I was happy to see that the legislature reviewed and passed a draft amendment to Article 13 of the Protection of Children and Youths Welfare and Rights Act (兒童及少年福利與權益保障法).
The amendment requires the Ministry of Health and Welfare to review the cause of death of children who die before the age of six and regularly announce the results. This is the first step toward conducting child death reviews (CDR), an effective method to prevent child and youth deaths.
Child death reviews collect information on the deceased, law enforcement personnel, the courts, child protective services and caretakers. Then, through a systematic discussion across organizations and fields of expertise, it identifies causes of child death that can be addressed and corrected.
The discussion might uncover matters such as child abuse, while a corrective measure might seek to improve a piece of equipment, an environment, a medical treatment or a public safety step. The process should be followed by an administrative action aimed at improving the situation and preventing similar tragedies from occurring.
A 1990 study into the causes of child deaths in North America found that deaths caused by child abuse were far more common than reported. The results prompted the US to introduce a CDR system in 1993. The importance of this system has been verified in several countries.
Two years ago, Linkou Chang Gung Memorial Hospital began to expand its child protective services. Since then, we have continuously highlighted the importance of introducing a CDR system.
Meanwhile, the hospital’s Child Protection Center has begun to review the hospital’s child emergency patients and conduct CDRs on child patients who suffer cardiopulmonary arrest prior to their arrival, collecting data, talking to family members and analyzing the causes of death.
The hospital last year published a CDR report on 152 children who suffered cardiopulmonary arrest prior to arriving at a single emergency room from 2005 to 2006. Among the cases, 55.3 percent were boys and 47.4 percent were less than one year old. The study found that 76.3 percent of child deaths occurred at home.
The three main causes of death before arrival were sudden infant death syndrome, unclear causes of death and trauma. The survival rate of children suffering cardiopulmonary arrest prior to their arrival at the emergency room was extremely low — 13.8 percent — as it is associated with poor neurological outcomes.
Studies have found that up to 35.5 percent of all child deaths are caused by trauma, child abuse, suffocation, drowning, hypoxia, fire or curtain cord strangulation. These deaths are preventable.
To effectively prevent such tragedies — and to expose deaths caused by abuse and other crimes — the government’s most urgent task is to recognize the importance of establishing a CDR system.
Lee Jung is director of Linkou Chang Gung Memorial Hospital’s Division of Pediatric General Medicine.
Translated by Perry Svensson
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