Hospital personnel have been shown to report child maltreatment to social services less frequently than other professionals. This quantitative study shows that one-half of the respondents within the four largest Swedish children's hospitals had never made a report. However, nurses' and nurse assistants' odds of being low reporters were significantly high, compared with physicians and hospital social workers. Longer working experience, access to guidelines and routines, and feelings of stress were strongly related to deciding not to report. Insecurity in assessment and ambivalence about how to act also had a strong effect, although different emotions had varying impacts on the different professions; hospital social workers were less strongly influenced by emotions in their decision-making.