Child Safety in Healthcare: Are We Overlooking These Critical Risks?
"New research reveals how families perceive adverse events in primary care—and what it means for your child's well-being."
In the late 1990s, a concerning trend emerged: patient safety was being compromised. The landmark report, To Err is Human, shed light on the fact that preventable errors in healthcare led to the deaths of tens of thousands of people. This sparked a global movement to prioritize patient safety and reduce unnecessary harm.
Since then, organizations like the American Academy of Pediatrics (AAP) and the World Health Organization (WHO) have launched initiatives to address this critical issue, particularly for vulnerable populations like children. These efforts emphasize system-level changes, professional training, and active involvement of patients and families.
But how safe is your child when they visit their local clinic? A recent qualitative study dug deep into this question, exploring the perceptions of families and caregivers regarding adverse events in primary care. The findings reveal potential blind spots and offer valuable insights for improving child safety in healthcare.
Contested Numbers, Measurable Burden
AHRQ's National Healthcare Quality and Disparities Report draws on National Patient Safety Database (NPSD) data to track national changes in healthcare errors, patient safety, quality, and disparities of care each year by condition and population group, with State-level breakdowns available through its State Snapshots. CDC FastStats figures from the 2019-2022 National Health Interview Survey show 1.5% of children ages 0-4 and 2.2% of children ages 5-11 in fair or poor health, while 8.0% of children ages 5-11 missed 11 or more days of school in the past year because of illness, injury, or disability, and 12.7% of children ages 2-5 have obesity (2017-March 2020). Analysts caution, however, that medical-error statistics in the U.S. are contested, with disputed definitions and data that is almost always underreported, yet the scale of preventable harm in American hospitals and clinics remains staggering by any estimate.
The Systems Approach and Its Limits
The majority of the patient safety literature in ambulatory pediatrics describes the frequencies and types of medical errors, but the study of effective interventions to reduce error-and particularly to reduce harm-has been limited. The dominant response has been the systems approach, which provides a framework for analyzing errors that includes retrospective techniques such as root cause analysis and prospective techniques such as failure modes and effects analysis. Many observers argue that while medical errors are an important public health problem and pose a serious threat to patient safety and quality of care, they are inevitable yet can be noticeably lessened through decisive action. In neonatal and pediatric IV infusion therapy, the risk is amplified by strategies such as the 'rule of six' with individualized, weight-based concentrations, prompting proposals for standard concentrations to reduce variability, improve safety, and facilitate electronic prescribing.
From 'Bad Systems' to a Century of Child Health Progress
The patient safety movement is traced most directly in Dr. Leape's 'Making Healthcare Safe: The Story of the Patient Safety Movement,' which outlines milestones in the current effort to reduce patient harm due to medical mistakes. The movement's most important initial insight was that errors are largely the result of bad systems, not bad people, a principle Leape himself complicates by controversially taking on the competence of clinicians rather than resting on a superficial application of the systems ideal. Child health carries a parallel legacy, as many important steps in its development emanated from discoveries focused on adult disease before the Archives of Disease in Childhood was inaugurated a century ago. Nearly a century of accomplishments in maternal and child health is likewise celebrated in the MCH Library's history collection.
What Adverse Events Look Like Through a Parent's Eyes
The study, conducted at a Basic Health Unit in Porto Alegre, Brazil, involved in-depth interviews with 11 family members and caregivers. Their experiences revealed a range of concerns, categorized into three key areas:
- Adverse Events in Healthcare Actions: These included issues like poorly administered vaccinations leading to complications and infections resulting from improper wound care.
- Access and Resolution as Safety Principles: Participants highlighted the importance of easy access to care and timely resolution of health issues. Barriers to access, such as appointment scheduling challenges, and lack of follow-up were seen as safety risks.
- Professional Qualification and Competence: Families emphasized the need for qualified healthcare professionals with the skills and knowledge to provide safe and effective care. Concerns were raised about staff attitudes, communication, and perceived lack of expertise.
New Evidence on Prescription and Diagnostic Errors
A 2025 systematic review in BMC Health Services Research, conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), set out to determine the prevalence of prescription errors in paediatric care, the factors associated with them, and the strategies used to mitigate them, noting that such errors are more prone to occur in paediatric care due to weight-based dosing and age-specific formulations. A Drug Safety study (October 2025) aimed to identify and describe the actual harm resulting from prescribing and medication administration errors in an acute paediatric setting, including the medication and patient demographic factors associated with harm. A multisite children's analysis, 'Child Age and Risk of Medication Error' (2024), examines the association between patient age and medication error risk to enable targeted safety interventions, while an AHRQ progress report on reducing diagnostic errors in primary care applies the Institute of Medicine's 'Improving Diagnosis in Health Care' definition of diagnostic error as the failure to establish an accurate and timely explanation of the patient's health problem(s) or to communicate that explanation.
