American (n=19) and eight percent were American Indian (n=16). In 52
cases, at least one of the parents was known to have been a first generation immigrant,
including six families from Asian countries, three from African countries and two from
Canada. The majority of infants who died whose parents were known to be first
generation immigrants were Hispanic (75 percent, n=39). Figure 15 shows deaths due
to prematurity by race/ethnicity for 2007 through 2011.
Figure 15. Percentage of Child Deaths due to Prematurity by Race/Ethnicity,
Arizona, 2007-2011
60
55

2007 (n=321)

50
50

2008 (n=271)
46 47

46

2009 (n=241)
2010 (n=197)

40

2011 (n=199)
33

33

32
29

30

23
20
14 14 14
8

10

10

8
5 4 5 4

6
3

2 3 3

0
Hispanic

White, Non-Hispanic African American

American Indian

Asian

In 2011, the majority of prematurity-related deaths were among infants who were 21
through 24 weeks gestational age (60 percent, n=119), followed by infants who were 25
through 36 weeks gestational age (23 percent, n=46). There were 34 infants who were
20 weeks or less (17 percent). For one infant, gestational age was unknown. There
were 52 deaths due to prematurity among infants in multiple births, 48 of those were
twins and 4 were triplets.
For 13 percent of the deaths, the mother reported that she did not receive any prenatal
care (n=25). Seventy-six percent of mothers started prenatal care within the first
trimester (n=152). For almost half of the prematurity deaths, the mother was 20 through
29 years of age at the time of the birth (48 percent, n=96). Thirteen percent of the
mothers were 19 years of age and younger (n=26), 31 percent were 30 through 39
years of age (n=62), and three percent of mothers were 40 years of age and older
(n=5). In 10 cases, the age of the mother at the time of death was unknown (5 percent).

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 41 of 101

Fifty-one percent of mothers whose infants died of prematurity were insured by the
Arizona Health Care Cost Containment System (AHCCCS) (n=100). Eleven percent of
mothers had less than a high school education (n=22), 40 percent completed high
school (n=80), and 38 percent completed at least some college (n=76). For eleven
percent of mothers, educational status was unknown (n=21). Mothers of multiple births
in which more than one child died in 2011, may be counted more than once.
For 82 percent of deaths due to prematurity, the mothers experienced pregnancy or
birth-related complications which may have contributed to the death (n=163), including
96 mothers who experienced preterm labor. Three percent of mothers were known to
have had non-gestational diabetes (n=6). In four percent of prematurity-related deaths,
mothers reported using illegal drugs during pregnancy (n=7), and two percent reported
heavy alcohol use (n=3). Ten percent of mothers reported smoking during pregnancy
(n=20). Table 11 shows risk factors for prematurity deaths.
Table 11. Risk Factors for Prematurity Deaths, Arizona, 2011
Factor*
Number
Percent
Mother had preterm labor
96
48%
Mother had chorioamnionitis (bacterial infection)
22
11%
Mother had incompetent cervix
13
7%
Mother used drugs and/or alcohol
13
7%
Mother smoked tobacco
20
10%
*More than one factor may have been identified for each death

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 42 of 101

SUDDEN UNEXPECTED INFANT DEATHS
Sudden infant death syndrome (SIDS) is the sudden death of an infant under age 1 that
cannot be explained after a thorough investigation has been conducted, including a
complete autopsy, an examination of the death scene, and a review of the clinical
history. 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. It is this case definition that local review teams use to determine if an infant’s
death occurred 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.
Although the number of sudden unexpected infant deaths remained the same in 2011
(n=114), these deaths comprised a higher percentage of total deaths than in 2010.
There were 114 unexpected infant deaths in Arizona in 2011, 14 percent of all child
deaths that year, compared to 13 percent of all child deaths in 2010. Fifty-seven percent
of unexpected infant deaths in 2011 were among males (n=65) and 43 percent were
among females (n=49).
Hispanic infants accounted for 44 percent of sudden unexpected infant deaths (n=51),
non-Hispanic Whites accounted for 33 percent (n=38), African Americans and American
Indian children accounted for 11 percent each (n=13 each).
Fifty-eight percent of the deaths were among infants younger than three months of age
(n=66). Thirty-three deaths were among infants between 3 and 5 months of age (29
percent), and 15 infants who died unexpectedly were 6 months of age or older (13
percent).
For 35 deaths, teams were unable to determine the cause of death (31 percent). Thirtyeight deaths were due to suffocation (33 percent). Thirty-eight were also determined to
have been caused by a medical condition (33 percent percent). Only two deaths were
due to SIDS (two percent). Table 12 shows sudden unexpected infant deaths by cause.
Table 12. Sudden Unexpected Infant Deaths by Cause,
Arizona, 2011 (n=114)
Cause
Number
Percent
Suffocation
38
33%
Medical Condition
38
33%
Undetermined
35
31%
SIDS
2
2%
Other injury
1
<1%
Total
114

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 43 of 101

Investigation
Law enforcement conducted scene investigations in 77 percent of sudden unexpected
infant deaths (n=88). Seventy-six percent of sudden unexpected infant deaths were
referred to medical examiners’ offices (n=87). Ninety-two cases received an autopsy. Of
the 19 deaths that were not known to have been referred to medical examiners, all were
due to a natural manner.
Seventy-nine children were known to have had toxicology tests performed. Sixty-six of
those children tested negative for substances. Eight children had positive toxicology
results. Of the eight children with positive toxicology results, three tested positive for
acetaminophen, two children tested positive for methamphetamine, one for
dextromethorphan, one for doxylamine and one for acetone. A child may have tested
positive for more than one substance. The toxicology results on five children were
unknown to the review team at the time of the review. Eighty-nine children were known
to have had x-rays.
Fifty-five percent of the 114 sudden unexpected infant deaths were determined by the
local review teams to have been preventable (n=63). For 20 deaths, local review teams
were unable to determine if the death could have been prevented. Thirty-one of the
deaths were determined to probably not have been preventable (27 percent). Unsafe
sleep environment was a contributing factor in 64 sudden unexpected infant deaths (56
percent), followed by lack of supervision (46 percent, n=52). Table 13 shows
preventable factors for sudden unexpected infant deaths.
Table 13. Preventable Factors for Sudden Unexpected Infant Deaths,
Arizona, 2011
Factor*
Number
Percent
Unsafe sleep environment
64
56%
Lack of supervision
52
46%
Drugs and/or alcohol
49
43%
Infant exposure to smoking
18
16%
*More than one factor may have been identified for each death

Unsafe Sleep Environments
Of the 114 sudden unexpected infant deaths, 69 percent occurred in sleep
environments (n=79). Sixty-four of these environments were determined to have been
unsafe. Suffocation was the cause of 31 unsafe sleep-related deaths. Only two deaths
met all of the criteria to have been classified as a SIDS death. For 24 deaths that
occurred in unsafe sleep environments, the cause of death was undetermined.
Thirty-six infants were bed sharing with adults and/or other children. Six of the adults
who were bed sharing with infants were known to have been impaired by alcohol and/or
drugs. Additionally, two of those infants were known to have had a crib or bassinet in
the home.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 44 of 101

Among the 64 unsafe sleep-related deaths, forty-two infants were sleeping in adult
beds, three were sleeping on the floor, two were sleeping on a couch and one was
sleeping on a waterbed. Thirty-six infants were put to sleep on their sides or stomachs.
Improvements in the investigations of all sudden unexpected infant deaths, including
consistent completion of the Infant Death Investigation Checklist, may increase review
teams’ abilities to identify risk factors (such as the lack of safety approved cribs in
homes).
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
autopsy, death scene investigation, and review of the child’s medical history. There
were two deaths identified as SIDS in 2011, compared to one in 2010, and 28 deaths in
2009.
This does not mean there has been a rapid decline in the number of infants who died
suddenly or unexpectedly. Among the child deaths reviewed in 2010 and 2011, local
teams were asked to use more stringent guidelines when classifying a death as SIDS.
Therefore, there was a decrease in the number of fatalities classified as SIDS, while at
the same time; there was a significant increase in the number of deaths classified as
having an undetermined cause of death as well as an increase in infant deaths due to
suffocation.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 45 of 101

MOTOR VEHICLE CRASHES AND OTHER TRANSPORT
FATALITIES
In 2011, 70 children died as the result of motor vehicle crashes (MVC) and other types
of transportation in Arizona (eight percent of child fatalities). Sixty-three deaths resulted
from motor vehicle-related crashes, 3 deaths resulted from an air transport crash, 2
deaths were due to off-highway vehicle crashes, 1 death was due to a train incident and
1 death was the result of a boat crash.
The rate of MVC/transport fatalities in 2011 was 3.7 deaths per 100,000 children, a
slight increase from 2010 when the deaths per 100,000 children was 3.6. Figure 16
shows the rates of child deaths due to MVC/transport from 2007 through 2011.
Figure 16. Rate of Child Deaths due to Motor Vehicle Crashes and Transport
(per 100,000 children), Arizona, 2007-2011
8.0

7.2

7.0
6.0
5.0

4.7

4.7

4.0

3.6

3.7

3.0
2.0
1.0
0.0
2007

2008

2009

2010

2011

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 46 of 101

The majority of transportation-related deaths in 2011 were among males (73 percent,
n=51) and 27 percent were among females (n=19). Forty percent of the children who
died were Hispanic (n=28); 34 percent were White, non-Hispanic (n=24); 19 percent
were American Indian (n=13); and seven percent were other races/ethnicities (n=5).
Figure 17 shows motor vehicle and other transport deaths by race/ethnicity.
Figure 17. Motor Vehicle and Other Transport Deaths by Race/Ethnicity,
Arizona, 2011 (n=70)
Other Races
7% (n=5)
American Indian
19% (n=13)
Hispanic
40% (n=28)

White, NonHispanic
34% (n=24)

The distribution of MVC/transport deaths by race/ethnicity was similar to the distribution
in 2010. Table 14 shows motor vehicle and other transport deaths among children by
race/ethnicity for 2007 through 2011.
Table 14. Motor Vehicle and Other Transport Deaths Among Children by Race/Ethnicity,
Arizona, 2007-2011
Race/Ethnicity
2007
2008
2009
2010
2011
American Indian
20
12%
15
18%
10
12%
11
18%
13
19%
Hispanic
69
42%
36
44%
37
45%
26
43%
28
40%
White, non-Hispanic
66
40%
26
32%
31
38%
20
33%
24
34%
Other
9
5%
5
6%
4
5%
4
6%
5
7%
Total
164
82
82
61
70

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 47 of 101

The largest percentage of MVC/transport deaths were among children ages 15 through
17 years of age (30 percent, n=21), followed by children 10 through 14 years of age (24
percent, n=17). Figure 18 shows MVC/transport deaths by age group.

