The leading cause of “unexpected or unusual” death among children in Baltimore is homicide, a tragic conclusion of the latest five-year report from city officials that explores how children die.

There were 208 such deaths among children under age 18 in the latest period ending in 2020, and the majority were among Black residents and other nonwhite groups, according to the Child Fatality Review Report.

A panel of officials led by the health department have long met to discuss the circumstances of each death, and the report is the sum of the panel’s conclusions. The report also outlines action being taken or planned to reduce the fatalities.

“As a city, we continue to lose too many of our young people to violence and neglect. These are children and teenagers who will never be able to grow up and realize their full potential,” said Mayor Brandon M. Scott in a statement.

“This report and its recommendations tie directly into our shared vision for equity throughout our city,” he said. “An overwhelming majority of the young people we lose to violence each year are children of color. We cannot lift our Black and Brown communities out of poverty and overcome systemic disinvestment without specifically prioritizing the safety of our youth.”

Of the 208 deaths, there were 69 homicides among children in the five-year span. That compares to the overall city homicide count that has exceeded 300 for each of the past seven years.

Among the children, there were also 60 sleep-related deaths; 40 accidents such as drownings, car crashes and accidental shootings; 20 natural deaths from undiagnosed conditions and asthma; 12 undetermined deaths; and seven suicides.

The city already has many prevention programs in place, such as B’more for Healthy Babies, the long-standing effort to reduce sleep deaths including sudden infant death syndrome. Scott said he plans to expand the city’s violence prevention efforts, in part by using American Rescue Plan funding.

The report does note a drop in the child fatalities in the most recent period compared to 2011-2015, when there were 236 deaths.

But city and health officials, who also partnered with the nonprofit LifeBridge Health’s Center for Hope, said that wasn’t good enough.

“The death of a child is a sentinel event, representing the worst possible outcome,” said Dr. Letitia Dzirasa, Baltimore’s health commissioner, in a statement.

“Unfortunately, many of these deaths are preventable,” she said. “We know that one child’s death affects that child’s family and the community as a whole. We also know that one death is one too many.”

The report noted that Baltimore’s 300th homicide victim of 2021 was a 5-year-old girl who suffered from abuse and neglect.

New programs expand on the notion that violence is a matter of public health. Priorities outlined in the report include: better support for parents, especially those involved in substance use or sale; earlier intervention by city agencies in families with children at risk of harm; prioritization by health care agencies and providers in preventing fatalities; and offering more opportunities for youth to instill hope for the future.

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