(1) According to the National Child Abuse and 
Neglect Data System, an estimated 1,720 children 
died from abuse or neglect in the United States in 
fiscal year 2017. Seventy-two percent of child fatali-
ties involved children younger than 3 years, and 50 
percent involved infants younger than 1 year. 
(2) According to the Commission to Eliminate 
Child Abuse and Neglect Fatalities, infants and tod-
dlers are at high risk of an abuse or neglect fatality 
compared to other age groups and require special at-
tention. Because these young children are seen by 
health care professionals, the Commission rec-
ommended coordinated, cross-system approaches to 
prevention. 
(3) Multiple studies have found that relatively 
minor, visible injuries in young infants, including 
bruising and intraoral injuries, are often indicators 
of abuse. Such injuries are commonly overlooked by 
medical providers, caregivers, and child welfare pro-
fessionals because they seem trivial. Without early 
intervention, physical abuse can escalate, resulting 
in severe injuries or even fatalities. Many child 
abuse professionals refer to such injuries as ‘‘sen-
tinel injuries’’ in young infants because of their im-
portance as early warning signs of abuse. 
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(4) Research conducted in Wisconsin showed 
that previous sentinel injuries were identified in 27.5 
percent of abused infants and 30 percent of infants 
who suffer abusive head trauma but were rare in in-
fants who had not been abused. Other studies have 
demonstrated similar rates of missed opportunities 
to identify abuse in young infants. 
(5) Proper identification of, and response to, 
such suspicious injuries provides an opportunity for 
early recognition and intervention to protect vulner-
able children and prevent many cases of abuse and 
related fatalities, as well as an opportunity to detect 
medical conditions that require urgent treatment. 
(6) Early detection of such injuries and effec-
tive evaluation and intervention requires education 
of caregivers of young infants, child protective work-
ers, and medical professionals about the significance 
of such injuries in young infants. 
(7) Best practices and protocols need to be de-
veloped to ensure an effective response by medical 
professionals, child protective services, and other 
professionals when sentinel injuries are detected. 
SEC. 3. DEMONSTRATION PROGRAM. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this section as the ‘‘Sec-
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retary’’) shall establish a demonstration program to award 
grants to eligible entities in order to test effective practices 
to improve early detection and management of injuries in-
dicative of potential abuse in infants under the age of 7 
months to prevent future cases of child abuse and related 
fatalities. 
(b) ACTIVITIES.—Recipients of grants under this sec-
tion— 
(1) shall use such award to— 
(A) develop, implement, or expand training 
and best practices to assist medical profes-
sionals in identifying, assessing, and responding 
to injuries indicative of potential abuse in in-
fants under the age of 7 months, particularly 
bruising and oral injuries; 
(B) develop protocols and policies that im-
prove communication and coordination between 
mandatory reporters and child protective serv-
ices when such reporters identify such injuries; 
and 
(C) conduct the evaluation under sub-
section (e); and 
(2) may use such award— 
(A) to raise awareness regarding the sig-
nificance of such injuries by mandatory report-
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ers, health professionals, the public, profes-
sionals caring for children, home visitors, child 
care workers, and child protective services staff; 
and 
(B) for other purposes, as the Secretary 
determines appropriate, including using the ap-
proaches 
described 
in 
subparagraphs 
(A) 
through (C) of paragraph (1) to address inju-
ries indicative of potential abuse in children 
aged 7 months and older. 
(c) ELIGIBLE ENTITIES.— 
(1) IN GENERAL.—To be eligible to receive a 
grant under this section, an entity shall— 
(A) demonstrate knowledge and experience 
providing health services to children and identi-
fying and responding to child maltreatment; 
and 
(B) submit to the Secretary an application 
at such time, in such manner, and containing 
such information as the Secretary may require, 
including— 
(i) a description of the entity’s 
planned activities, including— 
(I) plans to reduce child re-vic-
timization and child fatalities; and 
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(II) plans to evaluate success, in-
cluding pertinent data sources that 
will be developed or utilized; and 
(ii) entities with whom the applicant 
will collaborate in carrying out the activi-
ties under the grant. 
(2) MULTIDISCLIPLINARY PARTNERSHIPS.—An 
eligible entity shall be a multidisciplinary partner-
ship of stakeholders with knowledge and experience 
providing health services to children and identifying 
and responding to child maltreatment, which may in-
clude nonprofit organizations, community-based or-
ganizations, administrators of any programs funded 
under the Child Abuse Prevention and Treatment 
Act (42 U.S.C. 5101 et seq.), children’s health care 
providers, board-certified child abuse pediatricians, 
child protective services, child advocates, State child 
death review boards, child advocacy centers, State 
department of justice officials, children’s hospitals, 
disability organizations, and mental health and so-
cial services providers. 
(d) GRANT PERIOD.—Grants awarded under this sec-
tion are for a 3-year period. 
(e) EVALUATIONS.—The Secretary shall require each 
recipient of a grant under this section to— 
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(1) evaluate and assess— 
(A) the efficacy of the projects carried out 
with grant funds; and 
(B) the extent to which such projects re-
duced re-victimization of children and child fa-
talities; and 
(2) submit a report on such evaluation and per-
tinent data to the Secretary. 
(f) REPORT TO CONGRESS.—Not later than 1 year 
after the conclusion of the demonstration program under 
this section and the submission of the report and data 
under subsection (e)(1), the Secretary shall submit to 
Congress a report that includes— 
(1) an analysis of the strengths and opportuni-
ties of the program; 
(2) barriers or challenges for implementing or 
replicating best practices under the program; 
(3) the feasibility of a national educational cam-
paign on injuries indicative of potential abuse in in-
fants under the age of 7 months; and 
(4) areas for further research or evaluation to 
improve early detection of such injuries. 
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(g) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated 
$10,000,000 for the period of 2020 through 2022. 
Æ 
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