The prevailing belief is that approximately 2,000 infants and children die in the United States each year from abuse and neglect. Most deaths from known events are due to neglect. The most significant issue that emerged from a review of statistical literature was the variance among data sets. Most of the problem is likely due to problematic differences in two areas: definitions and data collection methods. Over the past several years, there has been considerable interest in review processes to analyze child fatalities. There is no uniform system of child death review in place in the United States. The American Academy of Pediatrics' (1999) policy statement on investigation and review of unexpected deaths makes seven recommendations. First, pediatricians should advocate for proper death certification; second, autopsies should be required in all deaths of children younger than 18 years that resulted from trauma or that were unexpected, suspicious, obscure, or otherwise unexplained; third, State laws should be enacted to establish comprehensive child death investigation and review at State and local levels; fourth, pediatricians should be involved with local and State review teams; fifth, public health, medical societies, and other groups should be involved in the child fatality review process; sixth, death scene investigators should be trained by physicians knowledgeable about sudden infant death syndrome, child development, pediatric disease, and child abuse; and seventh, public health initiatives aimed at death prevention can be developed by using review team data. One of the major contributions of child fatality review teams has been a new emphasis on the importance of a good death scene investigation. When a child is seriously injured or dies at home, first responders can contribute to subsequent case analysis by properly securing the death scene and coordinating an appropriate investigation by law enforcement personnel and others, including investigators from the office of the medical examiner. 1 table and 30 references