Dr. Mary-Fran Crosswell, Child Abuse Pediatrician and Chair of the South Carolina State Child Fatality Advisory Committee

Enacted in 1993 by South Carolina Code, the State Child Fatality Advisory Committee reviews completed investigations of deaths involving children aged 17 years and younger that are unexpected, unexplained, suspicious or criminal in nature.

As the chair of the South Carolina State Child Fatality Advisory Committee, I would like to share the topline findings of our 2024-2025 Annual Report.

This report is a solemn reminder of the challenges we face in preventing child deaths and a call to action for all of us committed to the safety and well-being of our children.

Over the past two years, our committee reviewed 473 cases of child fatalities occurring between 2019 and 2024. As a committee, we work to identify patterns in child fatalities that will guide efforts by agencies, communities, and individuals to decrease the number of preventable child deaths.

Key Findings of this Annual Report

Of the 473 cases reviewed, 24% were accidental deaths (not including motor vehicle accidents, which are categorized separately). The most frequent cause of accidental death was related to unsafe sleep environments for infants, reflected in 45% of all accidental deaths.

The next leading cause of accidental deaths was drowning, which occurred in 23% of accidental deaths, with the majority of those children being under the age of 5 (61%).

We continue to see the deadly impact of fentanyl on our youth. Overdoses accounted for 9% of accidental deaths, most commonly involving fentanyl, with teenagers being the most affected group.

Homicides accounted for 20% of all the deaths we reviewed. Most of these cases involved gun violence.  Suicide remains another devastating cause of death for the children of South Carolina, accounting for 10% of the fatalities reviewed, with self-inflicted gunshot wounds being the most common method.

Trends in Motor Vehicle Deaths

We also reviewed 104 motor vehicle deaths, with two major trends persisting. First, many young children involved in fatal crashes were unrestrained. Second, teenage drivers continue to face significant risks, especially related to distracted driving, speeding and failure to use seatbelts.

This is an area where we must improve public education and reinforce the importance of safety measures, such as seatbelt use and safe driving practices.

Infant Sleep-Related Fatalities

One important area of focus for the committee this year has been on infant sleep-related deaths. These fatalities represent a significant portion of both accidental and undetermined deaths.

Unsafe sleeping environments—whether it’s co-sleeping, improper bedding or the absence of a safe sleep surface—contributed to far too many deaths. We must do more to educate caregivers on safe sleep practices and provide resources to ensure every infant has a safe place to rest.

The Toll of Gun Violence

Another trend the committee found disturbing was the recognition of gun violence as a leading cause of death to children across multiple manners of death. Twenty-eight percent of all non-motor vehicle deaths were caused by gunshots, highlighting the fatal complication of access to guns for our youth.

The committee spent considerable time evaluating prevention strategies, with recommendations including improved education around safe storage of weapons, increased funding for parenting programs, and improving access to mental health for our youth.

Addressing the Racial Disparities

The report shows disproportionate death rates in minority children across multiple manners of death.

Our committee sought a bill—recently passed and signed into law—to add a representative from the South Carolina Commission for Community Advancement and Engagement, formerly the SC Commission for Minority Affairs, to the State Fatality Advisory Committee, with goal of assisting the committee in identifying effective prevention strategies for all of South Carolina’s children.

Protecting Children and Reducing Preventable Deaths

What are the next steps to protect our children from preventable deaths?

First, we must continue to support voluntary, evidence-based home visiting programs to educate new parents on safe sleep and child safety and continue to improve the messaging and stress the importance of safe sleep environments for every infant.

We must strengthen our campaigns around water safety, motor vehicle safety, substance abuse prevention and mental health awareness.

Finally, we must take an even deeper look into strategies to protect our children from gun-related deaths. 

This report is a call to action for all of us. Our children are depending on us to do better. Together, we can reduce preventable child deaths and create a safer future for South Carolina’s youngest citizens.