Figure 18. Motor Vehicle and Other Transport Deaths by Age Group,
Arizona, 2011 (n=70)
<1 Year
6% (n=4)
15-17 Years
30% (n=21)

10-14 Years
24% (n=17)

1-4 Years
21% (n=15)

5-9 Years
19% (n=13)

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 48 of 101

Of the 70 children who died in motor vehicles and other types of transportation, 43 were
vehicle occupants, 12 were pedestrians, three were air transport passengers, and two
children were riding bicycles. Among the 43 motor vehicle occupants, seven children
were drivers and 36 were passengers. Among the pedestrian deaths, three children
were killed due to vehicle backovers, all three children were three years of age or
younger. For the six children who died in motor vehicle crashes and other types of
transportation, their seating position in the vehicle was unknown. Figure 19 shows
motor vehicle crashes (excluding other types of transportation-related deaths) by age
group and location of the child.
Figure 19. Motor Vehicle Crash Deaths by Age Group,
Arizona, 2011 (n=64)
14
Driver (n=7)
12

12

Passenger (n=36)
Bicycle (n=2)

10

Pedestrian (n=12)
Unknown (n=7)

8

7

7

7
6

6

5
4

4

3

3 3

2
2

1 1 1
0

0 0 0

0

0

0

1
0

1

0

0
28-365 Days

1-4 Years

5-9 Years

10-14 Years

15-17 Years

Among the 36 motor vehicle passengers (not including one tractor death), 18 were
located in the back seat; nine were in the front seat; three were riding in a truck bed;
and six were in other or unknown locations. There were three additional deaths among
child passengers in air transit: all three were riding in a private plane. There were two
deaths of children riding off-highway vehicles. Both children were passengers and
neither was wearing helmets. One pedestrian child death involved a train and an
additional death involved a boat crash. It was unknown to the review team if the child
who died in the boat crash was wearing a life jacket. The two children who died while
riding bicycles were not wearing helmets.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 49 of 101

Forty-seven percent of children were known to have been improperly or not restrained
in vehicles (n=33). Almost one-third all children who were not properly restrained were
ages 10 through 14 years (30 percent, n=10). Figure 20 shows improper or unknown
restraint by age group.
Figure 20. Motor Vehicle and Other Transport Deaths Improper or Unknown
Restraint by Age Group, Arizona, 2011 (n=33)
<1 Year
9% (n=3)

15-17 Years
27% (n=9)

1-4 Years
21% (n=7)

5-9 Years
12% (n=4)
10-14 Years
31% (n=10)

Among the MVC/transport deaths in 2011 as well as in 2010, there were zero deaths
resulting from in utero injuries or dirt bikes.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 50 of 101

Ninety-one percent of all MVC/transport fatalities during 2011 were determined to have
been preventable (n=64). Lack of or improper use of vehicle restraints was identified as
a preventable factor for 33 transportation-related deaths among children (46 percent).
Fifteen children died in crashes in which drugs and/or alcohol was a factor (21 percent).
For 26 deaths, excessive speed was a contributing factor (37 percent). Twelve crashes
in which children died involved a driver who was distracted (17 percent). Table 15
shows preventable factors for MVC/transport deaths among children. This table does
not include factors identified for the three deaths involving air transportation or the one
incident involving a train, but does include the two off-highway vehicle deaths.
Table 15. Preventable Factors for Transportation-Related
Deaths Among Children, Arizona, 2011
Factor*
Number
Percent
Lack of vehicle restraint
33
46%
Excessive driving speed
26
37%
Reckless driving
24
34%
Drugs and/or alcohol
15
21%
Driver inexperience
12
17%
Driver distraction
12
17%
Red light running
5
7%
Lack of helmet
2
3%
Hazardous road conditions
2
3%
*More than one factor may have been identified for each death

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 51 of 101

DROWNING
In 2011, there were 32 child deaths due to drowning, which accounted for four percent
of all child deaths. In 2010, there were 33 deaths among children due to drowning, also
accounting for four percent of all child deaths in that year. The rate of drowning fatalities
in 2011 was 1.9 deaths per 100,000 children. This was a decline from 2010 when the
drowning rate was 2.0 per 100,000 children. Figure 21 shows the rates of child deaths
due to drowning from 2007 through 2011.
Figure 21. Rate of Drowning Deaths per 100,000 Children, Arizona, 2007-2011
2.5
2.0

2.0

2

1.9

1.7
1.5

1.4

1

0.5

0
2007

2008

2009

2010

2011

Sixty-six percent of drowning deaths in 2011 were among males (n=21), and 34 percent
were among females (n=11). Forty-seven percent of children who drowned were White,
non-Hispanic (n=15), 34 percent were Hispanic (n=11), nine percent were Asian (n=3),
six percent were African American (n=2), and 3 percent were American Indian (n=1).

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 52 of 101

Fifty-six percent of the drowning deaths were among children ages one through four
years (n=18), 22 percent were among children ages five through nine years (n=7), six
percent were among children ages 15 through 17 years (n=2), six percent were among
children ages 10 through 14 years (n=2), and 10 percent were among infants younger
than one year of age (n=3). Figure 22 shows drowning deaths by age group.
Figure 22. Drowning Deaths by Age Group Among Children,
Arizona, 2011 (n=32)
15-17 Years
6% (n=2)

28-365 Days
10% (n=3)

10-14 Years
6% (n=2)

5-9 Years
22% (n=7)
1-4 Years
56% (n=18)

The largest percentage of drowning deaths has been among children ages one through
four years. The percentage of deaths in this age group decreased from 66 percent in
2010 (n=22) to 56 percent in 2011 (n=18). There was an increase seen in children ages
5 through 9 years old. Of the seven 5 through 9 year-olds, three children were five years
old. Table 16 shows drowning deaths among children by age group for 2007 through
2011.
Table 16. Drowning Deaths Among Children by Age Group, Arizona, 2007-2011
Age Group
2007
2008
2009
2010
2011
0-27 Days
1
4%
0
0%
0
0%
0
0%
0
0%
28-365 Days
5
22%
1
3%
3
9%
2
6%
3
9%
1-4 Years
12
53%
25
87%
24
68%
22
67%
18
56%
5-9 Years
4
17%
2
7%
3
9%
4
12%
7
22%
10-14 Years
1
4%
0
0%
1
3%
2
6%
2
6%
15-17 Years
0
0%
1
3%
4
11%
3
9%
2
6%
Total
23
29
35
33
32

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 53 of 101

In 2011, 26 drowning fatalities occurred in pools, 24 pools were in-ground and 2 pools
were above ground. The other drowning deaths included two in open water and four
which occurred in bathtubs. Among the 26 drowning deaths which occurred in pools,
sixteen were known to have a pool fence. Among the two open water drowning deaths,
one was in a river and one was in a canal. Table 17 shows drowning fatalities by
location.
Table 17. Location of Child Drowning Fatalities,
Arizona, 2011 (n=32)
Location
Number
Percent
In ground pool
24
75%
Bathtub
4
13%
Above ground pool
2
6%
Canal
1
3%
River
1
3%
Total
32

The highest number of pool drowning deaths were among children ages one through
four years (69 percent, n=18). Figure 23 shows drowning location by age group.
Figure 23. Drowning Deaths by Age Group and Location Among Children,
Arizona, 2011 (n=32)
20
Open Water (n=2)

18

18

Pool/Hot Tub/Spa (n=26)
Bathtub (n=4)

16
14
12
10
8
6

5

4

3

2

2
0

0

0

0

1

1

0

0

1

1

0

0
28-365 Days

1-4 Years

5-9 Years

10-14 Years

15-17 Years

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 54 of 101

Ninety-four percent of child drowning fatalities were identified as preventable (n=30).
Lack of supervision was the most commonly identified preventable factor in child
drowning fatalities (84 percent, n=27), followed by access to water (63 percent, n=20).
Table 18 shows preventable factors for child drowning deaths in Arizona during 2011.

