Learning From Tragedy: A Survey of Child and Adolescent Restraint Fatalities

• NCJ Number: 216992
• Journal: Child Abuse & Neglect Volume: 30 Issue: 12 Dated: December 2006 Pages: 1333-1342
• Author(s): Michael A. Nunno; Martha J. Holden; Amanda Tollar
• Date Published: December 2006
• Length: 10 pages
• Publication Format: Article
• Publication Type: Case Study
• Language: English
• Country: United States of America

Annotation

This study examined 45 deaths of children and adolescents related to the use of physical or mechanical restraints in residential (institutional) placements in the United States from 1993 to 2003.

Abstract

The study found deficiencies in the reporting of deaths in institutions, it recommends reporting fatalities to an established State child fatality review board, and proposes that the use of restraints be governed by strict protocol and monitoring. The cause of death was confirmed by a reported autopsy in 41 of the cases. In 25 cases, the cause of death was asphyxia (lack of oxygen or excess of carbon dioxide in the body that is usually caused by interrupted breathing that causes unconsciousness). Cardiac arrest was the cause of death in 10 cases, and the remaining deaths were caused by exertion, blunt trauma, internal bleeding, hyperthermia, or sudden death. Physical restraints were implicated in 38 of the 45 fatalities. In six of the deaths, mechanical apparatus or restraints were used that involved cloth or Velcro straps, a mattress, handcuffs, leather straps, or a wheelchair. Staff rationale for the use of a restraint was known in only 23 of the 45 cases. In these cases restraints were used because the child refused to comply with staff or program requests and because the child engaged in a combination of aggressive and noncompliant behavior. None of the behaviors or conditions that prompted restraints met the standard of danger to self or others, which are the commonly accepted criteria for the use of a restraint. Study data were obtained from approximately 160 State agency commissioners and directors in the 50 States who were responsible for governing or regulating child welfare, juvenile justice, mental health, and mental retardation facilities. Case data were also obtained through Internet search engines and electronic news archives. 1 table and 27 references