Objectives: To identify causes and trends of violent deaths among children younger than 4 years in a northern region.
Study design: Retrospective analysis of medico-legal autopsy and police data.
Methods: Data from all 72 deaths from "external causes" 1977-2004, in children < 4 years from the northern half of Sweden were analysed.
Results: The death rate was 7.1 per 100,000 children and year during the first half of the study period, and 5.2 during the second half. Vehicle- and drowning-related deaths were halved. Fifteen were struck by motor vehicles (in 8 cases by heavy vehicles), 14 car occupants were killed in car crashes, 12 were killed by intentional violence inflicted by an adult, and 9 each were killed by (i) carbon monoxide/smoke inhalation, (ii) asphyxiation, or (iii) drowning. The boy:girl ratio was 1:1 in all groups, except in the groups "drowning" and "run over by motor vehicle", where boys dominated.
Conclusions: Medical professionals have a difficult but important task in identifying and taking action against child abuse and in promoting child safety especially in the traffic and home environments.