Objective

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.

Design

Systematic literature review.

Data sources

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.

Data extraction and synthesis

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.

Quality appraisal

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.

Results

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.

Conclusion

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.