HIQA has said it has "grave concerns" about the "significantly higher" number of children in direct provision centres referred to Tusla compared to the rest of the child population.
A newly published report says that 14% of children in direct provision were referred to Tusla compared to 1.6% for the general child population.
The report also raises concerns about the quality of service and said there was one referral about a child threatening suicide where the child was waiting three years for a response from the social work team.
Director of Regulation with HIQA Mary Dunnion said the quality of the child protection and welfare service provided to children across the four areas sampled in this inspection was "radically inconsistent."
She said: "A good quality of service" was provided to children and their families in Sligo/Leitrim/West Cavan and in Dublin North City.
In the Midlands the service was "mixed" but in Louth/Meath the service was "much poorer and some risks had not been identified and addressed by managers.
"There was no strategic plan in place to identify and meet the needs of this particularly vulnerable group of children and families," she said.
The report highlights that in 27 out of the 38 cases reviewed in Louth/Meath "children were not met with or seen by social workers to inform their decision making about the referral even though records indicated concerns about their safety and welfare."
It also said "there were significant delays in completing assessments and sharing information, which placed children at risk."
In one case there were significant concerns about an allegation of physical abuse of two children and the case was closed without children being visited, HIQA said.
There were about 1,600 children living in direct provision accommodation in Ireland, of these there were 209 referrals of child protection and welfare concerns relating to 229 children between August 2013 and August 2014.
Of the referrals 51% related to child welfare issues, while a further 49% referred to child protection concerns.
HIQA has made four recommendations to the Child and Family Agency including developing an "inter-cultural strategy to inform the provision of social services to ethnic minority children and families."
It also says there should be an audit "to ensure there are no children at risk of harm because of outstanding or incomplete assessments due to the movement of families between accommodation centres."