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Child Fatality Reviews Teams are multidisciplinary. Some investigate deaths primarily related to injury and  maltreatment and others review all child deaths

ITASCA, IL--Each year, more than 40,000 U.S. children under age 19 die from various causes, many of which are identified as potentially preventable during a process called a child fatality review.

The American Academy of Pediatrics describes the extensive work that goes into investigating children’s deaths and the significant role played by the pediatrician within an updated policy statement, “Child Fatality Review,” published in the March 2024 Pediatrics (published online Feb. 20).

Policy statements created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.  

“The child fatality review provides much more medical context and detail than what you’ll find on a death certificate,” said Erich K. Batra, MD, FAAP, lead author of the policy statement, written by the AAP Section on Child Death Review and Prevention; AAP Council on Injury, Violence, and Poison Prevention; and AAP Council on Child Abuse and Neglect.

“The review process helps us identify deaths that could have been prevented and work toward developing solutions within communities, social services and public health policies.”

For instance,  approximately 3,600 infants die suddenly and unexpectedly each year, usually during sleep, and child fatality reviews help explain possible causes. While a death certificate will contain vital statistics on a sudden unexpected infant death (SUID), a child fatality review will probe for underlying causes by asking questions such as: if a crib or bassinet met federal safety standards; whether the infant was put to sleep on their back but was found with the mouth and nose partially or fully obstructed by an object; or whether there was another person sharing their sleep environment.

Child Fatality Reviews Teams are multidisciplinary and often include coroners/medical examiners, law enforcement officers, child protective services staff, public health workers and health care providers. They have also investigated automobile collisions; inflicted injuries; drownings; suicides; and maltreatment. Some review teams restrict their investigation to issues primarily related to injury and maltreatment, and others review all child deaths regardless of presumed primary cause.

A multidisciplinary team conducts the reviews by sharing records and deliberation. The reviews provide contextual data, family history, data on underlying health or psychosocial vulnerabilities and community systems. These factors are especially important to examine and identify root causes of death, given that systemic racism and health disparities are affecting Black, Hispanic, and American Indian and Alaska Native children.

In 2018, 42 states reported that they used their child death fatality data to identify risk and protective factors in child drownings.

The AAP recommends:

  • All local, state, and tribal Child Fatality Review teams should include pediatric physician representation.
  • Pediatricians and AAP chapters should use recommendations from the review teams to inform local, state, tribal, and national policies and legislation to reduce preventable child deaths and improve children’s health.
  • State and federal policy that compensate members of the review teams for their time and expertise.
  • Every child’s death should be investigated as appropriate and as resources allow. This includes a timely autopsy and a report by a certified pediatric forensic pathologist in appropriate cases, when available, especially those that are unexpected (including SUID), suspicious, obscure or otherwise unexplained.

The policy statement provides recommendations, as well, on how to improve the process of child fatality reviews.

“This work is necessary but can be difficult and emotionally draining. What energizes us is when we know this hard work generates information that helps to protect other children from being injured or killed,” said Kyran Quinlan, MD, MPH, FAAP, a co-author of the policy statement. “AAP recommends offering support to child fatality review members, including professional training about secondary trauma to promote resilience.”


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.

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