Objective: Children and families enrolled in early childhood systems of care (SOC) present with various psychological and behavioral risk factors that may inhibit healthy development. Within a SOC, wraparound services are designed to increase families’ access to numerous child-serving sectors in order to target those risk factors. This study examined whether child and family risk factors at enrollment in an early childhood SOC predicted dosage, service recommendation, and usage of recommended services. Method: Participants were 144 children ranging in age from 1.38 to 5.89 years and their caregivers. Families completed measures of child and caregiver functioning prior to participation in the SOC. Service recommendation and usage were measured at intake and three months, respectively. We used multiple regression analysis to examine the relationship between risk factors and dosage of services received. Logistic regression analyses identified the relationships between risk factors and service recommendation and usage according to specific service types within the SOC. Results: Children with greater behavior problems received more services overall (R2 = .103, β = .243, p = .033). Child risk factors predicted recommendation for child welfare (trauma exposure: OR = 1.352, p = .052) and mental health services (behavior problems: OR = 1.061, p = .034; trauma exposure: OR = 1.316, p = .046), whereas families with substance use issues were less likely to be recommended for mental health services (OR = .229, p = .017). Conclusions: Findings highlight opportunities for improved service provision and service-level decision making in early childhood SOCs.