Objective: Child maltreatment (CM) fatalities are often preventable, and reviewing these deaths often highlights problems in law, policy or practice that can be addressed to prevent future deaths. Citizen Review Panels (CRPs) comprised of medical and child welfare professionals were established in 1996 to review Child Protective Services (CPS) practices as a requirement of the US federal Child Abuse Prevention and Treatment Act. We sought to evaluate the changes, if any, in the factors associated with the child deaths after CRP reviews in our state. Methods: The state Fatality CRP reviewed deaths of children less than 19 years of age identified from death certificates, county child death review reports, and state CPS agency case information. Findings were identified by the CRP in areas associated with professional practice during case identification and reporting, child protective services investigation, and during post-investigation services and case adjudication. Recommendations were reported to the state's director of social services, and the agency responded in writing as to the specific action(s) planned for each finding. We compared the annual number of maltreatment fatalities reviewed associated with each finding during 1999-2001 to the annual number of cases reviewed with each finding during 2002-2004 to ascertain whether the number of CM deaths changed. Results: The Fatality CRP identified 264 findings during 1999-2001 in 186 child deaths. These decreased to 172 findings in 170 deaths reviewed in 2002-2004. This was a 35% decrease in findings and a 9% decrease in the number of deaths associated with those findings. The majority of findings were associated with problems of non-compliance with existing state law or practice and poor practice/decision-making during CPS involvement. Following state actions, specific changes in policy and programs were noted for most findings, mostly in areas related to CPS investigation, assessment and service provision. Conclusions: Child fatality reviews by federally mandated citizen review panels offer the potential to reduce CM deaths by improving child protective service practices. Further research is needed which compares CRP and child fatality review team processes, team composition, and the role they can play in the child welfare system to prevent child abuse and neglect deaths. Practice implications: Reviews by Citizen Review Panels look at specific practice deficiencies in problematic cases in the child protective services system and can be used to identify areas of child welfare law, policy or practice needing improvement. CPS agencies can utilize their CRPs to improve CPS outcomes and reduce CM fatalities. (Contains 5 tables.)