Hospitals, Schools, Police: How Children's Institutional Contacts Shape Child Abuse Reporting – and Reveal Stark Racial Disparities

Around one in three American children will be reported to Child Protective Services (CPS) for suspected neglect or abuse by age 18. But who brings these children to CPS attention? New research by CSUS Interim Director Amanda Sheely, Frank Edwards, and Kelley Fong reveals that the answer depends heavily on a child's age – and their race.

Following Children Through Different Institutions

When families interact with CPS, it typically starts with a report from a professional – a teacher, doctor, police officer or social worker – who is legally required to report suspected child abuse or neglect. We analyzed national data from the 2015-2019 waves of the National Child Abuse and Neglect Data system (NCANDS) to understand how these reporting pathways change as children grow up.

We find that children’s interactions with different institutions as they age create opportunities for CPS reporting from different professionals.

For infants under age one, medical professionals are the primary reporters. This makes sense: childbirth involves substantial contact with hospitals and healthcare providers. About 11 in 1,000 infants have a CPS report filed about them.

As children age, the source of reports shifts dramatically. When children turn five and enter school, we see a sharp spike in reports from educators. Meanwhile, law enforcement reports remain consistently high across all childhood ages.

A Clear Pattern of Racial Inequality

Perhaps our most troubling finding is the stark racial disparity in CPS reporting – particularly for very young children.

Black children face the highest reporting rates across all age groups and all reporter types. For infants under one year old, the disparities are especially pronounced: 21 in 1,000 Black infants are reported to CPS, compared to just 2 in 1,000 Asian and Pacific Islander children.

American Indian and Alaska Native children also experience disproportionately high reporting rates, particularly from social service and law enforcement professionals.

Importantly, these racial disparities decrease somewhat as children age, but never disappear. By age 17, Black children are still reported at 6.4 per 1,000, compared to 1.4 per 1,000 for Asian and Pacific Islander children.

Why Reporting Source Matters

The pattern of who reports families varies not just by child age, but also by race and ethnicity in ways that differ across professional groups.

Among law enforcement, social service, and educational professionals, Black children consistently have the highest report rates. But among medical providers, the patterns are more complex, with American Indian, Alaska Native, Latine and White children reported at more similar rates.

These differences matter because they point to how various professional groups may contribute differently to racial inequality in CPS exposure.

What This Means for Families and Policy

Our findings underscore that CPS reports do not simply reflect differences in family circumstances. Instead, they are products of institutional processes and the surveillance that comes with routine interactions with schools, hospitals, and police.

There is little reason to expect that five-year-olds experience substantially different family conditions than four-year-olds. Yet we see a spike in CPS contact at age five – traced directly to children entering school and encountering teachers who are mandated reporters.

These patterns have real consequences. Being investigated by CPS causes stress, fear, and can lead families to avoid seeking help, even when children are not removed. For children, investigations are associated with adverse health outcomes.

The pronounced racial disparities we document – especially the heightened surveillance of Black families with infants – raise urgent questions about inequality in systems meant to protect all children.

Looking Forward

Understanding these institutional pathways is crucial for addressing inequality in child welfare. As families navigate healthcare, schools, and encounters with police, they face unequal risks of CPS report, depending on their children's ages and racial identities.

Policymakers and professionals need to recognize that mandated reporting, while intended to protect children, creates a form of state surveillance that falls unequally across families. Addressing this requires examining not just individual reporter decisions, but the broader institutional contexts that shape who comes into contact with CPS – and when.

Amanda Sheely is an Associate Professor in the Munk School of Public Policy & Global Affairs at the University of Toronto. Frank Edwards is an Associate Professor in the School of Criminal Justice at Rutgers University. Kelley Fong is Assistant Professor of Sociology at the University of California, Irvine.

This article is based on research published in Population Research and Policy Review. Please read the article here: https://link.springer.com/article/10.1007/s11113-025-09946-2