Table 18. Preventable Factors for Child Drownings, Arizona, 2011
Factor*
Number
Percent
Lack of supervision
27
84%
Access to water
20
63%
Drugs and/or alcohol
4
13%
*More than one factor may have been identified for each death

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 55 of 101

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 or were of undetermined
manners. Suicides, homicides, and natural deaths were excluded. In 2011, 135 children
died in or around the home (16 percent of all deaths that year). The majority of these
deaths occurred among males (65 percent, n=88) and 35 percent were among females
(n=47).
Forty-one percent of deaths that occurred in or around the home were among Hispanic
children (n=56), 39 percent were among White, non-Hispanic children (n=53), nine
percent were among American Indians (n=12), eight percent were among African
American children (n=11), and two percent were among Asian children (n=3).
Over half of the deaths that occurred in or around the home during 2011 were among
infants younger than one year of age (57 percent, n=77). Twenty-seven percent were
among children ages one through four years (n=36). Figure 24 shows home safetyrelated deaths by age group.
Figure 24. Home Safety-Related Deaths Among Children by Age Group,
Arizona, 2011 (n=135)
10-14 Years
4% (n=5)

15-17 Years
7% (n=10)

5-9 Years
5% (n=7)

1-4 Years
27% (n=36)

< 1 Year
57% (n=77)

The most common cause of death in an around the home was suffocation (31 percent,
n=42). Five of the six children who died by choking on food or small objects, did so in or
around the home environment. The second most common were deaths of an
undetermined cause (30 percent, n=40). Twenty-two children drowned in family pools
and four in bathtubs. Six children died as a result of poisoning and 100 percent of those
were children 15 through 17 years old. Motor vehicle collisions occurring in garages,
driveways, or home parking areas were included among the home safety-related
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 56 of 101

deaths, accounting for eight child deaths in 2011. Table 19 shows child deaths that
occurred in or around the home by cause.
Table 19. Child Deaths In or Around the Home by Cause,
Arizona, 2011 (n=135)
Cause
Number
Percent
Suffocation
42
31%
Undetermined
40
30%
Drowning
26
19%
Motor Vehicle Crash
8
6%
Poisoning
6
4%
Fire/Burn
5
4%
Fall/Crush
2
2%
Firearm
2
2%
Hanging
2
2%
SIDS
2
2%
Total
135

Seventy-nine percent of home safety-related deaths were determined to have been
preventable (n=106), and for sixteen percent, teams were not able to determine
preventability (n=21). The most commonly listed contributing factors were lack of
supervision (60 percent, n=80) and substance use (51 percent, n=69). Table 20 shows
preventable factors for home safety-related deaths.
Table 20. Preventable Factors for Child Deaths In or Around the Home,
Arizona, 2011
Factor*
Number
Percent
Lack of supervision
80
59%
Substance use
69
51%
Unsafe sleep environment
54
40%
Access to water
16
12%
*More than one factor may have been identified for each death

.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 57 of 101

SUICIDES
In 2011, there were 39 suicides among children in Arizona, which accounted for five
percent of all child deaths. In 2010, suicides accounted for three percent of all child
deaths (n=24). The child suicide rate in 2011 was 2.4 deaths per 100,000 children. This
was an increase from 2010 when the suicide rate was 1.5 deaths per 100,000 children.
Figure 25 shows the rates of child suicides from 2007 through 2011.
Figure 25. Rate of Suicides (per 100,000 children), Arizona, 2007-2011
3
2.4

2.5
2
2

1.7
1.6

2.0

1.5

1

0.5

0
2007

2008

2009

2010

2011

Sixty-two percent of the children who died by suicide during 2011 were males (n=24)
and 38 percent were females (n=15). Forty-nine percent were White, non-Hispanic
(n=19), 26 percent were Hispanic (n=10), 18 percent were American Indian (n=7), and
seven percent were other races (n=3).
The distribution of suicides by race/ethnicity varies by year. White, non-Hispanic
children comprised almost half of all child suicides in 2010 (49 percent, n=19). Table 21
shows suicides among children by race/ethnicity for 2007 through 2011.
Table 21. Suicides Among Children by Race/Ethnicity, Arizona, 2007-2010
Race/Ethnicity
2007
2008
2009
2010
2011
American Indian
4
14%
6
17%
5
19%
6
25%
7
18%
Hispanic
15
54%
9
26%
12
44%
8
33%
10
26%
White, non-Hispanic
8
29%
18
51%
9
33%
9
38%
19
49%
Other
1
3%
2
6%
1
4%
1
4%
3
7%
Total
28
35
27
24
39

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 58 of 101

In 2011, the majority of suicides were among children ages 15 through 17 years (64
percent, n=25), 33 percent were among children 10 through 14 years of age (n=13), and
3 percent were between 5 and 9 years of age (n=1). The youngest child who completed
suicide in 2011 was 7 years old. Figure 26 shows suicides among children by age
group.
Figure 26. Suicides Among Children by Age Group, Arizona, 2011 (n=39)
5-9 Years
3% (n=1)

10-14 Years
33% (n=13)

15-17 Years
64% (n=25)

The distribution of suicides by age group has remained consistent since 2005, with a
larger proportion of child suicides among children 15 through 17 years of age. Table 22
shows suicides among children by age group for 2007 through 2011.
Table 22. Suicides Among Children by Age Group, Arizona, 2007-2011
Age Group
2007
2008
2009
2010
2011
<10 Years
0
0%
0
0%
0
0%
0
0%
1
3%
10-14 Years
7
25%
9
26%
3
11%
9
37%
13
33%
15-17 Years
21
75%
26
74%
24
89%
15
63%
25
64%
Total
28
35
27
24
39

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 59 of 101

Hangings accounted for 62 percent of child suicides in Arizona during 2011 (n=24) and
firearm injuries accounted for 23 percent (n=9). The objects used in hanging suicides
were belts, ropes, strings and electrical cords. Figure 27 shows suicides among
children by cause of death and age group.
Figure 27. Suicides Among Children by Age Group and Cause of Death,
Arizona, 2011 (n=39)
14

13

5-9 Years (n=1)
10-14 Years (n=13)

12

15-17 Years (n=25)

10
10
8

7

6
4

3
2

2

1

1

1

0

0

0

1

0

0

0

0
Motor Vehicle

Firearm

Drowning

Hanging

Poisoning

In 2011, the distribution of cause of death varied by the sex of the child. As has been
observed in previous years, females were less likely to have used firearms to complete
suicide. Figure 28 shows suicides among children by cause of death and sex.
Figure 28. Suicides Among Children by Cause of Death and Sex,
Arizona, 2011 (n=39)
14

13
Male (n=24)

12

11

10

Female (n=15)

9

8
6
4
2

2

2

1

1
0

0

0

0
MVC

Firearm

Drowning

Hanging

Poisoning

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 60 of 101

Identification of children at risk for suicide can be difficult, and warning signs are not
always recognized or taken seriously. Eighteen children who took their own lives in
2011 were known to have talked about suicide to others (46 percent), 16 children were
known to have made prior suicide threats (41 percent), and nine children had made
prior suicide attempts (23 percent). Only five children were known to have been on
medication for mental illness at the time of their deaths (13 percent). Fifteen children
who completed suicide were known to have received prior mental health services (38
percent), but only seven children were known to have been receiving mental health
services at the time of their deaths (18 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 factor was
family discord, which was identified in ten suicides (26 percent). Table 23 shows factors
that may have contributed to the child’s despondency prior to suicide.
Table 23. Factors That May Have Contributed to the Child’s
Despondency Prior to Suicide, Arizona, 2011
Factor*
Number
Percent
Family discord
10
26%
History of problems with the law
9
23%
History of drug and/or alcohol use
8
21%
Recent breakup with boyfriend or girlfriend
4
10%
Failure at school
4
10%
Recent argument with boyfriend or girlfriend
3
8%
Victim of bullying
2
5%
*More than one factor may have been identified for each death

For nearly half of all suicides, important information regarding risk factors was unknown
to review teams, even after review of available law enforcement records. For example,
in 46 percent of child suicides, prior mental health services provided to the child were
unknown to the local review team (n=18). Improvements in the investigations of child
suicides may increase review teams’ abilities to identify risk factors.
Eighty-seven percent of child suicides were determined by the local team to have been
probably preventable (n=34). Thirteen percent (n=5) of child suicides were determined
by the teams to probably not have been preventable. The use of drugs and/or alcohol
was the most commonly identified preventable factor (51 percent, n=20), followed by
lack of supervision (21 percent, n=8), then access to firearms (18 percent, n=7). Table
20 shows preventable factors for child suicides.

Table 24. Preventable Factors for Child Suicides, Arizona, 2011
Factor*
Number
Percent
Use of drugs and/or alcohol
20
51%
Lack of supervision
8
21%
Access to firearms
7
18%
*More than one factor may have been identified for each death.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 61 of 101

HOMICIDES
Forty-two children were victims of homicide in Arizona during 2011, compared to 36 in
2010. Homicides accounted for five percent of all child deaths in Arizona during 2011.
The child homicide rate in 2011 was 2.6 deaths per 100,000 children. This was an
increase from a rate of 2.2 homicides per 100,000 children in 2010. Figure 29 shows the
rates of child homicides from 2007 through 2011.
Figure 29. Rate of Homicides (per 100,000 Children), Arizona, 2007-2011
4.0

3.9

3.8
3.6

3.5

3.4
3.2
3.0
3.0
2.8
2.6
2.6
2.4

2.2

2.2
2.0
2007

2008

2009

2010

2011

Fifty-two percent of homicide victims in 2011 were males (n=22) and 48 percent were
females (n=20). More than half of child homicides were among Hispanics 52 percent,
n=22), 21 percent were among White, non-Hispanics (n=9), and 14 percent were
among American Indians (n=6), the remainder of children were among other races.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 62 of 101

Thirty-one percent of homicides were among children ages birth to 365 days (n=13).
Children ages 15 through 17 years accounted for 26 percent of homicides (n=11).
Figure 30 shows homicides among children by age group.
Figure 30. Homicides Among Children by Age Group,
Arizona, 2011 (n=42)

15-17 Years
26% (n=11)

Birth-365 Days
31% (n=13)

10-14 Years
5% (n=2)

5-9 Years
9% (n=4)
1-4 Years
29% (n=12)

Compared to 2010, the greatest increase in homicides was observed among children
ages birth to 365 days (from 22 percent in 2010 to 29 percent in 2010) and children 1
through 4 years of age (from 16 percent in 2010 to 29 percent in 2011). Table 25 shows
homicides among children by age group for 2007 through 2011.
Table 25. Homicides Among Children by Age Group, Arizona, 2007-2011
Age Group
2007
2008
2009
2010
2011
0-27 Days
3
4%
1
2%
3
6%
1
3%
1
2%
28-365 Days
13
20%
14
23%
7
14%
8
22%
12
29%
1-4 Years
12
18%
7
12%
12
24%
6
16%
12
29%
5-9 Years
7
11%
2
3%
5
10%
6
16%
4
9%
10-14 Years
5
8%
6
10%
4
8%
4
11%
2
5%
15-17 Years
26
39%
30
50%
20
39%
11
31%
11
26%
Total
66
60
51
36
42

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 63 of 101

In 2011, blunt force trauma was the leading cause of death among child homicides (52
percent, n=22), followed by firearm injuries (29 percent, n=12). Figure 31 shows
homicides among children by cause of death.
Figure 31. Homicides Among Children by Cause of Death,
Arizona, 2011 (n=42)
Undetermined
5% (n=2)

