Every year, hundreds of thousands of children are abused and neglected in the United States. Child welfare specialists say it's an epidemic caused by mental illness, drug addiction and poverty.
A new report by the U.S. Department of Health and Human Services found an estimated 1,500 children in the United States died from abuse or neglect in 2003. The majority of them were under the age of 4.
"It is truly an epidemic," said Shay Bilchik, president and chief executive of Child Welfare League of America. "And we've seen the tremendous increase over the last 20 years."
States have the primary responsibility for dealing with abused children. Many have been unable to keep pace with the number of cases, despite increases in funding from the federal government.
Indiana is an example of a state in crisis.
"There are approximately 61,000 phone calls of abuse and neglect every year that come into our department," said Jim Payne, director of the Indiana Department of Child Services. Payne was appointed to overhaul the state's child protective services.
Indiana's child welfare system is in such disarray that the federal government says it is withholding millions of dollars in funding until the state makes significant improvements in its services.
Last year alone in Indiana, 19 children, who were already known to social workers, died of abuse and neglect.
Susan Swain is an Indiana social worker who routinely carries more than 50 cases at a time -- nearly three times the recommended number.
"I mean, I just feel like I can never get ahead," Swain said.
Many social workers say they are stunned by an increase in abuse in the middle class, putting additional strain on a system already under pressure.
"It covers across the socioeconomic spectrum," Bilchik said. "So this isn't about just impoverished families."
Swain was recently sent to a suburban Indianapolis neighborhood to remove two pregnant teenage girls from their parents, who were suspected of neglect.
"One of the pregnant children is on bed rest and she doesn't even have a bed in the home and she hasn't been going to school for four months," said Swain. "And the other child hasn't been going to school at all this year."
The two girls are now staying with grandparents under state supervision. They are part of a sea of children thought to be at risk around the country.
ABC News' Pierre Thomas filed this report for "World News Tonight."