National Trends in Child Maltreatment: A Decade of Divergent Progress
Child abuse and neglect represent one of the most significant public health challenges in the United States, with profound implications for long-term physical and mental health. While legislative and social interventions have sought to mitigate these risks, the trajectory of maltreatment incidence across different demographic groups has remained a subject of intense debate. A landmark whole-population study published in JAMA Pediatrics provides a comprehensive analysis of national trends from 2012 through 2023, offering a nuanced look at how race, ethnicity, and sex intersect with child welfare outcomes.
Highlights
- Confirmed cases of overall child maltreatment declined significantly from 2012 to 2023, with an average annual percent change (AAPC) of -1.53%.
- Referrals to Child Protective Services (CPS) remained stable, suggesting that while fewer cases are being confirmed, the volume of reported concerns has not decreased.
- Deep-seated disparities persist: Black children continue to experience the highest rates of confirmed maltreatment, while Asian, Native Hawaiian, and Pacific Islander children experienced the greatest relative improvements.
- Sexual abuse cases did not follow the general downward trend, and female children faced widening disparities in this subtype over the study period.
Background: The Burden of Child Maltreatment
The long-term consequences of child maltreatment—encompassing physical, sexual, and emotional abuse, as well as neglect—are well-documented. Survivors are at an increased risk for chronic conditions, including cardiovascular disease, obesity, and mental health disorders such as depression and PTSD. These experiences, often categorized as Adverse Childhood Experiences (ACEs), contribute to a cycle of trauma that can span generations. Despite numerous public health initiatives, children in minority racial and ethnic groups have historically been disproportionately represented in the child welfare system. Understanding whether these disparities are narrowing or widening is essential for refining preventive strategies and resource allocation.
Study Design and Methodology
This serial, population-based, cross-sectional study utilized data from the National Child Abuse and Neglect Data System (NCANDS), covering all CPS cases in the U.S. for children aged 0 to 17 years from January 2012 through December 2023. By integrating these records with population estimates from the U.S. Census Bureau, researchers were able to calculate incidence rates per 10,000 children. The study analyzed four primary subtypes of maltreatment: emotional abuse, physical abuse, sexual abuse, and neglect. Data were stratified by sex and by six racial and ethnic categories: American Indian/Alaska Native; Asian, Native Hawaiian, or Other Pacific Islander; Black; White; Multiple Races; and Hispanic.
Key Findings: The Paradox of Declining Rates and Static Disparities
Over the 12-year study period, the data reflected 7,326,987 confirmed cases and nearly 33 million referrals. The most striking finding was the divergence between confirmed cases and referrals. While confirmed cases of all forms of maltreatment (excluding sexual abuse) showed a steady decline (AAPC, -1.53; 95% CI, -2.07 to -1.05), the rate of referrals remained virtually unchanged (AAPC, 0.11). This suggests that the threshold for substantiating a case may have shifted, or that the underlying social factors driving reports have not abated.
Racial and Ethnic Divergence
The study highlighted a troubling “room for improvement” paradox. Asian, Native Hawaiian, and Pacific Islander children, who already had the lowest baseline incidence of maltreatment, saw significant declines (AAPC, -1.77). Conversely, Black children, who faced the highest incidence rates (121.69 confirmed cases per 10,000), experienced no significant improvement. Hispanic and White children also saw declines, with AAPCs of -1.81 and -0.74, respectively. These findings indicate that current child welfare and public health interventions are effectively reaching some populations while failing to close the gap for those at the highest risk.
Gender Disparities and the Crisis of Sexual Abuse
When examined by sex, both males and females experienced decreases in overall confirmed maltreatment. However, female children remained disproportionately affected. This disparity was most pronounced and widening in the category of sexual abuse (z score, 5.52; P < .001). Unlike other forms of maltreatment, sexual abuse rates did not decline significantly over the decade, representing a stagnant area of concern that requires targeted, sex-specific prevention efforts.
Expert Commentary: Structural Drivers and the Role of Poverty
The stability of maltreatment rates among Black children despite national declines is a clarion call for addressing structural inequities. Clinicians and researchers point to poverty as a primary driver of neglect—the most common subtype of maltreatment. Disparities in access to the social safety net, including housing assistance, nutritional support, and high-quality childcare, likely contribute to the sustained high rates in marginalized communities. Furthermore, the lack of decline in sexual abuse cases suggests that this subtype may be less sensitive to broad economic shifts and requires more specialized, forensic, and community-based interventions.
There is also the consideration of systemic bias within the referral process. The fact that Black children are referred at nearly double the rate of White children (550.54 vs 294.80 per 10,000) suggests that surveillance bias may play a role in how families of color interact with mandatory reporting systems. However, the high rate of confirmed cases in these same groups indicates that the need for support is genuine and unmet.
Conclusion: A Path Toward Equity
The findings of this whole-population study underscore a critical reality: general progress in public health does not automatically translate to equitable progress. While the overall decline in confirmed child maltreatment is a positive trend, the persistence of disparities by race and the widening gap in sexual abuse for female children are unacceptable. Moving forward, health policy must prioritize the combatting of poverty and the removal of barriers to public health benefits. For clinicians, these data emphasize the need for culturally sensitive screening and a focus on social determinants of health to support the most vulnerable families before they reach the point of CPS involvement.
References
Liu RT, Levin RY, Turnamian MR. A Whole-Population Study of National Trends in Child Abuse and Neglect by Sex, Race, and Ethnicity in the US. JAMA Pediatr. 2026 Jan 1;180(1):72-82. doi: 10.1001/jamapediatrics.2025.4487. PMID: 41212569.