Fall/Crush
2% (n=1)

Sharp Force
Trauma
5% (n=2)

Suffocation
7% (n=3)
Blunt Force
Trauma
52% (n=22)
Firearm Injury
29% (n=12)

For 36 percent of the homicides, the perpetrator was the biological father of the child
(n=15). In 17 percent of cases the review teams were unable to determine the nature of
the relationship between the perpetrator and the child. Mothers’ partners were
responsible for five child homicides in 2011 (12 percent) and the child’s
friend/acquaintance was the perpetrator in five child deaths (12 percent). Strangers
accounted for seven percent of the homicides (n=3) and gang members were
responsible for two homicides. Table 26 shows homicides among children by
perpetrator.
Table 26. Homicides Among Children by Perpetrator,
Arizona, 2011 (n=42)
Perpetrator*
Number
Percent
Biological Father
15
36%
Unknown
7
17%
Mother’s partner
5
12%
Child’s friend/acquaintance
5
12%
Stranger
3
7%
Other relative
2
5%
Gang member
2
5%
Child’s boy/girlfriend
1
2%
Biological Mother
1
2%
Step-father/mother
1
2%
*Perpetrator may fall into more than one category for each
death.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 64 of 101

One hundred percent of child homicides were determined to have been preventable
(n=42). Drugs and/or alcohol was the most commonly identified preventable factor in
child homicides (79 percent, n=33), followed by lack of supervision (21 percent, n=9).
Involvement in a gang was a factor in two homicides. Table 27 shows preventable
factors for child homicides in Arizona during 2011.
Table 27. Preventable Factors for Child Homicides, Arizona, 2011
Factor*
Number
Percent
Drugs and/or alcohol
33
79%
Lack of supervision
9
21%
Involvement in gang
2
5%
*More than one factor may have been identified for each death

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 65 of 101

FIREARM-RELATED FATALITIES
There were 23 firearm-related fatalities in 2011, compared to 22 in 2010. Firearms
accounted for three percent of all child deaths in 2010 and 2011. Eighty-three percent of
the firearm-related deaths in 2011 were among males (n=19) and 17 percent were
among females (n=4). Sixty-one percent were among Hispanic children (n=14) and 30
percent were among White, non-Hispanic children (n=7).
The most significant increase in firearm-related deaths was among children ages 15
through 17 years. In 2010, children ages 15 through 17 years accounted for 32 percent
of firearm-related deaths (n=7). In 2011, children ages 15 through 17 years accounted
for 65 percent of firearm-related deaths (n=15). There were three firearm-related deaths
among children ages 10 through 14 years (13 percent), compared to 8 deaths among
this age group in 2010 (36 percent). Figure 32 shows firearm-related fatalities among
children by age group, and Table 28 shows the distribution of firearm-related child
fatalities by year from 2007 through 2011.
Figure 32. Firearm-Related Deaths Among Children by Age Group,
Arizona, 2011 (n=23)
Birth-4 Years
9% (n=2)

5-9 Years
13% (n=3)
15-17 Years
65% (n=15)

10-14 Years
13% (n=3)

Table 28. Firearm-Related Deaths Among Children by Age Group, Arizona
2007-2011
Age Group
2007
2008
2009
2010
2011
<10 Years
5
10%
5
10%
8
25%
7
32%
5
22%
10-14 Years
7
15%
7
14%
1
3%
8
36%
3
13%
15-17 Years
36 75% 37 76% 23 72%
7
32% 15 65%
Total
48
49
32
22
23

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 66 of 101

In 2011, 52 percent of firearm-related deaths were homicides (n=12), 39 percent were
suicides (n=9), and four percent were accidents (n=1). Figure 33 shows firearm-related
deaths among children by manner.
Figure 33. Firearm-Related Deaths Among Children by Manner,
Arizona, 2011 (n=23)
Undetermined
4% (n=1)

Accident
4% (n=1)

Suicide
39% (n=9)
Homicide
52% (n=12)

Handguns accounted for the majority of firearm-related fatalities among children in 2011
(79 percent, n=18), followed by shotguns (13 percent, n=3). Table 29 shows types of
firearms involved in child deaths during 2011.
Table 29. Types of Firearms Involved in
Child Deaths, Arizona, 2011 (n=23)
Type
Number
Percent
Handgun
18
79%
Shotgun
3
13%
Hunting rifle
1
4%
Unknown
1
4%
Total
23

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 67 of 101

Among the 23 firearm-related deaths, 39 percent of firearms were stored loaded (n=9).
In 22 percent of the cases, the child was the owner of the fatal firearm (n=5). Figure 34
shows the owners of the firearms used in child fatalities.
Figure 34. Owners of Firearms Involved in Child Deaths,
Arizona, 2011 (n=23)
Other
4% (n=1)
Relative
9% (n=2)

Child Owner
22% (n=5)

Acquaintance
8% (n=2)

Stranger
13% (n=3)
Parent
22% (n=5)

Unknown
22% (n=5)

In almost half of firearm-related child deaths, the firearm’s storage location was
unknown to the review teams (48 percent, n=11). It is important to note that among the
child deaths where the storage location is unknown, sixty-four percent were being
carried on a person (n=7). In five cases, there was no attempt to conceal the fatal
firearm. One firearm was stored in a locked safe, but the child had access to the key.
The remaining firearms were not stored in secured locations. Table 30 summarizes the
locations of the firearms involved in child deaths during 2011.
Table 30. Locations of Firearms Involved in
Child Deaths, Arizona, 2011 (n=23)
Location
Number
Percent
Unknown
11
48%
No attempt to conceal
5
22%
Drawer/cabinet
4
17%
Under a mattress or pillow
2
9%
Safe
1
4%
Total
23

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 68 of 101

Ninety-six percent of the firearm-related deaths in 2011 were determined to have been
preventable (n=20). Drugs and/or alcohol were known to have been involved in 70
percent of firearm-related deaths (n=16). Lack of supervision was a factor in 17 percent
of the deaths (n=4), and involvement in a gang was a factor in four percent of firearmrelated child deaths (n=1). Table 31 shows preventable factors for firearm-related
fatalities in Arizona during 2011.

Table 31. Preventable Factors for Firearm-Related Deaths
Among Children, Arizona, 2011
Factor*
Number
Percent
Drugs and/or alcohol
16
70%
Lack of supervision
4
17%
Involvement in gang
1
4%
*More than one factor may have been identified for each death

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 69 of 101

MALTREATMENT FATALITIES
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
(ADES) for the National Child Abuse and Neglect Data System (NCANDS). NCANDS
includes 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 or were within
the jurisdiction of Tribal Nations or other states, these deaths would not be included in
ADES’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.
It is important to note the differences in reporting of maltreatment numbers in this report
compared to the number of maltreatment fatalities reported by ADES. ADES may report
a fatality that the maltreatment subcommittee does not. Similarly, some maltreatment
fatalities in this report are not posted by ADES. There are several cases where Arizona
Child Protective Services would not have had information based on prior reports or
open cases at the time of a child’s death. For instance, the maltreatment subcommittee
may determine a death to be maltreatment when a death occurred because vehicle
restraints were available and not used.
Per A.R.S. § 8-807. ADES is required to post information on child fatalities due to abuse
or neglect by the child’s parent, custodian or caregiver. This information is posted when
the information comes to ADES’ attention and a final determination of the fatality due to
abuse or neglect has been made. The determination is made by either a substantiated
finding or specific criminal charges filed against a parent, guardian or caregiver for
causing the fatality or near fatality. The prior CPS reports are related to the child victim
and the alleged perpetrator.
To gain greater understanding of the contribution of abuse and neglect 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 four conditions must be met:
1.

2.
3.

Was there “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” as it applied to the circumstances
surrounding the death? (From the U.S. Department of Health and Human
Services definition of maltreatment).
The relationship of the individual accused of committing the maltreatment to the
child must be the child’s parent, guardian, or caretaker.
A team member, who is a mandated reporter, would be obligated to report a
similar incident to Child Protective Services.
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 70 of 101

4.

An act or failure to act during critical moments in which the child, left without
adequate supervision, food, shelter or medical care dies by a suddenly arising
danger.

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 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, a child who died in a motor vehicle crash due to the parent driving
while intoxicated would be considered a maltreatment death.
In 2011, there were 71 deaths classified as maltreatment, which was eight percent of all
child deaths that year. This was an increase from 70 child maltreatment deaths in 2010
(also eight percent of all child deaths). In 2011, 52 percent of maltreatment deaths were
among males (n=37) and 48 percent were among females (n=34). Forty-two percent of
the children who died due to maltreatment were Hispanic (n=30), 34 percent were
White, non-Hispanic (n=24), 13 percent were American Indian (n=9), eight percent were
African American (n=6), one percent were Asian (n=1) and one percent were 2 or more
races (n=1).
More than half of all maltreatment deaths were among children younger than one year
of age (52 percent, n=37). Figure 35 shows maltreatment deaths among children by age
group.

