Child Abuse & Neglect 35 (2011) 96–104 Contents lists available at ScienceDirect Child Abuse & Neglect Identifying children at high risk for a child maltreatment report  Howard Dubowitz ∗ , Jeongeun Kim, Maureen M. Black, Cindy Weisbart, Joshua Semiatin, Laurence S. Magder Department of Pediatrics, University of Maryland School of Medicine, 520 W. Lombard Street, Baltimore, MD 21201, USA article info Article history: Received 11 September 2009 Received in revised form 7 September 2010 Accepted 10 September 2010 Available online 4 March 2011 Keywords: Child maltreatment Child abuse Neglect Risk factors Prevention abstract Objective: To help professionals identify factors that place families at risk for future child maltreatment, to facilitate necessary services and to potentially help prevent abuse and neglect. Method: The data are from a prospective, longitudinal study of 332 low-income families recruited from urban pediatric primary care clinics, followed for over 10 years, until the children were approximately 12 years old. Children with prior child protective services involvement (CPS) were excluded. The initial assessment included sociodemographic, child, parent and family level variables. Child maltreatment was assessed via CPS reports. Risk ratios (RRs) and their 95% confidence intervals (CIs) were estimated using Cox regression models. Results: Of the 224 children without a prior CPS report and with complete data who were followed for an average of 10 years, 97 (43%) later had a CPS report. In a multivari- ate survival analysis, 5 risk factors predicted CPS reports: child’s low performance on a standardized developmental assessment (RR = 1.23, 95% CI = 1.01–1.49, p = .04), maternal education ≤ high school (RR = 1.55, CI = 1.01–2.38, p = .04), maternal drug use (RR = 1.71, CI = 1.01–2.90, p < .05), maternal depressive symptoms (RR per one standard deviation higher score = 1.28, CI = 1.09–1.51, p < .01), and more children in the family (RR per addi- tional child = 1.26, CI = 1.07–1.47, p < .01). Conclusions: Five risk factors were associated with an increased risk for later maltreat- ment. Child health care and other professionals can identify these risk factors and facilitate necessary services to strengthen families, support parents and potentially help prevent child maltreatment. © 2011 Published by Elsevier Ltd. Introduction The prevalence and toll of child maltreatment (i.e., all forms of abuse and neglect) have been amply established (Pilowsky et al., 2008; Gaudin, 1999; Sedlak et al., 2010; Teicher et al., 2004; US DHHS, 2010). The challenge is to develop and evaluate promising strategies to help prevent this complex problem (Dubowitz & Guterman, 2005; Macmillan et al., 2009). Preventive interventions need to build on a clear understanding of the risk factors and etiology of child maltreatment.  This grant was funded by the U.S. Department of Health and Human Services, Administration on Children and Families, Office on Child Abuse and Neglect, 90CA1749. ∗ Corresponding author. 0145-2134/$ – see front matter © 2011 Published by Elsevier Ltd. doi:10.1016/j.chiabu.2010.09.003