Screening tools used by paediatric healthcare providers to identify child maltreatment by parents or caregivers: a systematic review

TL;DR

This review evaluates screening tools used by pediatric healthcare providers to identify child maltreatment, finding few validated tools for very young children or neonatal care.

Contribution

The study systematically reviews the reliability and validity of screening tools for child maltreatment in pediatric healthcare settings.

Findings

Only 13 distinct screening tools were identified, mostly for physical abuse in emergency rooms.

No tools were found for neonatal care, and few were validated for children under 3 years old.

The Escape and Pediatric Hurt-Insult-Threaten-Scream-Sex tools showed the highest quality evidence.

Abstract

To evaluate the reliability and validity of screening tools designed to identify child maltreatment by parents or caregivers in paediatric healthcare settings, particularly for use in early childhood or neonatal care.

Systematic literature review.

The Cochrane Library, Embase, Cinahl and Ovid Medline were searched for studies published up to June 2025. Eligibility criteria for selecting studies: studies evaluating screening tools intended for use by caregivers or healthcare professionals to identify child maltreatment in paediatric healthcare settings. Included tools targeted children under 18 years of age.

Key characteristics of included tools were extracted, including type of maltreatment assessed, number of items, tool format and the age range of the child population. Data on reliability and validity were synthesised narratively due to heterogeneity in methods and outcomes.

Risk of bias and the quality of Patient Reported Outcome Measure development were assessed using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist, which also guided the grading of evidence strength.

In total, 1874 abstracts and 84 full-text articles were reviewed. 14 articles featuring 13 distinct screening tools were identified, most of which were used to detect physical abuse in emergency room settings. Only the Escape tool was evaluated in two studies, both of very good quality; the study evaluating the Pediatric Hurt-Insult-Threaten-Scream-Sex tool also demonstrated very good quality. The remaining studies varied in methodological quality and evidence strength. No tools were identified for children in neonatal care settings, and few were validated for children aged 0–3 years, none for neonatal care.

This review highlights the limited number of validated tools suitable for identifying maltreatment in very young children and across different contexts, particularly neonatal care. Future research should address these critical gaps to better support the early identification of child abuse within diverse clinical settings.

PROSPERO (2023), registration number CRD42023483966.

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