‘It was just not a good year for children’
Deaths among Arizona’s young increased in 2020
“There’s a lot we need to do, and can do, to decrease the suicide deaths and improve mental health in children.” Dr. Mary Ellen Rimsza
Pediatrician and chair of the Arizona
Child Fatality State Team
COVID-19 killed 12 Arizona children under age 18 last year, and the pandemic indirectly caused at least 29 other child deaths, a new state report says.
The 28th annual Arizona Child Fatality Review analyzes the deaths of all 838 children ages birth through 17 who died during the calendar year of 2020, which included the first 91⁄2 months of the COVID-19 pandemic. Both the rate and number of overall child deaths in Arizona rose between 2019 and 2020, the report’s authors wrote.
“It’s disturbing because we have increased child deaths. We had been dropping steadily, so that is the most disturbing factor,” said pediatrician Dr. Mary Ellen Rimsza, chair of the Arizona Child Fatality State Team.
“It kind of fits with what’s been happening nationally in terms of deaths that we’re seeing during the pandemic — more substance abuse, more suicides.”
Deaths from firearms, motor vehicle crashes and suicides all rose in 2020. Racial disparities, an ongoing problem with child deaths in Arizona, continued in 2020 with Native American, Hispanic and Black children dying at rates disproportionate to their population.
The motor vehicle crash death rate increased by 54%, firearm mortality by 41% and the suicide rate grew by 30% between 2019 and 2020, the state report says.
“There’s a lot we need to do, and can do, to decrease the suicide deaths and improve mental health in children, which was especially problematic during all the pandemic,” Rimsza said.
“We know nationally there’s been an uptick in suicide deaths in both children and adults due to the COVID pandemic ... Children are especially hard hit when they can’t be around their peers. It was just not a good year for children.”
Poverty: A risk factor for childhood deaths
The report includes a section on COVID-19, which says that more than half of the children under age 18 who died from COVID-19 in Arizona in 2020 were younger than 12 years old and half were living in a rural part of the state.
The most common risk factor, in COVID deaths and deaths from other causes, was poverty, the report found.
“We have a high child poverty rate in our state that I think needs to be addressed as kind of an overarching issue,” Rimsza said. “Lack of access to health care, particularly in rural areas, especially was borne out with deaths due to COVID.”
The review team found 12 deaths of children in Arizona directly related to COVID-19 infection in 2020, which works out to a rate of 0.73 deaths per 100,000 children — more than twice the national mortality rate of 0.27 deaths per 100,000 children, the report said.
The report defines a direct COVID-19 death as a death where infection by the SARS-CoV-2 virus that causes COVID-19 was the immediate or underlying cause of death of the child, including cases where COVID-19 was diagnosed at autopsy or the child was suspected to have COVID-19, or the birth parent contracted COVID-19 during pregnancy.
An investigation of death certificates and cases found “strong evidence” that 29 child deaths in Arizona were indirectly related to the pandemic, including deaths that occurred during school closures when the children may not have died had they been physically in school.
Those deaths included poisonings, motor vehicle crashes and suicides.
“We always review natural deaths, which is what a COVID death is because it is a medical death. But we reviewed it in far greater detail, going over the information to try to pick up these indirect COVID deaths especially,” Rimsza said.
“Although this is a national standard that the National Child Fatality Review Program has set up, they said we were one of the first to look at this information.”
Because of limitations on available information to provide context for all the deaths, the 29 deaths classified as indirect COVID-19 fatalities may be an undercount for that category, the review team wrote in the report.
Deaths due to child abuse, neglect declined slightly
Two positive trends in the report were that deaths because of child abuse and child deaths in unsafe sleep conditions declined between 2019 and 2020, Rimsza said.
In 2020, 95 deaths of children under age 18 were due to child abuse or neglect, which was a 5% decrease from 2019, according to the report. Nearly three-quarters of the children who died of abuse or neglect were younger than 5.
The report includes a long list of recommendations for families and policymakers.
Among actions that could help prevent future child deaths, the report suggests:
Providing more funding to the Department of Child Safety to retain highly effective staff, because its workforce is charged with “making very difficult decisions concerning child safety that can help reduce child abuse and neglect.”
Getting vaccinated. Parents should get vaccinated and have their children vaccinated as soon as it is available for their child’s age group to prevent COVID-19 infection or hospitalization.
Wearing face coverings. Children should wear a face mask outside the home when they are in indoor settings or crowded outdoor settings and when traveling on school buses, planes, trains or other forms of public transportation and while in transportation hubs such as airports and bus stations.
Offering community-based firearm safety events. The events could increase the number of firearm owners that are receiving safe storage practice training and education.
Educating children, parents, and caregivers on safe pedestrian practices, including avoiding distracted walking.
Improving community awareness of prescription drug misuse.
Implementing universal screening for substance use and mental health issues during adolescent well visits to health-care providers.
Offering evidence-based, best practice suicide prevention training to school staff and making them aware of resources like the suicide prevention toolkits developed by the Substance Abuse and Mental Health Services Administration and the American Foundation for Suicide Prevention.