Sometimes social policies and institutions designed to help children do more harm than good. As the number of children enrolled in day care, treatment facilities, correctional institutions and foster care increases so does concern with institutional maltreatment.

Some child advocates argue that any institutionalization of children is abusive. Placement of children with adults in jails, correctional facilities or treatment centers puts children at significant risk of abuse and is prohibited in many areas.

Children placed in treatment and correctional facilities must be given a label. Designation as retarded, delinquent, emotionally disturbed or mentally ill can enable a child to receive special services that may benefit him or her. Such a label also places a child at significant risk of subsequent maltreatment. Some advocates say that institutional labeling is itself a form of abuse. Others point to the deprivation of freedom and denial of legal protection that often goes with institutional care.

Abuse within institutions may take several forms. Residents of full-time, 24-hour residential institutions may suffer physical neglect associated with poor nutrition, lack of exercise and idleness due to a lack of programmed activities. Medical abuse and neglect may also occur when health problems go untreated or when medication is dispensed without adequate monitoring or controls.

Many institutions, due to their age or lack of adequate funding, do not meet minimal standards for safety. Children living in these institutions may suffer burns from unprotected radiators, lacerations or fractures from poorly designed or defective buildings and furnishings and numerous other environmentally induced injuries.

Children in institutional settings may suffer physical abuse at the hands of staff, other residents or outsiders. Some children suffering developmental disabilities or mental illness must be protected from self-inflicted injuries.

In recent years, a number of child sexual abuse cases in residential facilities and day care centers have received media attention. Historical accounts indicate that sexual exploitation of children in institutions has long been a problem. Recent publicity has caused institutions and lawmakers to consider new ways of protecting children from sexual abuse outside the family.

Problems associated with institutional abuse stem from many different sources. Treatment and correctional facilities are often inadequately funded. Lack of funds may lead to neglect of physical facilities and inadequate supervision of children. Poor recruitment procedures for child care workers and foster families also share blame for the increased risk of maltreatment. Finally, many institutions have simply failed to realize or acknowledge real or potential abuse.

Residential facilities have a responsibility to protect children from abuse. Most governmental, licensing and accreditation authorities require specific procedures for investigation of alleged maltreatment of children. Institutions are typically required to involve a neutral third party, in most cases a child protection or licensing agency, in the investigation of all such complaints. Recent civil suits have forced child care facilities to screen applicants for employment more carefully and to develop more thorough procedures for ensuring the safety of children.

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