This research was begun with the assistance of Susan Gallagher while the author worked at Children's Safety Network, Education Development Center, Inc. Additional information on cases is always welcome: email the author at guardwilliams@rcn.com or telephone (781) 478-2126.

Abstract: A trained librarian conducted searches over the Internet through news databases and other sources for information on heat stroke deaths to children in the passenger compartment of motor vehicles. This analysis foucuses on 79 deaths among children aged 4 or younger in the US from 1984-2000. Distinct patterns were found distinguishing deaths occurring to children who gained access to the vehicles themselves from children who were left behind by adults. More than 1/4 of the adults responsible were daycare providers, van drivers, or babysitters. There were also differences in the profiles of children who were left for less than two hours vs. those who were left as long as ten hours. Deaths to children in hot cars are preventable, but different strategies need to be employed to counter the varying circumstances.

Methodology: A trained librarian conducted searches over the Internet through news databases and other sources for information on heat stroke deaths to children in motor vehicles. Information on the circumstances, victim, caregiver, temperature, location, vehicle, legal charges and other details were gathered and entered into a database designed by the author. WONDER was searched for deaths coded E.900.0-900.9 to children under age 5 for 1979 - 1997 and Medline was searched for relevant literature. The National Pediatric Trauma Registry was searched by request; the author searched the Johns Hopkins Autopsy Resource database and child fatality review team reports as available; messages were also posted on listservs for injury prevention and child death professionals, seeking additional cases. Excluded from this analysis are: non fatal cases, international deaths, deaths occurring in the trunks of vehicles, and incomplete records. There are 79 cases with sufficient information to allow inclusion in this analysis.

Results: The deaths fell into three broad categories of circumstances:

1) Children playing, who let themselves or others into unlocked vehicles (20 cases). Most of these children were toddlers, ages two and three. There were five incidents involving deaths to two children each. Most of the children were in the vehicle for less than two hours. Patterns that were identified related to this group of deaths included distracted or sleeping parents, unlocked vehicles (including abandoned cars) and in some cases, design features of the vehicle that helped entrap the children.

Sample cases:

Record #65. Florida, 1998. On a hot June day, a mother and children were at their backyard pool. A 2-year-old girl wandered off and climbed in the open door of a minivan in the driveway. The door slid shut behind her. She was found within 15 minutes but died. No charges were filed.

Records #85 and 86 Illinois, 1999. On a July day, a 2 1/2-year-old boy and his 1 1/2-year-old brother disappeared from a fenced backyard. More than 100 emergency personnel searched for over an hour before opening the family vehicle. The deaths were ruled accidental.

Records #133 and 134. Washington, DC, 1995. A mother of five children was filling the backyard pool on a July morning. A 2-year old boy and 4-year-old girl were missing. The mother searched for several hours before calling 911 at 4:30. The children were found in a neighbor's disabled car. Neighborhood residents said that children often played in abandoned vehicles because they were afraid of bullies and drug dealers in the parks and playgrounds. The remaining children were removed from custody while the investigation continued.

2) Children who were left in vehicles by adults who were aware that they were doing so (24 deaths). The adults sometimes intended to leave the child (who was usually sleeping) for only a brief time but became distracted with work or fell asleep. There were two cases involving twins. In one-third of the cases, the children were left for longer than eight hours. Patterns found in this grouping included six cases in which the parent had marginal housing (staying with a boyfirend in a motel, with friends, having the children sleep in the car, etc.), seven cases in which the parent went to work, and five cases where the mother was aged 21 or younger. Legal charges were brought in 21 of the cases; the mother was charged in eleven of the deaths and the father for five.

Sample cases:

Record #11. New Hampshire, 1997. A mother did not want to disturb here sleeping 2-year-old and left the girl in a running car on a March day. The car was left in the sunshine with the heat on for one hour in the home driveway. No charges were immediately brought.

Record #57. Louisiana, 1998. A father was bringing his 18-month-old son to daycare on a July morning. He stopped at his new business to check on something and became embroiled in a problem, forgetting the child for three hours until 1:30 in the afternoon. Charges of negligent homicide were filed but no action had been taken a year later.

