This commentary argues that risks to children are least acceptable where there is a representation by professionals or agencies that children will be safeguarded when not being cared for by parents. It is expected that when children are entrusted to the care of nonparents, such as hospitals, that they will receive proper care and be protected. The highest standard of care for children applies to professions and institutions that hold themselves out to be beneficial for children. However, only 19 percent of American hospitals have a written systematic approach or protocol for managing child maltreatment occurring in their facility. It is recommended that there be a sharing of strategies for assuring accountability for hospitals to prevent abuse in their institutions. In addition, it is recommended that there be improved and focused screening of staff and professionals, patient complaint options, hospital ombudsmen, or otherwise improved risk management systems. There is the need for systematic approaches to protecting children from maltreatment while in hospitals. References