• Report
  • October 1, 2011

Defining the Children's Hospital Role in Child Maltreatment, Second Edition

Defining the Children's Hospital Role in Child Maltreatment Second Edition Cover ImageBackground

Defining the Children's Hospital Role in Child Maltreatment, Second Edition communicates the collective intent on the part of children's hospitals to counter child maltreatment, empower community partners in this regard, and help more children grow up without the threat of abuse or the pain of neglect. These guidelines do not describe clinical parameters, provide assistance in medical decision-making or provide criteria for accreditation. They outline what a child protection team at a children's hospital should offer in way of infrastructure, staffing, functions and systems to be considered a basic program, advanced program or center of excellence.

The three levels are not a ranking for competitive evaluation; they are a framework for self assessment to set goals for growth and development within the context of each community's needs.

Second Edition Highlights

  • New subspecialty: The first cohort of 191 child abuse pediatricians was certified in October 2009. The second edition recommends that all advanced programs and centers of excellence have a board certified child abuse pediatrician, with few exceptions.
  • Community benefit: Most children's hospitals are classified as not-for-profit because the community services they provide might otherwise become a public responsibility. Since the publication of the first edition, there has been increased scrutiny of hospitals' qualifications for tax exemption. The second edition outlines hospital activities related to child abuse treatment, education and prevention that can be quantified as community benefit.
  • Prevention: Echoing a national focus on preventative health care, the second edition outlines how the child protection team contributes to prevention activities in the hospital and community.

Core Messages

  • Now a subspecialty, child abuse pediatricians should be utilized when their medical expertise is needed. The role of the general pediatrician remains the same: treat and refer, and take ownership when appropriate.
  • The opinions rendered by child abuse experts in discerning the manner of injury are essential for the entire response system to work and to determine the next steps taken by protective and criminal justice agencies and the medical community.


The Association urges other national organizations to likewise pursue and define their roles within the complicated and interdependent system of child abuse response and prevention.

  1. All acute care children's hospitals should, at a minimum, meet the recommendations for a basic program.
  2. All advanced programs and centers of excellence should be medically directed, in most cases by a certified child abuse pediatrician.
  3. All acute care children’s hospitals that meet one or more of the following criteria should have a medically directed child protection team that is at either the advanced or center of excellence level.
    • Have a trauma center designated by the state and/or verified by the American College of Surgeons as a Level I or II adult or pediatric trauma center
    • House an intensive care unit
    • Have an academic residency
    • House a burn unit

This resource was produced prior to the merger of NACHRI, N.A.C.H. and CHCA, which became the Children's Hospital Association.