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There are many ways you can help children and their families get the care they need.
Child Protection Team (CPT) is a multidisciplinary team of consultants comprised of physicians, attorneys, psychologists, social workers, nurses, nurse practitioners and advocates, including several members of the AWAKE and CPCS teams.
CPT provides 24 hour, on-call coverage, expert consultation services, professional training and case-specific support to hospital staff on issues of child maltreatment. Additionally, the team includes a Nurse Liaison to the Department of Children and Families who works in close collaboration with hospital and DCF staff to respond to the unique needs of children being treated at Boston Children's Hospital while in the legal custody of DCF.
Child Protection Program at Boston Children's Hospital trains hospital staff
and community providers to identify, evaluate, and treat children for whom abuse and neglect has been suspected and/or confirmed. Training program also trains staff to respond to survivors of interpersonal violence (IPV) including children who's well-being has been impacted by exposure to this violence in an effort to enhance their level of safety.
are designed to help Boston Children's faculty and staff become comfortable
with the language and techniques used to screen for abuse. Faculty and staff
also learn how to respond sensitively to a disclosure in ways that ensure the
safety of the victim, as well as other family members, hospital patients and
families or staff who may be placed at risk by the disclosure.
addition to in-house training for faculty and staff, the Child Protection
Program is also available to provide trainings on a variety of topics as
Studies suggest that the incidence of certain comorbidities are correlated with duration and severity of abuse, thus suggesting that reports of abuse to appropriate child protection agencies may have long term, as well as immediate, health benefits for the victim.
Therefore, it is essential that pediatricians and other health care providers understand the scope of the problem and learn how to identify cases of abuse and neglect, as well as families at risk. Here we outline the scope of the problem.
The Federal Child Abuse Prevention and Treatment Act (Pub. L. No. 93-247 (1974)) defines child abuse and neglect to be, at a minimum:
The definition of sexual abuse includes the following:
A child is defined to be a person who has not attained the lesser of:
Each state may further define child abuse and neglect, provided the definitions fall within the minimum standard set by CAPTA. Massachusetts reporting laws define child abuse and neglect as follows:
Most of the following descriptions are adapted from the U.S. Department of Health and Human Services guide, "A Coordinated Response to Child Abuse and Neglect: A Basic Manual."(2)
Physical Abuse: characterized by physical injury (i.e. bruises and fractures) resulting from punching, beating, kicking, biting, burning, or otherwise harming a child. Although the injury is not an accident, the parent or caretaker may not have intended to hurt the child. The injury may have resulted from overdiscipline or physical punishment that is inappropriate for the child's age or condition. The injury may be a result of a single episode or of repeated episodes and can range in severity from minor bruising to death. Any punishment that involves hitting with a closed fist or an instrument, kicking, inflicting burns, or throwing the child is considered physical abuse regardless of the severity of the injury sustained.
Sexual Abuse: includes a wide range of behavior - fondling a child's genitals, oral-genital contact, intercourse, rape, sodomy, forcing a child to perform a sexual act on an adult, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials. Sexual abuse is usually defined as acts committed by a person responsible for the care of the child (i.e. a parent, babysitter, day care provider, etc.), whereas sexual assault is usually defined as acts committed by a person not responsible for the child's care.
Emotional/Psychological Abuse: includes acts or omissions by the parents or other persons responsible for the child's care that have caused, or could cause, serious behavioral, cognitive, emotional, or mental disorders. In some cases, the acts alone (without any harm evident in the child's behavior or condition) warrant Department of Social Services (DSS) intervention; for example, the use of extreme or bizarre forms of punishment, such as torture or confinement in a dark closet. For less severe acts, such as habitual scapegoating, belittling, or rejecting treatment, demonstrable harm to the child is often required for DSS to intervene.
Physical Neglect: includes refusal of or delay in seeking health care, abandonment, inadequate supervision, and expulsion from home or refusing to allow a runaway to return home.
Emotional Neglect: includes such actions as chronic or extreme spouse abuse in the child's presence, permission of drug or alcohol use by the child, and refusal or failure to provide needed psychological care.
Educational Neglect: includes permission of chronic truancy, failure to enroll a child of mandatory school age, and in attention to a special education need.
Munchausen Syndrome by Proxy: a form of child abuse in which a parent (usually the mother) purposefully fabricates illness in her child or reports concerning symptoms (such as seizure activity, apnea, etc.) not seen by objective witnesses, and repeatedly seeks medical care for the child, denying knowledge as to the cause of the illness or injury. Acute signs and symptoms often subside when child and parent are separated.(3)
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”