This paper compares and contrasts child death review (CDR) structures and processes in six countries – Australia, New Zealand, the United States, Canada, England and Wales. It presents findings from a comparative study based on analysis of data from 18 case studies. Data were collected through a combination of documentary analysis, interviews and observations. The study found that CDR processes vary according to: where the function is located and whether review is undertaken at state, local or national level; whether review is rooted in legislation; the focus of review; whether dedicated funding is provided; whether families are involved in the process; and whether structures are supported by useful data systems. It was not possible to evaluate the effectiveness of different review systems but the findings suggest that structure makes little difference in terms of determining the extent to which CDR findings inform prevention effort and activity. While factors such as lack of funding, lack of national data, or lack of legislation may hinder the work of CDR teams, CDR findings have informed prevention initiatives despite such barriers. Copyright © 2013 John Wiley & Sons, Ltd. ‘It presents findings from a comparative study based on analysis of data from 18 case studies’ Key Practitioner Messages Standardisation and aggregation of data at national or state level are crucial for effective CDR. A model of individual review, cross‐case review and themed review can result in real learning and practice change. A public health model of CDR offers the most potential in terms of prevention. Families can contribute key information but participation must be managed sensitively and take account of cultural issues. ‘A model of individual review, cross‐case review and themed review can result in real learning and practice change.’