In today’s world, every institution providing care for children should expect that members of its staff will be accused of abusing children entrusted to their care. To best protect themselves an institution should have an organized approach to management or a protocol. This study reports on a retrospective series of cases reflecting allegations of patient abuse by hospital staff collected from Child Protection Team (CPT) and hospital archives from one pediatric hospital in a metropolitan area between 1982 and 1996. The study intended to describe a hospital CPT’s effort to develop and implement a protocol for systematic evaluation and management of accusations that hospital staff have abused pediatric patients and learn how to avoid problematic patient encounters. Data were collected using a standard format including victim and alleged perpetrator demographics, incident characteristics, and hospital and protective services responses. Results indicate that as the CPT learned of initial complaints of patient abuse it became apparent that the reports and their management were laden with confusion. Many risk factors for accusation and management became apparent. Child victims had a high frequency of chronic illness and their families frequently had histories of prior abuse, mental illness, and social disarray. Hospitals caring for children should expect that they will receive complaints, ranging from legitimate to false and realize that even if they interact appropriately with patients they are at risk of abuse accusations. Action needs to be taken to minimize the risk. However, few children’s hospitals have formal protocols for internal management of or training programs to avoid allegations. Several institutional and individual staff recommendations are presented regarding the prevention and recognition of allegations. Future studies should focus on quantifying the frequency of abuse allegations on a national level. Appendix 1-2 and references