The COVID-19 pandemic raised serious concerns about child maltreatment, which is known to increase in frequency and severity during times of high stress. The present study used diverse data sets to concurrently examine changes in identification and medical evaluation of maltreatment allegations from before to during COVID-19. Four sources of data were collected from two counties for the months of March through December, 2019 and 2020, including reports to social services and child maltreatment evaluation center medical evaluations (CMECs). The number of reports, number of children reported, and rate of children reported were used to evaluate identification. Incidence was estimated based on the number of medical evaluations conducted at the CMECs. Maltreatment type, reporter type, and child demographics were also considered. Across both counties, there were significantly fewer reports and reported children in 2020 compared with in 2019, signifying decreased identification of suspected maltreatment cases. This was especially true in spring and fall when children are typically in school. Across both counties, the proportion of children reported to the county that received medical evaluations was higher in 2020 compared with in 2019. This suggests that the pandemic was related to an increase in the occurrence of maltreatment serious enough to warrant medical evaluations, or perhaps in the relative number of serious cases identified. Findings show divergent trends in reporting and evaluation of suspected maltreatment cases from before to during COVID-19. Identification and service delivery methods need creative solutions to adapt to changing environments. Medical, social, and legal systems need to prepare for increases in families seeking services as pandemic-related restrictions are lifted.