Peer-reviewed article

First Substantiated Child Maltreatment Among United States Children Aged 0–3: Reports by Medical Professionals

Kayla Wartman, Fred North, Raymond Earl Davis, Weihai Zhan · 7 Apr 2026

Abstract

Abstract Background. Medical professionals, key mandated reporters, play a critical role in identifying first-time child maltreatment victims, yet little is known about the characteristics and recurrence patterns of maltreatment first detected by this group. Objective. To examine trends in child maltreatment and the racial and geographic disparities in recurrence among young children with the first victimization reported by medical professionals. Methods. Children aged 0–3 from the National Child Abuse and Neglect Data System (2012–2021) were included in the analysis. Kaplan-Meier curves and Cox proportional hazard models were used to assess racial and geographical disparities in the recurrence of child maltreatment. Results. Despite fluctuations in the incidence of first maltreatment reported by medical personnel, the proportion of first maltreatment cases reported by medical professionals increased steadily from 20% in 2012 to 30% in 2021. Among children who were not placed in foster care following their first maltreatment, compared to non-Hispanic white children, multiracial children had a higher recurrence risk (adjusted hazard ratio [aHR] 1.17, 95% confidence interval [CI] 1.13–1.22), while Asian (aHR 0.56, 95% CI 0.48–0.66), Native Hawaiian/other Pacific Islander (aHR 0.67, 95% CI 0.52–0.87), and African American (aHR 0.77, 95% CI 0.76–0.79) children had a lower risk. Children in nonmetro counties had a slightly higher risk than those in metro counties. Conclusions. These findings highlight the growing role of medical professionals in reporting maltreatment of young children. Further research is needed to investigate the underlying causes of disparities, particularly racial disparities, in recurrence.