Learning from Tragedy: A Twenty Five-Year (1993-2017) Survey of the Fatal Restraints of Children and Young People in the United States

Physical restraint, the use of staff to hold a youth to contain acute physical behavior that is likely to result in injury to the youth or others, has been used in residential and school settings as a safety intervention. Yet, restraints can have harmful or even fatal consequences when physiological risks are unknown or ignored.

The study’s purpose is to learn from restraint fatalities to inform training, policy, regulation, and practice. We report 25-years of child (1993-2017) restraint fatalities in residential facilities, community schools, and foster care. Since there is no central reporting for restraint fatalities in the USA we used media reports and other public documents to discover 74 fatalities.

The study’s findings show 1) a dramatic decrease in restraint fatalities over the 25-year period, 2) where fatalities occur there is a higher likelihood of inherent problems with training, supervision, and high restraint use coupled with a lack of understanding of basic physiological risks. There is some evidence that the cumulative impact of severe trauma increases the risk to children.

Since there is no reliable central reporting system this methodology and its findings are a valuable resource for policy, training, and practice.