Figure 35. Maltreatment Deaths Among Children by Age Group,
Arizona, 2011 (n=71)

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 71 of 101

Homicide was the leading manner of maltreatment deaths for Arizona children in 2011
(39 percent, n=28). For six percent of the maltreatment deaths, the manner of death
was unable to be determined by the review team after review of all available information
(n=4). Seventeen percent of maltreatment deaths were due to natural manners (n=12).
Examples of maltreatment deaths due to natural manners of death included prenatal
substance use resulting in premature birth, or failure to obtain medical care. Thirty-eight
percent of the maltreatment deaths were due to accidents (n=27). Maltreatment-related
accidental deaths included unintentional injuries caused by significant negligence or
substance abuse by a parent or guardian. Figure 36 shows maltreatment deaths by
manner.
Figure 36. Maltreatment Deaths Among Children by Manner,
Arizona, 2011 (n=71)
Undetermined
6% (n=4)
Natural
17% (n=12)
Homicide
39% (n=28)

Accident
38% (n=27)

Blunt/sharp force trauma, drowning and suffocation were the leading causes of
maltreatment-related deaths among children in Arizona in 2011. Table 32 shows
maltreatment deaths among children by cause and manner.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 72 of 101

Table 32. Maltreatment Deaths Among Children by Cause and Manner,
Arizona, 2011 (n=71)
Cause
Natural
Accident
Homicide
Undetermined
Medical
6
0
0
0
Prematurity
5
0
0
0
Motor vehicle crash
0
8
0
0
Firearm
0
0
3
0
Suffocation
0
6
3
0
Drowning
0
12
0
0
Blunt/sharp force trauma
0
0
21
0
Hanging
0
1
0
0
Undetermined
1
0
1
4
Total
12
27
28
4

Total
6
5
8
3
9
12
21
1
6
71

Seventeen percent of the maltreated children in Arizona during 2011 were known to
have had physical, mental, and/or sensory disabilities (n=12), including one child with
autism.
For 48 percent of maltreatment deaths, the perpetrator was the child’s biological mother
(n=34). In 28 percent, the perpetrator was the child’s biological father (n=20). In ten
percent of the maltreatment deaths, the perpetrator was the mother’s partner (n=7), for
six percent of maltreatment fatalities the review team was unable to determine which
caretaker was responsible (n=4), and for the remainder of the maltreatment fatalities the
perpetrator was a relative or foster parent (eight percent, n=6). Table 33 shows
maltreatment deaths among children by perpetrator.
Table 33. Maltreatment Deaths Among Children
by Perpetrator, Arizona, 2011 (n=71)
Perpetrator*
Number
Percent
Mother
34
48%
Father
20
28%
Mother’s partner
7
10%
Unable to determine
4
6%
Other relative
4
6%
Foster parent
2
2%
Total
71
*May not have been under the jurisdiction of Arizona Child
Protective Services

There were 12 fatalities among children two years of age or younger due to abusive
head trauma during 2011. Seven of these children were known to have been shaken.
This was an increase from 2010, when eight children two years of age and younger died
as a result of abusive head trauma.
Ninety-six percent of the child maltreatment deaths in 2011 were determined to have
been preventable (n=68). For three percent of maltreatment deaths, local review teams
were not able to determine preventability (n=2). Drugs and/or alcohol contributed to 69
percent of the deaths (n=49). Lack of supervision contributed to 45 percent of
maltreatment deaths (n=32). Table 34 shows preventable factors for child maltreatment
deaths.
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 73 of 101

Table 34. Preventable Factors for Maltreatment Deaths Among Children,
Arizona, 2011
Factor*
Number
Percent
Drugs and/or alcohol
49
69%
Lack of supervision
32
45%
Unsafe sleep environment
9
13%
*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
agencies in other jurisdictions, such as tribal authorities and other states. If a child
protective agency investigated a report of maltreatment for 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 not substantiated.
In 2011, 34 children who died from maltreatment were from families with prior child
protective services involvement (48 percent). Among these 34 families, 15 had an open
case with a child protective service’s agency at the time of the death (44 percent). This
was an increase from 2010, when there were 18 families with prior child protective
services involvement (26 percent), five of which were open at the time of death. Figure
37 shows child maltreatment deaths by status with child protective services.
Figure 37. Maltreatment Deaths Among Children by Status with Child
Protective Services, Arizona, 2010 and 2011
100%

7% (n=5)

90%
80%

19% (n=13)

70%

Total CPS
Involved
Cases, 26%
(n=18)*

21% (n=15)

27% (n=19)

60%

Total CPS
Involved
Cases, 48%
(n=34)*

50%
40%

Case Open at Time of Death
74% (n=52)

30%
20%

History of Involvement, Case
Closed

10%

No History of Involvement

52% (n=37)

0%
2010 (n=70)

2011 (n=71)

*These cases may not have been under the jurisdiction of Arizona Child Protective Services. This happens
when prior history is identified through a tribal agency or a state other than Arizona.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 74 of 101

For 14 maltreatment deaths, mandatory reporters did not notify Arizona Child Protective
Services that after a complete investigation, the deaths were suspected to have resulted
from child maltreatment (20 percent). These 14 cases were reported to Arizona Child
Protective Services by the Child Fatality Review Program. The number and percentage
of maltreatment deaths not reported to Arizona Child Protective Services decreased
from 49 percent in 2010 (n=34) to 20 percent in 2011 (n=14).
There were 26 child maltreatment deaths in 2011 in which legal charges had been filed
or were pending against the perpetrator(s) of the abuse or neglect at the time of the
review (37 percent). In an additional four cases, charges were not filed because the
perpetrator was deceased. Since additional criminal investigation may be required prior
to filing legal charges against those involved in a child maltreatment death, information
on legal outcomes may not be available to the local team at the time of the death
review. In 2011, there were 23 deaths in which legal outcomes were unknown to the
local review team (32 percent).

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 75 of 101

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 seven years,
100 percent of child deaths in Arizona have been reviewed, and data from 2007 through
2011 are included in the following tables in order to provide five full years of comparison
data.
The Neonatal Period, Birth Through 27 Days
Table 35. Deaths Among Children Ages Birth Through 27 Days by Cause and Manner,
Arizona, 2011 (n=334)
Cause
Natural
Accident
Suicide
Homicide Undetermined
Total
142
Medical*
139
2
0
0
1
181
Prematurity
179
0
0
0
2
5
Suffocation
0
5
0
0
0
1
Blunt/Sharp Force
0
0
0
1
0
Trauma
5
Undetermined
0
0
0
0
5
Total
318
7
0
1
8
334
*Excluding SIDS and prematurity
Table 36. Deaths Among Children Ages Birth Through 27 Days by Cause,
Arizona, 2007-2011
Cause
2007
2008
2009
2010
2011
Prematurity
281
58%
256
60%
221
60%
180
54%
181
54%
Medical*
180
37%
155
37%
128
35%
145
43%
143
43%
Undetermined
4
1%
6
1%
5
1%
6
2%
5
2%
SIDS
4
1%
3
1%
1
<1%
0
0%
0
0%
MVC/Transport
5
1%
2
<1%
2
<1%
1
<1%
0
0%
Other
5
1%
1
<1%
5
1%
0
0%
1
<1%%
Suffocation
5
1%
0
0%
4
1%
1
<1%
5
1%
Exposure
0
0%
0
0%
1
<1%
0
0%
Drowning
1
0%
0
0%
0
0%
0
0%
0
0%
Total
485
423
366
334
334
*Excluding SIDS and Prematurity
Table 37. Deaths Among Children Ages Birth Through 27 Days by Manner,
Arizona, 2007-2011
Manner
2007
2008
2009
2010
2011
Natural
464
96%
414
98%
349
95%
324
97%
318
95%
Undetermined
6
1%
6
1%
7
2%
7
2%
8
2%
Accident
12
2%
2
<1%
7
2%
2
1%
7
2%
Homicide
3
1%
1
<1%
3
1%
1
<1%
1
<1%
Suicide
0
0
0%
0
0%
0
0%
0
0%
Total
485
423
366
334
334

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 76 of 101

The Post-Neonatal Period, 28 Days Through 365 Days
Table 38. Deaths Among Children Ages 28 Days Through 365 Days by Cause and Manner,
Arizona, 2011 (n=175)
Cause
Natural Accident Suicide Homicide Undetermined Unknown
Total
75
Medical*
74
0
0
0
1
0
17
Prematurity
16
0
0
0
0
1
4
MVC/Transport
0
4
0
0
0
0
1
Firearm
0
3
0
1
0
0
34
Suffocation
0
31
0
1
2
0
3
Drowning
0
3
0
0
0
0
2
SIDS
1
0
0
0
1
0
9
Blunt/Sharp
0
0
0
9
0
0
Force Trauma
30
Undetermined
1
0
0
1
28
0
Total
92
38
0
12
32
1
175
*Excluding SIDS and prematurity
Table 39. Deaths Among Children 28 Days Through 365 Days by Cause,
Arizona, 2007-2011
Cause
2007
2008
2009
2010
2011
Medical*
83
37%
91
43%
77
42%
82
43%
75
43%
Undetermined
25
11%
44
21%
35
19%
56
29%
30
17%
Suffocation
21
9%
21
10%
13
7%
22
11%
34
19%
SIDS
33
15%
17
8%
27
15%
1
<1%
2
1%
Prematurity
35
15%
15
7%
18
10%
17
9%
17
10%
Blunt/Sharp
8
3%
9
4%
3
2%
6
3%
9
5%
Force Trauma
Other non5
2%
6
3%
3
2%
3
2%
1
<1%
Medical
MVC/Transport
7
3%
6
3%
2
1%
1
<1%
4
2%
Drowning
5
2%
1
<1%
3
2%
2
1%
3
2%
Exposure
2
1%
1
<1%
0
0%
1
<1%
0
0%
Fire/Burn
6
3%
0
0%
0
0%
0
0%
0
0%
Poisoning
1
0%
0
0%
1
<1%
1
<1%
0
0%
Hanging
1
0%
0
0%
0
0%
0
0%
0
0%
Total
225
211
183
192
175
*Excluding SIDS and Prematurity
Table 40. Deaths Among Children Ages 28 Days Through 365 Days by Manner,
Arizona, 2007-2011
Manner
2007
2008
2009
2010
2011
Natural
147
65%
116
55%
116
63%
109
57%
92
53%
Undetermined
27
12%
52
25%
42
23%
50
26%
32
18%
Accident
38
17%
29
14%
18
10%
25
13%
38
22%
Homicide
13
6%
14
7%
7
4%
8
4%
12
7%
Suicide
0
0%
0
0%
0
0%
0
0%
0
0%
Unknown
0
0%
0
0%
0
0%
0
0%
1
<1%
Total
225
211
183
192
175

