The research, published in Emergency Medicine and Frontiers in Sociology [20 April], reveal a concerning rise in knife-related fatalities among children under 17, from 21 deaths in 2019/20 to 36 in 2023/24, and highlight the social and environmental factors that put young people at risk.
In the Emergency Medicine Journal study, researchers from Bristol Medical School examined the demographics and pre-injury, injury, and post-injury factors associated with the deaths of 145 children and young people under the age of 18 who died from knife wounds in England between April 2019 and March 2024. The study is the first to analyse data from the National Child Mortality Database (NCMD) together with hospital, social care and police data to identify potential strategies to prevent the number of children and young people who die from knife injuries in England.
Of the 145 young lives lost, 90% were male, with an average age of 14.4 years. Three quarters of deaths (75.9% 110 young people) were from areas facing the greatest levels of poverty in England, with rates of death 8 times higher in these areas. There were 47 (32.4%) children and young people from Black or Black British ethnicity who died and 45 (31.0%) children and young people from White ethnicity.
When analysed on a population basis, children and young people of Black or Black British ethnicity were around 13 times more likely to die of knife related injury than children and young people of White ethnicity, reflecting social and environmental inequalities. The rate of death was around 14 in every 1 million Black and Black British children and young people each year compared to 1 in every 1 million for children and young people of White ethnicity. London was the region where the majority (62 young people, 42.8%) of all deaths from knife injuries occurred.
Most children who were victims of knife-related deaths were involved with statutory services prior to injury, with possible intervenable points prior to death.
When the researchers looked separately at data from London and the rest of England, and by ethnic background, they found the highest death rates were among Black or Black British children and young people living in London, around 18 in every 1 million each year. The lowest rates were seen among White children and young people living outside London, fewer than 1 in every 1 million each year.
Of the 57 cases available for detailed analysis, injuries to the chest and neck caused 75.9% of deaths (44 young people) and 60.3% (35 young people) died before reaching hospital. Post-mortem data showed that 69.1% (38 young people) died from a single fatal wound underlining how quickly one knife injury can become deadly.
There were 53 school aged children, of whom almost half 47.2% (25 young people) had been excluded from school for periods prior to their death.
Adverse childhood experiences were common among these young people. The most common adverse childhood experience was a documented history of domestic violence and abuse (DVA) which was present in 57.9% (33) of cases. Children experienced physical abuse at home in 37.0% (21) of cases and 1.7% (1) of children and young people had experienced documented sexual abuse.
The loss of a key adult figure (through separation or bereavement) was recorded in 50.9% (29) of cases. A quarter of children 24.5% (14) lived with an adult with mental illness, and nearly a third 31.57% (18) lived in a household with substance abuse. Neglect was experienced by 17.5% (10) of children and young people and 8.8% (5) experienced emotional abuse.
Gang involvement was mentioned in 36.8% (21 young people) of case files, while 68.4% (39 young people) children and young people had documented involvement in illegal substances. Concerns about carrying knives were recorded in 25.5% (14 young people) of cases. More than half (59.6%, 34 young people) had both experienced and perpetrated violence.
The findings indicate that the group at highest risk of experiencing a fatal stab wound in England are children and young people of Black/Black British ethnicity who live in urban areas of deprivation. Many of the children and young people that died were exposed to multiple difficult childhood experiences before death and were well known to statutory services.
Dr Tom Roberts, NIHR Academic Clinical Lecturer in Emergency Medicine at Bristol Medical School: Translational Health Science (THS) at the University of Bristol and A&E clinician at North Bristol NHS Trust (NBT) and lead author on the study, said: "Knife-related fatalities among children and young people are a significant public health concern. Our research identifies where action could be taken to prevent future tragedies and demonstrates the urgent need to support children facing adversity and marginalisation. Despite frequent contact with services, many children received no targeted support for adverse childhood experiences, especially domestic violence and abuse, revealing major gaps in early intervention."
Dr Edd Carlton, Consultant Senior Lecturer in Emergency Medicine at Bristol Medical School: Translational Health Science (THS) at the University of Bristol, A&E clinician at North Bristol NHS Trust (NBT) and co-author on the study, added: "Our findings show how dangerous carrying a knife can be, a single stab wound can prove fatal. It also emphasises the urgent need for prevention strategies that address the social, environmental, and structural factors behind these deaths. Reducing health inequities could help tackle the underlying risks faced by young people. The study also gives clinicians a clearer understanding of the potentially injured structures that can quickly become life-threatening."
Multiple forms of violence linked to child knife‑crime deaths
The second study in Frontiers in Sociology, examined the circumstances around the 58 deaths of children under 18 in England who died from knife injuries between 2019 and 2024 and had detailed NCMD case files. The research explored how and why these children died, and the different types of violence they may have been exposed to at home, school or in their communities.
Importantly, the study revealed that 58 children who died had experienced some form of violence or harm during their lives. More than half (59%) had faced multiple types of harm, and 59% had also harmed others, with a third doing so in more than one way. This overlap, being both a victim and a perpetrator, highlights how complex children's experiences of violence can be.
Most children (81% 47 young people) had experienced at least one form of violence, in the community, separate from the school environment, either as a victim, a perpetrator, or both.
The research showed that children's experiences of harm were often not fully recognised or responded to. Many were both victims and perpetrators in different settings, the home, school, or community, but services often focused only on one aspect of their experience. As a result, children were frequently overlooked, support was fragmented or repeated, and in some cases, not provided at all.
These gaps meant that children's overlapping experiences of harm weren't recognised early enough, preventing timely and effective intervention. The findings underline the urgent need for a joined‑up, child‑centred approach that considers the full range of violence children may face and addresses the underlying causes, rather than reacting to individual incidents in isolation.
Dr Jade Levell, Senior Lecturer in Social and Public Policy (Criminology and Gender Violence) in the School of Policy Studies at the University of Bristol, and lead author of the Frontiers in Sociology study, said: "Our analysis shows that many of these children experienced multiple forms of violence across home, school, and community before their early deaths.
"Although it is not possible to conclusively say whether a specific intervention would have made a difference, it is plausible to believe that appropriate interventions that acknowledge the extent of violence cutting across different domains of home, school and community in some children's lives could have made a positive difference.
"Preventing these tragedies requires urgent, family-centred action. Providing at-risk children with access to specialist, child-focused support, particularly around domestic violence and abuse, could help shape better strategies to prevent future child knife-crime deaths."
Professor Karen Luyt, Programme Director for the National Child Mortality Database, Professor of Neonatal Medicine at the University of Bristol and Healthier Childhoods lead at NIHR ARC West, added: "Every child's death is a profound loss. By learning from every child death, we can identify where systems, services and support need to be improved to protect children's lives."
Papers
'Pre-Injury, injury and post-injury factors leading to death in children and young people who were victims of knife crime in England between 2019-2024: a review of the National Child Mortality Database' by T Roberts et al. in Emergency Medicine Journal [open access]
'Childhood violence across distinct, overlapping, and concurrent contexts: polyvictimization, polyperpetration, and missed interventions points among child knife crime fatalities in England' by Jade Levell et al. in Frontiers of Sociology [open access]
Policy research briefing
'Going beyond 'safer streets': reducing fatal knife injuries among children and young people in England' by Dr Tom Roberts, Dr Jade Levell in PolicyBristol
