Hiqa has said allegations of child abuse made to the Child and Family Agency in the Midlands are not always reported to Gardaí.
The body has released a report into Tusla which raises serious concerns about its services.
The health watchdog has said 22 children were removed from their homes by Gardaí as a result of its work earlier this year.
Hiqa carried out a nine-day inspection of Tusla's operation across Laois, Offaly, Westmeath and Longford and it has highlighted significant risks in a number of areas.
Tusla has said it welcomes the report, saying the inspections allow the organisation ensure services are continuously improved.
“Tusla is committed to improving child protection and welfare services and will continue to build on the significant progress that has been made in the past 12 months,” said chief operations officer Jim Gibson.
“A range of measures have been implemented, including strengthening the management structure, allocating additional staff to reduce backlogs and activating a robust action plan to address key areas for improvement. This coupled with the determination and commitment of the staff during a challenging period for the service has led to a stronger service and support system in the area.”
You can read Tusla’s reaction to the report in full here.