In 1990 to 1995, the homicide rate for children aged 1 to 14 in the United States was five times the rate in other industrialized countries (CDC, 1997). The rate of suicide was twice as high for the United States. Although the overall death rate for children decreased substantially during 1950 to 1993, homicide rates tripled and suicide rates quadrupled. More recently, child deaths due to homicide have been declining (NCHS, 2001c). Firearms are the major cause of homicide deaths among children in the United States. Gunshot wounds account for 5 percent of pediatric injuries seen in emergency departments and produce the highest death rate due to injury (NPTR, 2001).5
In 1999, homicide was the fourth leading cause of death for children aged 1 to 4 years and was also the fourth leading cause for 5- to 9-year-olds, who had the lowest rate among children. Homicide mortality was nearly threefold higher (2.5 deaths per 100,000, or 376 deaths) for children aged 1 to 4 years than for the 5 to 9 age group (0.9 per 100,000, or 186 deaths). As discussed below, homicide mortality rates vary not only by age but by sex and other characteristics.
Although young children are less likely to be victims of violence than are adolescents, when they are victims, parents and other caretakers are more likely than acquaintances and strangers to have inflicted the abuse, especially for children aged 1 to 4. Within the category of parents and other caretakers, analyses of data from the Federal Bureau of Investigation indicate that parents accounted for 60 percent of the abuse reported to the police, and stepparents and boyfriends or girlfriends of parents accounted for 19 percent (Finkelhor and Ormrod, 2001). As discussed in Chapter 8, such abusive situations present ethical and legal problems related to normal parental responsibilities for decisions about children’s medical care.
The age groups 10 to 14 and 15 to 19 include the adolescent years. Adolescents can, however, be categorized differently based on social, biological, or developmental criteria. For example, those age 18 and older are legally adults. In most states, they can obtain a driver’s license at age 16. Still, pediatricians may continue to care for patients with complex chronic conditions even after they have entered early adulthood.