Data were obtained from a cross-sectional chart review from a random sample of pediatric hospitalizations in 1988-90 in three cities for five condition groups (n=5,446); this included evidence of clinicians' concerns about physical abuse or neglect and reports to CPS, as well as family income, ethnicity, family structure, child's age, and illness severity at admission. Concerns about abuse were noted in 2.5 percent of the total sample, and concerns about neglect for 3.1 percent and 2.9 percent of children were reported to CPS. Concerns about abuse were most frequent in children with head trauma (8.2 percent), and concerns about neglect were most frequent in children with toxic ingestion (12.3 percent). Young age of child, low income, and single-parent family were independently associated with increased frequencies of concerns and reports. Low income was significantly associated with clinicians' concerns about neglect, but not abuse or reports to CPS. Ethnicity was not significant after controlling for income and family structure. Severity of illness was associated with concerns about physical abuse among children with head trauma and with concerns about neglect and frequency of reporting for children with meningitis. Study results confirm the associations among neglect, poverty, and single-parent families for hospitalized children. Increasing severity of illness may make clinicians consciously or unconsciously consider that care has been delayed and the child neglected. 5 tables and 42 references