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Child maltreatment is a leading cause of death and disability in children in the United States. More than 3 million reports to Child Protective Services (CPS) are made every year in the US. In 2019, over 1,800 children died of child maltreatment; this is more children than died from influenza, respiratory syncytial virus (RSV) and COVID combined. The number of children dying due to maltreatment has increased 11% over the past 5 years suggesting that current efforts to protect children are insufficient. The long-term costs of child maltreatment cannot be underestimated. Children who have been maltreated often have lifelong adverse health, social, and economic consequences. 

Accurate and timely recognition of the early signs of child maltreatment is critical to decreasing morbidity and mortality. This is especially true for young children who are victims of child physical abuse. A significant proportion of children who suffer severe morbidity and/or mortality due to physical abuse had been previously evaluated by physician(s) who did not recognize the abuse.

Despite evidence-based recommendations from the American Academy of Pediatrics (AAP), medical providers fail to consistently screen for and evaluate for abuse even in high-risk situations. Studies have also shown persistent and pervasive disparities in screening practices related to patient race and socioeconomic status and hospital characteristics. Data suggest that ongoing efforts at education of providers have not been successful.  

Data collected over the past 7 years suggests that embedding child abuse-clinical decision support (CA-CDS) into the electronic health record (EHR) can help to improve identification, evaluation and reporting of suspected maltreatment while mitigating racial disproportionality. The CA-CDS consortium was founded to ensure that there is a cohesive, well-coordinated multi-disciplinary approach to CA-CDS integration and dissemination.  


Child Maltreatment 2019 (U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau) (2021).


Corso PS, Lutzker JR. The need for economic analysis in research on child maltreatment. Child Abuse Negl. Jul 2006;30(7):727-38.

Currie J, Widom CS. Long-term consequences of child abuse and neglect on adult economic well-being. Research Support, N.I.H., Extramural Research Support, U.S. Gov't, Non-P.H.S. Child Maltreat. May 2010;15(2):111-20.

Felitti VJ, Anda RF, Nordenberg D, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. May 1998;14(4):245-58.


Guenther E, Powers A, Srivastava R, Bonkowsky JL. Abusive head trauma in children presenting with an apparent life-threatening event. J Pediatr. Nov 2010;157(5):821-5.

Jackson AM, Deye KP, Halley T, et al. Curiosity and critical thinking: identifying child abuse before it is too late. Clin Pediatr (Phila). Jan 2015;54(1):54-61.

Jenny C, Hymel KP, Ritzen A, Reinert SE, Hay TC. Analysis of missed cases of abusive head trauma. JAMA. Feb 17 1999;281(7):621-6.

King WK, Kiesel EL, Simon HK. Child abuse fatalities: are we missing opportunities for intervention? Pediatric Emergency Care. Apr 2006;22(4):211-4.

Letson MM, Cooper JN, Deans KJ, et al. Prior opportunities to identify abuse in children with abusive head trauma. Child Abuse Negl. Sep 25 2016;60:36-45.

Oral R, Yagmur F, Nashelsky M, Turkmen M, Kirby P. Fatal abusive head trauma cases: consequence of medical staff missing milder forms of physical abuse. Pediatr Emerg Care. Dec 2008;24(12):816-21.

Pierce MC, Smith S, Kaczor K. Bruising in infants: those with a bruise may be abused. Pediatr Emerg Care. Dec 2009;25(12):845-7. 

Ravichandiran N, Schuh S, Bejuk M, et al. Delayed identification of pediatric abuse-related fractures. Comparative Study

Research Support, Non-U.S. Gov't. Pediatrics. Jan 2010;125(1):60-6.

Thackeray JD. Frena tears and abusive head injury: a cautionary tale. Pediatr Emerg Care. Oct 2007;23(10):735-7.

Thorpe EL, Zuckerbraun NS, Wolford JE, Berger RP. Missed opportunities to diagnose child physical abuse. Pediatr Emerg Care. Nov 2014;30(11):771-6.

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