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 77 of 101

Children, One Through Four Years of Age
Table 41. Deaths Among Children Ages One Through Four Years by Cause and Manner,
Arizona, 2011 (n=106)
Cause
Natural
Accident
Suicide
Homicide Undetermined Unknown
Total
40
Medical*
39
0
0
0
1
0
1
Prematurity
1
0
0
0
0
0
15
MVC/Transport
0
15
0
0
0
0
1
Firearm
0
0
0
1
0
0
8
Suffocation
0
7
0
1
0
0
18
Drowning
0
18
0
0
0
0
10
Blunt/Sharp
0
0
0
10
0
0
Force Trauma
3
Hanging
0
3
0
0
0
0
5
Undetermined
0
0
0
0
5
0
1
Poisoning
0
1
0
0
0
0
2
Fire/Burn
0
1
0
0
1
0
2
Fall/Crush
0
2
0
0
0
0
Total
40
47
0
12
7
0
106
*Excluding SIDS and prematurity
Table 42. Deaths Among Children Ages One Through Four Years by Cause,
Arizona, 2007-2011
Cause
2007
2008
2009
2010
2011
Medical*
45
40%
67
53%
50
38%
52
44%
40
38%
Drowning
12
11%
25
20%
24
18%
22
18%
18
17%
MVC/Transport
21
18%
10
8%
20
15%
19
16%
15
14%
Other non11
10%
7
5%
11
8%
7
6%
0
0%
Medical
Undetermined
8
7%
7
5%
10
8%
6
5%
5
5%
Blunt/Sharp
7
6%
4
3%
7
5%
4
3%
10
9%
Force Trauma
Firearm
2
2%
2
2%
4
2%
2
2%
1
1%
Poisoning
2
2%
2
2%
0
0%
0
0%
1
1%
Exposure
1
1%
2
2%
0
0%
2
2%
0
0%
Fire/burn
2
2%
1
1%
3
2%
2
2%
2
2%
Fall/crush
2
2%
2
2%
Hanging
1
<1%
3
3%
Prematurity
0
0%
0
0%
1
1%
0
0%
1
1%
Suffocation
2
2%
0
0%
0
0%
0
0%
8
8%
Total
113
126
130
119
106
*Excluding SIDS and Prematurity
Table 43. Deaths Among Children Ages One Through Four Years by Manner,
Arizona, 2007-2011
Manner
2007
2008
2009
2010
2011
Natural
49
43%
67
53%
54
42%
52
44%
40
38%
Accident
45
40%
43
34%
56
43%
52
44%
47
44%
Undetermined
7
6%
9
7%
8
6%
8
7%
7
7%
Homicide
12
11%
7
5%
12
9%
6
5%
12
11%
Suicide
0
0%
0
0%
0
0%
0
0%
0
0%
Unknown
1
<1%
0
0%
Total
113
126
130
119
106
Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 78 of 101

Children, Five Through Nine Years of Age
Table 44. Deaths Among Children Ages Five Through Nine Years by Cause and Manner,
Arizona, 2011 (n=54)
Cause
Natural
Accident
Suicide
Homicide
Undetermined
Total
26
Medical*
26
0
0
0
0
13
MVC/Transport
0
13
0
0
0
3
Firearm
0
0
0
3
0
1
Suffocation
0
1
0
0
0
7
Drowning
0
7
0
0
0
1
Blunt/Sharp
0
0
0
1
0
Force Trauma
1
Hanging
0
0
1
0
0
1
Undetermined
0
0
0
1
1
Fire/Burn
0
1
0
0
0
Total
26
22
1
4
1
54
*Excluding SIDS and prematurity
Table 45. Deaths Among Children Ages Five Through Nine Years by Cause,
Arizona, 2007-2011
Cause
2007
2008
2009
2010
2011
Medical
37
55%
43
64%
42
63%
31
53%
26
48%
Prematurity
0
0%
0
0%
1
1%
0
0%
0
0%
MVC/Transport
13
19%
10
15%
15
22%
10
17%
13
34%
Other
7
10%
8
12%
6
9%
2
3%
0
0%
Drowning
4
6%
2
3%
3
4%
4
7%
7
13%
Fire/Burn
1
1%
2
3%
0
0%
2
3%
1
2%
Hanging
1
1%
1
1%
0
0%
0
0%
1
2%
Firearm
5
9%
3
6%
Undetermined
1
2%
1
2%
Fall/Crush
2
3%
0
0%
Blunt/Sharp
1
1%
1
1%
0
0%
0
0%
1
2%
Force Trauma
Suffocation
1
1%
0
0%
0
0%
1
2%
1
2%
Poisoning
2
3%
0
0%
0
0%
0
0%
0
0%
Total
67
67
67
58
54
*Excluding SIDS and Prematurity
Table 46. Deaths Among Children Ages Five Through Nine Years by Manner,
Arizona, 2007-2011
Manner
2007
2008
2009
2010
2011
Natural
37
55%
42
63%
43
64%
32
55%
26
48%
Accident
23
34%
19
28%
19
28%
20
34%
22
41%
Undetermined
0
0%
4
6%
0
0%
0
0%
1
2%
Homicide
7
10%
2
3%
5
7%
6
10%
4
7%
Suicide
0
0%
0
0%
0
0%
0
0%
1
2%
Total
67
67
67
58
54

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 79 of 101

Children, 10 Through 14 Years of Age
Table 47. Deaths Among Children Ages 10 Through 14 Years by Cause and Manner,
Arizona, 2011 (n=72)
Cause
Natural
Accident
Suicide
Homicide Undetermined
Total
34
Medical
34
0
0
0
0
17
MVC/Transport
0
16
1
0
0
3
Firearm
0
0
2
1
0
1
Suffocation
0
0
0
1
0
2
Drowning
0
2
0
0
0
2
Blunt/Sharp
0
2
0
0
0
Force Trauma
10
Hanging
0
0
10
0
0
1
Undetermined
0
0
0
0
1
2
Fire/Burn
0
2
0
0
0
Total
34
22
13
2
1
72
*Excluding SIDS and prematurity
Table 48. Deaths Among Children Ages 10 Through 14 Years by Cause,
Arizona, 2007-2011
Cause
2007
2008
2009
2010
Medical
40
43%
34
46%
43
59%
29
44%
MVC/Transport
27
29%
19
26%
13
18%
12
18%
Firearm
7
8%
7
9%
1
1%
8
12%
Hanging
6
6%
6
8%
3
4%
7
11%
Other
4
4%
2
3%
8
11%
1
2%
Fall/Crush
3
3%
2
3%
2
3%
0
0%
Poisoning
2
2%
2
3%
0
0%
1
2%
Blunt/Sharp
1
1%
1
1%
0
0%
0
0%
Force Trauma
Exposure
1
1%
1
1%
2
3%
1
2%
Suffocation
0
0%
0
0%
0
0%
0
0%
Drowning
1
1%
0
0%
1
1%
2
2%
Undetermined
3
5%
Fire/burn
2
2%
92
74
73
66
*Excluding SIDS and Prematurity

34
17
3
10
0
0
0
2
0
1
2
1
2
72

2011
47%
24%
4%
14%
0%
0%
0%
3%
0%
1%
3%
1%
3%

Table 49. Deaths Among Children Ages 10 Through 14 Years by Manner,
Arizona, 2007-2011
Manner
2007
2008
2009
2010
2011
Natural
40
43%
33
45%
47
64%
30
45%
34
47%
Accident
35
38%
26
35%
17
23%
18
27%
22
31%
Suicide
7
8%
9
12%
3
4%
9
14%
13
18%
Homicide
5
5%
6
8%
4
5%
4
6%
2
3%
Undetermined
5
5%
0
0%
25
3%
5
8%
1
1%
Total
92
74
73
66
72

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 80 of 101

Children, 15 Through 17 Years of Age
Table 50. Deaths Among Children Ages 15 Through 17 Years by Cause and Manner,
Arizona, 2011 (n=96)
Cause
Natural Accident Suicide Homicide Undetermined Unknown
Total
25
Medical*
25
0
0
0
0
0
21
MVC/Transport
0
20
1
0
0
0
15
Firearm
0
1
7
6
1
0
1
Suffocation
0
1
0
0
0
0
2
Drowning
0
1
1
0
0
0
3
Blunt/Sharp
0
0
0
3
0
0
Force Trauma
13
Hanging
0
0
13
0
0
0
4
Undetermined
2
0
0
1
1
0
9
Poisoning
0
6
3
0
0
0
1
Fire/Burn
0
1
0
0
0
0
2
Fall/Crush
0
1
0
1
0
0
Total
27
31
25
11
2
0
96
*Excluding SIDS and prematurity
Table 51. Deaths Among Children Ages 15 Through 17 Years by Cause,
Arizona, 2007-2011
Cause
2007
2008
2009
2010
Firearm
36
22%
37
27%
23
18%
7
8%
MVC/Transport
49
30%
35
25%
30
23%
18
19%
Medical*
35
22%
30
22%
32
25%
20
22%
Hanging
6
4%
13
9%
12
9%
11
12%
Poisoning
17
11%
10
7%
15
12%
16
17%
Other
7
4%
4
3%
4
3%
8
9%
Exposure
4
2%
4
3%
5
4%
6
6%
Drowning
0
0%
1
1%
4
3%
3
3%
Undetermined
4
2%
1
1%
1
1%
2
2%
Fall/Crush
0
0%
1
1%
0
0%
0
0%
Blunt/Sharp
0
0%
1
1%
2
2%
1
1%
Force Trauma
Fire/Burn
3
2%
0
0%
0
0%
0
0%
Suffocation
1
1%
Total
161
137
128
93
*Excluding SIDS and Prematurity

15
21
25
13
9
0
0
2
4
2
3
1
1
96

2011
16%
22%
26%
14%
9%
0%
0%
2%
4%
2%
3%
1%
1%

Table 52. Deaths Among Children Ages 15 Through 17 Years by Manner,
Arizona, 2007-2011
Manner
2007
2008
2009
2010
2011
Accident
74
46%
49
36%
48
37%
43
46%
31
32%
Natural
34
21%
30
22%
32
25%
18
19%
27
28%
Homicide
26
16%
30
22%
20
16%
11
12%
11
11%
Suicide
21
13%
26
19%
24
19%
15
16%
25
26%
Undetermined
6
4%
2
1%
4
3%
4
4%
2
2%
Unknown
2
2%
0
0%
Total
161
137
128
93
96

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 81 of 101

APPENDIX B: POPULATION DENOMINATORS FOR ARIZONA
CHILDREN
The population denominators shown below were used in computing the rates presented
in this report. Denominators for 2007 through 2009 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.
Population denominators for 2010 were tabulated from the 2010 Decennial Census,
Summary File 1, available online from: www.census.gov.
2011 population denominators were pulled from the Arizona Vital Statistics, 2011 from:
www.azdhs.gov/plan/menu/info/pop/pop11/pd11.htm.