Records #4 and #5. Tennessee, 1995. A 20-year old mother of a 1-year old boy and 23-month-old girl went to visit her boyfriend at a motel at 4:30 a.m. in June. She left the children in their car seats and locked the car, which had tinted windows. She fell asleep with the boyfriend and did not wake up for eight to ten hours. At the trial, her history of alcohol abuse and mental health issues were detailed. She was convicted of aggravated child abuse.

3) Children who were left in vehicles by adults who were unaware that they were leaving a child (22 cases). These events sometimes occurred when the adult thought the other parent was taking the child to daycare, when they were so impaired that they didn't realize the baby was in the car, or the baby fell asleep and the adult forgot about their passenger by the time they reached their destination. There were no multiple cases. Four children were left for more than eight hours.

Patterns included:

impaired adults

multiple other children present in 12 cases

three cases involving foster parents

two cases with children with special health needs.

Charges were brought in five cases, not brought in eleven, and unknown for six cases. In several incidents, charges were recommended but not filed.

Sample cases:

Record #48. Arizona, 1996.A family with nine children returned from church at noon in August. A 14-month-old boy was sleeping in his car seat, and there was confusion over who was responsible for bringing him inside. He was found on the backseat seven hours later.

Record #34. Texas, 1999. A mother left a party at 3 a.m. after drinking and headed home, 40 miles away, with her 8-month-old and 3-year old. She felt sleepy and parked the car, and then accepted a ride from a passerby. She brought the 3-year old with her and locked the car. The next day she couldn't remember where she had left the car or baby. A deputy found the baby in his child safety seat in the car at 2:30 in the afternoon. The mother was charged with reckless injury to a child; CPS was investigating whether to leave the toddler in the home.

There are thirteen additional cases in which it was not clear whether or not the adult was aware of the child's presence when they left the vehicle.

A secondary analysis examined the 59 cases in which adults left the children in vehicles, whether they were aware of it or not. Of the twenty cases involving girls, 37% were left for eight hours or longer. Of the 39 cases involving boys, 18% were left for longer than eight hours.

Twenty-seven percent--16 deaths--of cases in which an adult left a child in a vehicle involved daycare providers, babysitters, daycare van drivers, and/or chaperones.

Ten cases involved licensed facilties or providers. Five were informal caregivers; one was undetermined.

There were 8 girls and 8 boys; their ages ranged from 4 months to 3 years, with a mean of just over 20 months.

Caregivers were charged in 5 cases.

Eleven deaths occurred on a van or school bus.

Eleven cases occurred in southern states

Children were left from 30 minutes to 10 hours with a mean of almost 4 hours, and one unknown length of time.

Conclusion: News stories can give a richness of detail not available through WONDER, including circumstances in which the child gained access to or was left in the vehicle; details on the child, vehicle, and parent; legal charges; length of time child was left, and how child was found. Newspapers also cover some non fatal cases. Names of investigators are often included which coud be used for follow-up. Finally, WONDER, currently has no data newer than 1997. Using Internet-based news sources the author has identified deaths as recent as eight weeks ago.

There are disadvantages: The legal outcome of nonfatal cases may be obscured. Multiple stories covering the same case sometimes contain confliciting information. There is no single national newspaper indexing database so the searcher must use multiple venues to gain maximum coverage. A lack of controlled vocabulary also presents obstacles for searcing. The use of Internet news sources tends to slant the data in favor of recent years, as more newspapers publish on the Net. Coverage of one death can prompt increased reporting of similar events, giving the appearance of a trend where one may not exist.

RECOMMENDATIONS:

Hot summer safety tips from health departments, pediatricians, and others should include routine reminders to parents and caregivers to:

Keep cars locked when not in use

Avoid leaving infants and young children in cars

Look in the car first if a toddler goes missing.

EMS, police and 911 operators should encourage parents to immediately search the car when children are missing, especially on hot days.

Child death review teams should review all child deaths in enclosed spaces.

Heat stroke prevention can be promoted along with child safety seat promotion, through auto dealers and manufacturers, and through parent education classes.

Reasonable guidelines should be developed and promoted in collaboration with parents. Messages should emphasize:

Cars are inappropriate places for children to play -- keep the car locked -- or to nap -- bring the sleeping child to a spot where they will stay safe.

Author: Anara Guard, MLS, Safetytips.com.
Presented at the International Child Passenger Safety Technical Conference
Arlington, TX
June 2000.
Reprinted with the permission of the author.
Contact the Author:guardwilliams@rcn.com
or telephone (781) 478-2126.