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A comprehensive overview of all studied individual, relational, community, and societal risk factors that precede severe physical child abuse is critical to inform preventive efforts. All available studies of substantiated, diagnosed, self-reported, or caretaker-reported physical child abuse were reviewed and assessed for risk of bias, and meta-analyses of risk factors were carried out when feasible. The review was pre-registered: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018094317. Observational studies were included. PubMed, Embase, PsycINFO, Scopus, EBSCOhost, ProQuest, OpenGrey, and Bielefeld were searched. No limits were placed on language or publication year. A total of 29,060 records were found on the 18th of December, 2018, screened and extracted by two reviewers. Ninety-one reports were included, and of these, 37 reports were left out of results due to high risk of bias. A total of 139 risk factors were reported. The results suggest that attention to families with underweight infants, low parental education, multiple births, and former reports to social services may provide opportunities for prevention of severe physical child abuse. Overall, results showed a deficiency of evidence with low risk of bias, and a lack of any evidence from low-income countries.