Table 53. Population of Children Ages Birth Through 17 Years by County
of Residence, Arizona, 2007-2011
2007
2008
2009
2010
2011
Apache
25,708
25,713
25,888
22,660
22,808
Cochise
34,478
34,786
35,356
30,250
30,099
Coconino
35,867
35,840
36,439
31,788
31,716
Gila
13,130
13,545
14,002
11,471
11,451
Graham
9,833
10,536
10,819
10,575
10,718
Greenlee
2,355
2,551
2,496
2,463
2,463
La Paz
4,143
4,130
4,074
3,678
3,682
Maricopa
1,051,575
1,059,737
1,064,572
1,007,861 1,014,790
Mohave
45,146
45,589
45,296
41,265
41,301
Navajo
35,821
35,684
35,814
31,973
31,901
Pima
242,411
243,987
244,390
225,316
226,652
Pinal
72,802
80,600
81,414
99,700
101,929
Santa Cruz
14,624
14,880
14,898
14,560
14,752
Yavapai
43,925
44,725
44,969
40,269
40,305
Yuma
58,446
59,083
59,089
55,185
56,547
Total
1,690,264
1,711,386
1,719,515
1,629,014 1,641,114

Table 54. Population of Children Ages 0 Through 17 Years by Age Group,
Arizona, 2007-2011
2007
2008
2009
2010
2011
<1 Year
102,587
98,995
92,263
87,557
88,211
1-4 Years
396,458
402,486
406,201
368,158
370,926
5-9 Years
457,956
465,088
469,372
453,680
457,080
10-14 Years
455,724
462,890
467,149
448,664
451,983
15-17 Years
277,927
281,927
284,530
270,955
272,908
Total
1,690,264 1,711,386 1,719,515 1,629,014 1,641,108

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 82 of 101

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. §363503). 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, for children whose families only recently moved to Arizona or for
children residing in tribal communities. 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.
After review by the local team, review data are entered into an electronic database
maintained by the National Center for Child Death Review. Completed data are
downloaded from the National Center for Child Death Review database, cleaned, and
analyzed using SAS software, Version 9.3 (copyright 2010, SAS Institute Inc., Cary,
NC).

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 83 of 101

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
Frances Marabel
April Maggio (proxy)
Arizona Department of Economic Security
Division of Children Youth, and Families
Kathryn Bowen, MD
University of Arizona College of Medicine
David K. Byers
Leticia D’Amore (proxy)
Administrative Office of the Courts
Mary Ellen Cunningham
Irene Burnton (proxy)
Arizona Department of Health Services
Bureau of Women’s and Children’s Health
Steve Dingle, MD
Markay Adams (proxy)
Arizona Department of Health Services
Division of Behavioral Health Services
Tim Flood, MD
Arizona Department of Health Services
Bureau of Public Health Statistics
Randy Force
Phoenix Police Department

Blaine Gadow
Maricopa County Attorney’s Office
Wade Kartchner, MD
Navajo County Public Health Services
Gaylene Morgan
Office of the Attorney General
John Raeder
Ashley Miles
Governor’s Office for Children, Youth and
Families
Beth Rosenberg
Children’s Action Alliance
Kim Simmons
Arizona Department of Economic Security
Division of Developmental Disabilities
Roy Teramoto, MD
Indian Health Service
David Winston, MD, PhD
Forensic Pathologist
Pima County Forensic Science Center

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 84 of 101

Apache County Child Fatality Review Team
Chair/Coordinator
Rebecca Stinson
Apache County Youth Council
Members
Gladys Ambrose
Navajo Nation Division of Social Services
Earl Anderson
New Hope Safe House
Commander Matrese Avila
Apache County Sheriff’s Office
Michael Downs
Little Colorado Behavioral Health Center
Detective Ricardo Herreras
Springerville 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
Chief Donny Jones
St. Johns Police Department
Debbie Neckel
St. Johns Police Department
Detective Mike Nuttall
Springerville Police Department

Christie Orona
Arizona Department of Economic Security
Division of Children, Youth and Families
Debbie Padilla
Apache County Public Health Services
Scott Poche
Little Colorado Behavior Health Center
Chris Sexton
Apache County Public Health Services
Keli Sine-Shields
Apache County Public Health Services
James Sielski, DO
Medical Examiner
North Country Community Health Center
Jim Staffnik, PhD
St. Johns Middle School
Detective Mike Sweetser
Eager Police Department
Cathy Taylor, MD
North Country Community Health Center
Sandra Thompson
Little Colorado Behavioral Health Center
Michael B. Whiting
Apache County Attorney’s Office
Siona Willie
Office of Environmental Health and
Engineering
Indian Health Service

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 85 of 101

Cochise County Child Fatality Review Team
Chair/Coordinator
Nilda Townsend
Committee for the Prevention of Child Abuse
Recording Secretary
Paula Peters
Cochise County Medical Examiner’s Office
Members
Joy Craig
Arizona Department of Public Safety
Parent Representative

Judy Pike
Psychologist

Vincent Fero
Arizona Department of Public Safety

Melodi Polach
South Eastern Arizona Behavioral Health
Services

Guery Flores, MD
Cochise County Medical Examiner’s Office

Rebecca Reyes, MD
Pediatrician

Tonianne Goebel
Domestic Violence Specialist

Rodney Rothrock
Cochise County Sheriff’s Office

Avneesh Gupta, MD

Nicole Sanchez
University of Arizona, South

Angela Hillig
Sierra Vista Police Department
Stacy Jones
Army Community Services
Debbie Nishikida
Arizona Department of Economic Security
Division of Children, Youth, and Families

Delcy Scull
Cochise County Juvenile Court
Mary Scott
Cochise County Prosecutor’s Office
Hal Thomas, EdD
Sierra Vista Public Schools Board Member

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 86 of 101

Coconino County Child Fatality Review Team
Chair/Coordinator
Heather Taylor
Coconino County Public Health Department

Members
Bill Ashland, RN
Flagstaff Medical Center

Lizette Melis
Coconino County Public Health Department

Glen Austin
Flagstaff Pediatrics

Archiaus Mosley, MD
Coconino County Medical Examiner

Roberta Coons
Flagstaff Police Department

Michael Oxtoby
Coconino County Public Health Department

Robert Fagan
Federal Bureau of Investigation

William Pribil
Coconino County Sheriff’s Office

Rex Gilliand
Coconino County Sheriff’s Office

McDonald Rominger
Federal Bureau of Investigation

Ann J. Goh
Coconino County Public Health Department

Casey Rucker
Flagstaff Police Department

Diana Holt, PNP
Flagstaff Pediatrics

Cindy Sanders, RN
Flagstaff Medical Center

Amy Jelliffe
Northern Arizona Regional Behavioral
Health Association

Kris Stark
Victim Witness

Kelsey Koustik
Flagstaff Police Department

Cindy Trembley
Division of Children, Youth, and Families
Department of Economic Security

Mike Lesser
CCAO

Jared Wotasik
Flagstaff Police Department

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 87 of 101

Gila County Child Fatality Review Team
Chair/Coordinator
Jean M. Oliver
Time Out, Inc.
Members
Lucinda Campbell, RN, BSN
Gila County Health Department

Barbara Thompson
Childhelp

Yvonne Harris
Arizona Department of Economic Security
Case Aide, Payson Office

Detective Matt VanCamp
Payson Police Department

Katrisha Stuler
CASA Coordinator

Terry Vest
Education Coordinator
Time Out, Inc.

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 88 of 101

Graham County and Greenlee County Child Fatality Review Team
Chair/Coordinator
Brandie Lee
Parent

Members
Kenny Angle
County Attorney
Graham County Attorney’s Office

Karen Cosand
Department of Economic Security
Division of Children, Youth and Families

Jean Aston
Domestic Violence Specialist
Mt. Graham Safe House

Darla Hansen, RN
Graham County Health Department

Scott Bennett
County Attorney
Graham County Attorney’s Office
Robert Coons, DO
County Medical Examiner

Neil Karnes
Health Director
Graham County Health Department
Richard Keith, MD
Pediatrician
Gila Valley Clinic
Detective Diane Thomas
Safford Police Department

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 89 of 101

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, M.Ed.
Assistant Coordinator
Arielle Unger, BS
Members
Markay Adams
Division of Behavioral Health Services
Arizona Department of Health Services

Rhonda M. Cash
Division of Children, Youth and Families
Arizona Department of Economic Security

Stephanie Anastasia, MSW

Kimberly Choppi, MSN-Ed, RN, CPEN
Maricopa Integrated Health System

Elisha Au Franklin, MC
La Frontera Arizona,
Empact Suicide Prevention Center

Kathryn Coffman, MD
Phoenix Children’s Hospital

Sergeant Kevin Baggs
Mesa Police Department

Detective Dan Coons
Chandler Police Department

Darryl Bailey, MSW
Division of Children, Youth and Families
Arizona Department of Economic Security

Cindy Copp, MSW
Division of Children, Youth and Families
Arizona Department of Economic Security

Angela M. Baker
Phoenix Children’s Hospital

Shawn Cox, LCSW
United States Attorney’s Office

Wendy Bernatavicius, MD
Phoenix Children’s Hospital

Frances Baker Dickman, PhD, JD

Sara Bode, MD
Phoenix Children’s Hospital
Sergeant Jess Boggs
Chandler Police Department
Detective Jennifer Borquez
Arizona Department of Public Safety
Catherine Brown, MSW
Banner Samaritan Hospital

Paul S. Dickman, MD
Phoenix Children’s Hospital
University of Arizona College of Medicine
Ilene Dode, PhD, LPC
CEO Emeritus
EMPACT Suicide Prevention Center
Amira El-Ahmadiyyah, LCSW
Phoenix Children’s Hospital