Where Progress Has Come Up Short
Critics of pediatric-specific safety initiatives note that the evidence base is weighted toward describing error frequency rather than demonstrating harm reduction, and interventions that perform well in adult settings do not always transfer cleanly to children's care, where weight-based dosing and developmental variation complicate standardization. Where well-publicized initiatives have fallen short, the failures are typically attributed to inconsistent implementation, limited training, and underreporting rather than to the underlying approaches. The skeptical reading of such results is that, in the absence of stronger outcome-based data, claims about improved child safety should be treated with some caution.
Comparing Safety Across Care Settings
Comparisons across settings-such as inpatient units, ambulatory clinics, and primary care-suggest that children face distinct medication and diagnostic error risks tied to dosing calculations and age-specific presentation. Limited comparative evidence tends to show similar error categories recurring across settings precisely because the underlying systems (prescribing, handoffs, documentation) are shared. How relative rates and severity of harm actually differ between settings, however, remains an area where published data are too sparse and too variable to draw firm conclusions.
Empowering Parents: Taking an Active Role in Your Child's Safety
The research highlights a critical need for healthcare providers to actively engage with families, listen to their concerns, and address their perceptions of safety. By fostering open communication and building trust, healthcare systems can create a safer environment for children.
The Emerging Consensus
The overall picture across this literature is one of convergence: whether the lens is medication errors, diagnostic errors, or system failures, the recurring conclusion is that harm to children is produced less by individual mistakes than by the design of the care pathway around them. Commentators repeatedly emphasize that measurement itself is a problem, since rates are contested, definitions inconsistent, and underreporting widespread, so any success claim should be read with appropriate caution. Where experts do agree, it is that child-specific interventions, careful selection of outcomes, and honest reporting of implementation difficulties will matter as much as the interventions themselves.
Frontiers Still at the Demonstration Stage
Looking ahead, the clearest directions emerging in the field are prospective safety techniques, standardized dosing where feasible, and designs that anticipate rather than react to failure. The growing availability of electronic prescribing and structured reporting systems is expected to support these approaches, though progress will depend on how faithfully they are implemented on the pediatric front line. Early indications are encouraging, but most of these frontiers remain at the demonstration stage, so claims about their impact should be regarded as projections rather than settled results.
System Failures Reach Far Beyond the Child
Systemic challenges to pediatric safety extend well beyond any single clinical act. A 2023 Frontiers in Pediatrics article argues for methods that co-design child health initiatives with children and families themselves rather than using predesigned programs, accompanied by thoughtful outcome selection and reporting of implementation challenges to promote learning. Analyses of hospital errors also document consequences that reach healthcare professionals themselves, not just patients, and AHRQ PSNet's 2022 Year in Review highlighted system failures' impact on healthcare workers and the ways to support them. Practical guidance for pediatric care emphasizes safer incident reporting systems, family engagement, and the WHO's call for child-centered safety as core elements of preventing harm.
Families and Clinicians at the Center
Behind every statistic in this literature is a child and a family whose experience of care is shaped by communication, trust, and how errors are disclosed. When things go wrong, the human impact extends to the clinicians involved, who carry the burden of having caused or witnessed harm. Meaningfully improving child safety therefore depends as much on how the system treats people-families and providers alike-as on the technical accuracy of a prescription or a diagnosis. These human dimensions are widely acknowledged in principle, though they are generally described qualitatively rather than measured.
So, what can you do as a parent or caregiver? Here are a few key takeaways:
<ul> <li><b>Speak up:</b> Don't hesitate to voice your concerns to healthcare providers. If something doesn't seem right, ask questions and seek clarification.</li> <li><b>Be informed:</b> Understand your child's health conditions, medications, and treatment plans.</li> <li><b>Advocate for access:</b> Ensure your child has timely access to primary care and follow-up services.</li> <li><b>Partner with providers:</b> Work collaboratively with healthcare professionals to create a safe and supportive care plan for your child.</li> </ul> By taking an active role in your child's healthcare, you can help prevent adverse events and ensure their well-being.