Roughly half of the Pennsylvania children who have died since 2020 never received the full, formal review that state law promises, a breakdown that public health experts say can hide deadly patterns in plain sight. Under state statute, every county is supposed to convene a local multidisciplinary team to examine every death of a resident under 21. In practice, many of those panels, especially in rural counties, have sputtered or gone dormant, leaving fewer hard lessons and prevention ideas reaching Harrisburg.
According to reporting from Spotlight PA, internal reports shared with the Pennsylvania Department of Health show that since 2020 about half of childhood deaths across the state have not been reviewed at all. The gaps are concentrated in smaller, rural counties where teams meet only sporadically or lack key members. Former coordinators and advocates told reporters that the tedious work of pulling medical records and entering case data often falls to a few overextended volunteers.
State numbers paint a patchwork picture
According to the Pennsylvania Department of Health’s 2023 Child Death Review Annual Report (Pennsylvania Department of Health), the statewide review rate in 2023 climbed to nearly 60% of the 1,551 child deaths recorded that year. That still left more than 600 deaths untouched by local review teams. The report also highlighted a sharp racial gap, finding that Black or African American children died at about twice the rate of white children. As for causes, about 47% of reviewed deaths were tied to medical conditions, while roughly 45% involved external factors such as vehicle crashes, overdoses, or violence.
Why local teams say they cannot keep up
A multiyear evaluation, summarized in coverage from Spotlight PA, found that the Child Death Review program has long functioned as what researchers called an “unfunded mandate.” Counties are required to run teams, but many have had to rely on unpaid chairs and a bare handful of volunteers to do nearly all the work. Staff turnover and pandemic disruptions left some panels meeting only once or twice a year. Chairs told reporters that chasing hospital and coroner records is slow, technical work, and local leaders say those resource problems directly translate into fewer completed reviews and fewer chances to suggest life saving fixes.
A $2.5 million ask and the politics
Gov. Josh Shapiro’s proposed 2026 to 27 budget includes $2.5 million to shore up the state’s Child Death Review system by funding staff, technical assistance, and grants to help counties with data collection and prevention projects, according to the administration’s Budget in Brief. Officials say the money would first help counties streamline record requests, standardize how they enter data, and pay for targeted local prevention efforts. Advocates counter that while the proposal is a meaningful start, real reform will require ongoing staffing and a more robust statewide data system.
What researchers recommend
Researchers and local leaders have outlined a straightforward fix list. They suggest building regional review teams for sparsely populated counties, assigning state level staff to handle medical record collection and data entry, requiring teams to meet a minimum number of times each quarter, and setting clear deadlines for finishing reviews. They also want changes to state law so the program is explicitly focused on prevention and participation is easier for small counties. Those adjustments, advocates argue, would turn child death reviews from a side job for volunteers into a practical public health tool.
Legal and policy stakes
Pennsylvania’s Public Health Child Death Review Act of 2008 spells out the framework: every county must create a local multidisciplinary team to review deaths of people age 21 and under, and the Department of Health coordinates the program at the state level, according to Act 87. The law, however, sets out duties without attaching a dedicated funding stream or meaningful enforcement. That gap is why researchers have urged statutory changes, including minimum meeting requirements, timelines for completing reviews, and an enforcement mechanism. Lawmakers would have to amend Act 87 to make any of that happen.
Without money and hands on state support, advocates warn, review panels will keep falling short and preventable patterns in child deaths may never be addressed. The governor’s relatively modest budget request gives legislators a chance to repair a program that has been limping along for years. What they do next will help decide whether these reviews actually lead to safer homes, safer streets, and fewer families living through the worst phone call of their lives.
