One in three children in the United States will be reported to child protective services (CPS) before they turn 18. For Black children, that number is nearly one in two.

This is not a minor issue. Reporting touches millions of families—disproportionately Black, Brown, Indigenous, immigrant, disabled, and poor. But most families learn how this system works only after they are already in it.

This piece is for you. Read it before that happens. Understand your risks so you can mitigate them.

What mandated reporting is—and what it isn’t

Mandated reporters are people required by law to report suspected child abuse or neglect to CPS. This includes doctors, nurses, teachers, social workers, and many others.

The bar for filing a report is low: “reasonable suspicion.” Reporters do not need proof. They do not need to ask you questions first. And in most states, they face no legal consequences for reporting you unfairly, unjustly, or incorrectly.

Child abuse and neglect are also misdiagnosed.

Although the vast majority of cases are unsubstantiated, CPS involvement is often traumatizing for families of color. A report does not guarantee your family will receive food, housing, Mental health care, or any other support. What it does guarantee is scrutiny and the risk of your child being removed from your home.

Why this falls hardest on Black and Brown families

Black children are reported to CPS at nearly twice the rate of white children. Native children have the highest rates of entry into foster care. This is not because abuse or neglect is more common in these communities. It is because conditions created by racism—like poverty, food insecurity, and housing instability—are treated as neglect and then policed more heavily.

Providers are trained to report—and to face legal consequences if they do not. They are rarely trained to recognize how racism shapes what they see as “suspicious.” There are no clinical standards requiring them to consider racial bias and stereotypes before filing. And there are no consequences when they get it wrong. This is concerning because children in foster care face heightened risks of abuse, and some have even died.

What you need to know—and do

While these risks are concerning, families can protect themselves in the following ways.

1. If you are pregnant or recently postpartum, do not give your urine without asking questions. You can be drug tested without your knowledge or consent in many states—and a positive result can trigger a CPS report, even when false positives happen. Ask your provider directly: Will I be drug tested? Under what circumstances? What happens with the results?

   In some states, nonconsensual drug testing during pregnancy has been limited or banned, so it is important to know your state’s laws. If you use any substances—including cannabis, which is legal in many states, or prescribed opiates—be aware that a positive test can still be reported to CPS regardless of legality.

2. If you question or push back on medical recommendations, providers might report you for medical neglect. I watched a Black family nearly reported to CPS—not because they were neglectful, but because they asked questions. They had experienced untreated pain, missed diagnoses, and delayed care—all things that made the healthcare system untrustworthy. They didn’t say no to surgery. They were saying: Help us understand why, and why now. I’ve also seen parents whose children are experiencing Mental health crises be threatened with reporting if they do not take their children home.

   If you ever feel pressured to consent to something you don’t understand, ask for more time and more information. Ask to speak with a patient advocate or to involve a provider you trust. Bring a family member or trusted ally with you to appointments. Having support in the room matters. Document your conversations—dates, what was said, who said it. Be mindful that when providers label you as “difficult” or “noncompliant” in the chart, this can prime suspicion among other providers.

3. Because neglect related to poverty is the main reason why families are reported, be proactive about housing and nutrition. If you are experiencing instability, have a plan you can name: where you are staying, who you are staying with. Medical records are a legal document, and previous diagnoses like “failure to thrive” can prime providers to report neglect.

4. Hold your healthcare providers accountable by asking: How do you account for racial bias in your reporting decisions? Their answer will tell you something important about the care you are receiving. You also have the right to request your medical records at any time. I’ve often rewritten negative narratives or challenged racial stereotypes about unfit parents in notes. You can ask a trusted provider to do the same.

   You deserve healthcare that protects your family, not care that puts you at risk.

5. If a report is filed, know your rights—and risks. CPS often shows up unexpectedly. You do not have to let CPS into your home without a court order or warrant. You have the right to an attorney. If you cannot afford one, ask about legal aid in your area, and ensure you find an attorney who has the right expertise.

   Investigations are often invasive and traumatic—even when they close without a finding. Children in foster care face elevated risks of abuse, and some have died in CPS custody. Kemari Morgan died in foster care after being removed from his mother. He is not alone.

A Family I Won’t Forget

I worked with a 12-year-old girl on the autism spectrum—I’ll call her Maya—whose parents were Black and transgender. They were devoted, attentive, and present at every appointment. During a routine checkup, Maya mentioned offhand that her sister had hit her head with a book. Her mother, who was there, explained immediately: Her older sister had tossed it to her to catch. No injury. No concern.

But I knew another provider—one who was rushed, or inexperienced, or shaped by assumptions about who these parents were—might have filed a report on the spot. And months later, when Maya repeated the comment to a school counselor, that’s exactly what happened. CPS showed up at their door.

The investigation closed without a finding. But as Maya’s father told me, “Because we were warned, we weren’t completely caught off guard. Still—it was terrifying.”

That’s why I wrote this. Being warned is not the same as being protected. But it can help you protect yourself. Hold your providers accountable.