The placement of a child into out-of-home care (OHC) by child protective services can be considered an indicator of child maltreatment, be it abuse or neglect. Children who experience abuse or neglect have a significantly increased risk for longterm medical and mental health complications from living with toxic stress; advances in developmental sciences point out a public health imperative of securing a consistently safe, stable, and nurturing environment for every child.1 Globally, studies from high-income countries reveal high and increasing rates of placement of children into OHC. These trends are worse in children from historically marginalized backgrounds. However, there are no clear data to support that placement into OHC is actually an effective long-term intervention for child maltreatment.2 In this issue of Pediatrics, Dr Nevriana and colleagues3 describe the likelihood that a child who has a parent with a mental health condition is placed in OHC. Using linked administrative records from across several Swedish national registers, the investigators identified and followed a cohort of >1000000 children born in Sweden and their parents. The authors found that depending on the child’s age, parental education, and type of mental health condition, some children are up to 15 times more likely to be placed in OHC than children whose parents do not have a mental health condition. This is a massive increase in risk. Many of us who work with children in the foster care system and their families are not surprised that there is an increased risk, but the degree of additional risk is eye-opening.