Towards a Systemic Approach of Child Protection in Medical Settings: A Case Study on the "Hospital-Stranded Children" Phenomenon in China

Background and Purpose: Hospital-stranded children are defined as children who are left by their parents in medical settings for over six months. This emerging population is drawing increasing public attention in China. These children, who legally are not classified as orphans, are excluded from existing permanent placement policies in China. Though the role of healthcare institutions in the early identification and reporting of child protection cases has been consistently identified in the literature, evidence still showed an insufficient awareness of child protection among Chinese pediatricians, and very few studies have focused on child protection in Chinese medical institutions.

Guided by a systemic structure of child protection proposed by Wulczyn, this study aims to answer the following questions: (1) What are the experiences of hospital-stranded children? (2) What are the strengths and weaknesses of existing protective practices in Chinese hospitals? (3) What policy and cultural factors have contributed to this social problem?

Methods: Using a multiple-case design, 20 hospital-stranded children from three children's hospitals in a first-tier Chinese city were included in this study. Sixteen hospital personnel participated in semi-structured interviews, including physicians, social workers, administration staff and care workers. Interview findings, case records, and field observations were analyzed using a thematic analysis approach. Current child protection practices were analyzed through a child protection system model.

Results: The children in this study were well cared for by the hospitals, but their rights to provision, participation, and protection were violated due to the lack of a national child protection system. Three key weaknesses of child protection practices were identified: underreporting of suspected cases, delayed action after reporting, and inadequate follow-up services. The ineffectiveness of the national child welfare system and the family-oriented cultural values in China also created barriers to the protection of hospital-stranded children.

Conclusion and Implications: The findings suggest that professional child protection training for healthcare workers and collaboration among departments within and outside hospitals are necessary to offer a systematic protective network for hospital-stranded children at the institutional level.

At the policy level, first, centrally coordinated child protection system should be developed nationwide, including a national child protection agency that bears the primary responsibility for child protection for all children in the country. Within the central agency and its local branches, a case transfer mechanism should be developed to alleviate the restrictions of the Hukou system among local authorities across regions. Second, the existing laws and policies regarding mandatory reporting should be strengthened with strict enforcement to lower the underreporting rate of professional personnel. Furthermore, supporting facilities of the child protection agency need to be improved, and professional social workers should be available to assess the status of the child and the family and decide the duration and nature of the temporary placement a child requires. Finally, public awareness of child protection still needs to be raised in all child-related settings in China, including healthcare facilities.