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 90 of 101

Jon Eliason
Maricopa County Attorney’s Office
Michelle Fingerman, MS
Childhelp Hotline and School Based
Programs
Rebecca Fitzpatrick, MSW
Division of Children, Youth and Families
Arizona Department of Economic Security
Timothy Flood, MD
Bureau of Public Health Statistics
Arizona Department of Health Services
Sergeant Mike Hill
Tempe Police Department
Sharon Jones, RHIT
Hospice of the Valley
Maura Kelly, M.Ed.
Division of Children, Youth and Families
Arizona Department of Economic Security

Sandra McNally, MA, LISAC
La Frontera Arizona,
EMPACT Suicide Prevention Center
Casey Melsek, MSW
Division of Children, Youth and Families
Arizona Department of Economic Security
Edward Miller
Division of Children, Youth and Families
Arizona Department of Economic Security
Sally Moffat, RN
Injury Prevention Center
Phoenix Children’s Hospital
Christa Morgan
Division of Children, Youth and Families
Arizona Department of Economic Security
Ayrn O’Connor, MD
Banner Health, Good Samaritan Hospital
Sergeant Jennifer Pinnow
Arizona Department of Public Safety

Karin Kline, MSW
Arizona State University
Center for Applied Behavioral Health Policy

Sergeant Mike Polombo
Phoenix Police Department

Rebecca Krumm
Division of Children, Youth and Families
Arizona Department of Economic Security

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

Detective Chris Loeffler
Phoenix Police Department

Leslie Quinn, MD
Phoenix Children’s Hospital

Sergeant Eric Lumley
Phoenix Police Department

Detective Ray Roe
Phoenix Police Department

Andrew Mariono, MSW/MPA
Division of Children, Youth and Families
Arizona Department of Economic Security

Pam Roman
Hospice of the Valley

Terence Mason, RN
Mesa Fire Department

Dena Salter, MBA
Maricopa Wings to Safety
Maricopa Integrated Health System/DMG

Sergeant Dana McBride
Mesa Police Department

Michele F. Scott, MD
Phoenix Children’s Hospital

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 91 of 101

Wendy Shepherd, MA, PI
Voices Empowered
Laurie Smith, MSN, PCNS-BC
Cardon Children’s Medical Center
Connie Smyer
Retired Deputy County Attorney

Jon Terpay, Director
Chandler Gilbert Community College
Law Enforcement Training Academy
Denis Thirion, MA
La Frontera Arizona,
Empact Suicide Prevention Center
Zannie Weaver
US Consumer Product Safety Commission

Melissa Sutton
Swim Kids USA
Katrina Taylor
Childhelp National Child Abuse Hotline

Detective Sergeant David L. Wilson
El Mirage Police Department
Joseph T. Zerella, MD
Pediatric Surgeon
Stephanie Zimmerman, MD
Phoenix Children’s Hospital

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 92 of 101

Mohave County and La Paz County Child Fatality Review Team
Chair
Vic Oyas, MD
Havasu Rainbow Pediatrics
Coordinator
Anna Scherzer
Mohave County Department of Public Health
Members

Bruce Leeming
Mohave County Health Department

Dawn Abbott
Mohave Mental Health Clinic, Inc.
Earl Chalfant
Lake Havasu City Police Department
Suzanne Clark
Kingman Aid to Abused People
Domestic Violence Specialist
Craig Diehl, MD
Pediatrician

Patty Mead, RN, MS
Mohave County Health Department
Megan McCoy
Mohave County Attorney’s Office
Sherri Michel-Singer
Arizona Department of Economic Security
Division of Children, Youth and Families
Detective Steve Parker
Mohave County Sheriff’s Office

Detective Todd Foster
Kingman Police Department
Loria Gattis
Mohave County Medical Examiner
Lieutenant Larry Kubacki
La Paz County Sheriff’s Office
Victoria Stazio
Mohave County Attorney’s Office

Angelica Pichardo
Mohave County Health Department
Melissa Register
Mohave County Probation Department
Lieutenant Steve Smith
Bullhead City Police Department
Debra Walgren
Arizona Department of Economic Security
Division of Children, Youth and Families
Rexene Worrell, MD
Mohave County Medical Examiner

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 93 of 101

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

Members
Tammy Borrego, RN
Injury Prevention
Summit Regional Medical Center
Kenneth Brown
WMAT Social Services
Trent Clatterbuck
Navajo County Medical Examiner’s Office
Detective Sergeant Roger Conaster
Winslow Police Department

Detective Sergeant Tim Dixon
Holbrook Police Department
Kirk Grugel
Navajo County CASA
Wade Kartchner, MD
Navajo County Public Health Services
Kateri Piecuch
Arizona Department of Economic Security
Division of Children, Youth and Families
Amy Stradling
Navajo County Public Health Injury
Prevention

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 94 of 101

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
Nicole Abdy, MD
Department of Pediatrics
University of Arizona
Albert Adler, MD
Indian Health Service

Rachel Crampton, MD
Department of Pediatrics
University of Arizona
Detective Robert Dobell
Tucson Police Department
Detective Marty Fuentes
Tohono O’odham Police Department

Carol Baker
Pima County Health Department
Katie Barry
Family Support Specialist
Healthy Families
Norma Battaglia, RN, MS
Pre-Hospital Manager
Tucson Fire Department
Judith Becker, PhD
Department of Psychology
University of Arizona
Kathy Benson, RN
Retired School Nurse

Amy Gomez
Emerge
Lori Groenewold, MSW
Children’s Clinics for Rehabilitation
Karen Harper
Southern Arizona Child Advocacy Center
Captain Ryder Hartley
Northwest Fire Department
Greg Hess, MD
Chief Medical Examiner
Pima County Medical Examiner’s Office

Lee Bucklin
Rincon Valley Fire Department

Karen Ives
Pima County Juvenile Detention Center

Lori Clark, MSW
Division of Children, Youth and Families
Department of Economic Security

Lynn Kallis
Pilot Parents Program of Southern Arizona

Rosanne Cortez
Victim Services
Pima County Attorney’s Office

Patricia Kleiman
Retired Teacher
Special Needs Instructor

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 95 of 101

Tracy Koslowski
Public Education/Information Manager
Drexel Heights Fire Department
Kiran Kulkarni, MD
Department of Pediatrics
University of Arizona
Joseph Livingston, MD
Department of Pediatrics
University of Arizona
Chan Lowe, MD
Department of Pediatrics
University of Arizona
Kathleen Malkin, RN
Public Health Department
Stacey Meade
Casa de los Ninos
Trudy Meckler
Administrative Associate
University of Arizona
Joan Mendelson
Attorney
Brenda Neufeld, MD
Indian Health Service

Sergeant Sonia Pesqueria
Pima County Sheriff’s Office
Cindy Porterfield, DO
Pima County Medical Examiner’s Office
Carol Punske, MSW
Division of Children, Youth and Families
Arizona Department of Economic Security
Sue Rizzi
Tucson Fire Department
Laurie San Angelo
Pima County Attorney General’s Office
Deborah Weber, RN
Public Health Department
Commander Donald Williams
US Public Health Services
Indian Health Service
David Winston, MD, PhD
Pima County Medical Examiner’s Office
Dale Woolridge, MD
Department of Pediatrics
University of Arizona

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 96 of 101

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

Members
Jason Agresta
Pinal County Sherriff’s Office

Rocky Jimenez
Eloy Police Department

Graham Briggs
Pinal County Health 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

Vonnie Fuentes
Research Nurse
Maricopa Integrated Health Systems
Patrick Gard
Deputy County Attorney
Pinal County Attorney’s Office
Butch Gates
Family Advocacy Center
Jeffrey Gibson
Pinal County Medical Examiner’s Office
Christina Holt
Pinal County Family Advocacy Center

Murphies Law
Retired EMS Respondant
Leslie Montijo
Psychology Graduate
Albert Phelps
Pinal County Sherriff’s Office
Gerald Smith
Children’s Justice Coordinator
Pinal County Attorney’s Office
Tom Schryer
Director
Pinal County Health Department
Ashley Walker
Coolidge Police Department

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 97 of 101

Yavapai County Child Fatality Review Team
Chair/Coordinator
Barbara Jorgensen, MSN, RN
Yavapai County Community Health Services
Administrative Specialist
Carol Espinosa
Members
Susan Bell
CASA

Dennis McGrane
Yavapai County Attorney’s Office

Jerry Bruen
Yavapai County Attorney’s Office

Kathy McLaughlin
Citizen Advocate

Sue Carlson
Licensed Counselor

Cynthia Ross
Yavapai County Medical Examiner’s Office

Delores Cordova
Division of Children, Youth and Families
Department of Economic Security

Becky Ruffner
Prevent Child Abuse Arizona

Karen Dansby, MD
Pediatrician

Kathy Swope, RN
School Nurse
Yavapai County Education Services Agency

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 98 of 101

Yuma County Child Fatality Review Team
Chair/Coordinator
Ryan Butcher
Injury Prevention Coordinator
Yuma County Health District
Members
Maria Estrada
Arizona Department of Economic Security
Division of Children, Youth and Families
James Holland
Medical Examiner’s Office
Melvin Lawson
Yuma Police Department
Detective Debbie Machin
Yuma Police Department

Mary Mochnal
Yuma Regional Medical Center
Patti Perry, MD
Yuma Regional Medical Center
Cactus Kids
Chip Schneider
Amberly’s Place
Robert Vigil
Medical Examiner’s Office

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 99 of 101

Arizona Department of Health Services Bureau of Women’s and
Children’s Health
Office of Injury Prevention
Tomi St. Mars, MSN, RN, CEN, FAEN, Chief, Office of Injury Prevention
Marla D. Herrick, BSW, M.Ed., MA, Child Fatality/Maternal Mortality Review Program Manager
Brenna V. Rabel, MPH, Injury Epidemiologist
Teresa Garlington, Administrative Secretary

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 100 of 101

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

Arizona Child Fatality Review Program, Nineteenth Annual Report , November, 2012 - Page 101 of 101