Childhood abuse and neglect has remained a serious public awareness issue. In Texas and Illinois, childhood abuse and neglect is a particularly pertinent issue given its prevalence within these states. The researcher decided, therefore, to investigate what orthopedic pediatric physicians believe are the facilitators and barriers to reporting suspicions of childhood abuse or neglect in their orthopedic practices in Texas and Illinois. Qualitative methods were used to collect data from the participants, who are members of a physicians' organization directory consisting of nine hundred and twenty five members. Findings revealed themes that serve as facilitators to reporting child abuse and neglect, including history of, clear signs of, observed interactions of, corroboration with other physicians, delegated reporting personnel, clear hospital response protocol, access to Child Protective Service contact information, and a past history of following up with medical appointments. The barriers to reporting child abuse and neglect included fear of wrongful accusation and the negative stigma attached to a false accusation, an inability to obtain factual medical history, sympathy with family, mimicking medical conditions, time spent in follow up, and the recognition of contributing social issues. The significance of this study is that the findings describe facilitators and barriers to reporting child abuse and neglect. These facilitators and barriers are important because they influence the physician's reporting child abuse and neglect, which impacts children unable to defend themselves.