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Despite child-initiated harm being prevalent and causing significant developmental impacts, these cases present unique challenges for recognition in current legal frameworks designed for adult perpetrators. This study examined patterns in substantiated reports involving children who harmed other children (CHOC) using National Child Abuse and Neglect Data System administrative data from 2018 to 2019. We documented state statutory and policy variations in recognizing minors as perpetrators and corresponding identification rates; compared report and perpetrator characteristics between CHOC reports versus adult-perpetrated cases using descriptive statistics; and examined differences in CHOC cases by the presence of sexual abuse allegations. Among more than 885,000 substantiated reports, 2.4% involved CHOC, with state rates ranging from 0.2% to 9.7%, corresponding to state definitional frameworks. Reports involving CHOC differed significantly from adult-perpetrated cases: Victims were typically older and without siblings, reports more often originated from parents and mental health personnel, and foster care placement occurred less frequently. When CHOC had adult coperpetrators, these adults were younger and showed elevated sexual abuse rates compared with adult-only perpetrator cases, yet they primarily committed neglect whereas their CHOC predominantly committed sexual abuse. Among CHOC reports, those with sexual abuse allegations disproportionately involved White families, older victims, and CHOC who were younger, male, and often related to the victim. Findings show substantial cross-state policy variation and distinct report characteristics requiring targeted responses, highlighting opportunities for developmentally appropriate, trauma-informed, and family-centered interventions addressing the needs of both CHOC and victims.<\/jats:p>","DOI":"10.1177\/08862605261429552","type":"journal-article","created":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T03:51:33Z","timestamp":1774756293000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding Child-to-Child Harm: A National Analysis of Child Protection Responses"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3777-4213","authenticated-orcid":false,"given":"Eunhye","family":"Ahn","sequence":"first","affiliation":[{"name":"Washington University in St. Louis, MO, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Keunhye","family":"Park","sequence":"additional","affiliation":[{"name":"Michigan State University, East Lansing, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea Lane","family":"Eastman","sequence":"additional","affiliation":[{"name":"University of Southern California, Los Angeles, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsey","family":"Palmer","sequence":"additional","affiliation":[{"name":"University of Utah, Salt Lake City, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joana","family":"Tolchinsky","sequence":"additional","affiliation":[{"name":"Michigan State University, East Lansing, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"crossref","unstructured":"Adams A. 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