An autopsy-based study on child mortality under six in Taiwan: Forensic autopsy findings and the complexities of causal determination

AI Summary

Respiratory diseases (35.1%), asphyxia (23.0%), and brain injuries (11.1%) were leading causes; infants predominated; milk aspiration caused 64.3% of asphyxia deaths.
Most deaths occurred at home; seasonal and temporal patterns observed for respiratory, asphyxia, sudden death, multiple trauma and brain injury cases.
Study warns possible over-attribution from pathology alone and calls for standardised diagnostic frameworks, integrated clinicopathological assessment, and caregiver education to prevent avoidable deaths.

J Formos Med Assoc. 2026 Jun 23:S0929-6646(26)00688-1. doi: 10.1016/j.jfma.2026.06.032. Online ahead of print.

ABSTRACT

BACKGROUND: This autopsy-based study investigated causes and risk factors for mortality among children under six years of age in Taiwan, using forensic data from the Institute of Forensic Medicine, Ministry of Justice, between 2020 and 2023. Autopsies can identify causes not captured in clinical records.

METHODS: A total of 305 forensic autopsy cases of children under six years of age were retrospectively reviewed, excluding stillbirths. Demographics, causes and manners of death, and contextual factors (scene, season, and time) were analyzed. Odds ratios and chi-square tests were used to assess associations.

RESULTS: The most common causes of death among the autopsied cases were respiratory diseases (35.1%), asphyxia (23.0%), and brain injuries (11.1%). Infants under one year comprised the majority of cases. Asphyxia occurred primarily in infants, with milk aspiration accounting for 64.3% of asphyxia-related deaths. Children aged 1-6 years showed higher proportions of asphyxia and trauma than other groups. Most deaths occurred at home. Seasonal trends were noted for respiratory diseases, sudden death, multiple trauma, and brain injuries, while temporal trends were observed for respiratory and asphyxia deaths. Homicides accounted for 8.2% of cases, with male predominance.

CONCLUSION: Respiratory diseases, asphyxia, and brain injuries were the most common causes of death among autopsied children under six in Taiwan. The high proportion attributed to respiratory diseases and milk aspiration may indicate over-attribution based on pathology alone. These findings highlight the need for standardized diagnostic frameworks and integrated clinicopathological assessment. Public health strategies should prioritize caregiver education and prevention of avoidable deaths.

PMID:42336745 | DOI:10.1016/j.jfma.2026.06.032

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