Balancing safety and privacy in pediatric units, part 1

In pediatric healthcare settings, providing security is not just about keeping people safe. It’s also about protecting the emotional well-being of some of the most vulnerable patients in the healthcare system. That’s why pediatric units require an approach to safety that prioritizes physical protection alongside patient privacy.

The fact is, security leaders operating in these environments face a delicate balancing act. Traditional security measures can feel intrusive or intimidating to young patients and their families. At the same time, the risks are real and varied, from unauthorized visitors and custody disputes to abduction threats, behavioral incidents, and even human trafficking concerns.

In this two-part series, I’ll explore how security leaders can strike the right balance between safety and dignity in pediatric units. 

This first part focuses on understanding the risks, regulatory considerations, and the tensions that can arise when privacy and protection are at odds. 

The security landscape of pediatric units

Security in pediatric healthcare environments differs significantly from adult hospital settings. Children, especially those undergoing medical treatment, are not just physically vulnerable but also emotionally sensitive. They may be scared, confused, or in pain, and their caregivers are often under extreme stress. 

The result is an atmosphere where tensions can escalate quickly, and where the presence of a security officer must be reassuring rather than intimidating.

In pediatric units, security professionals must also account for a higher volume of non-staff individuals. Parents, guardians, siblings, extended family, and legal custodians are frequently present at all hours. This raises concerns about unauthorized access, compliance with visitor protocols, and patient safety, particularly in cases where there are legal or custody complications.

The stakes are even higher when considering the potential for child or infant abduction. Pediatric and maternity wards require heightened vigilance around exit points, ID verification, and child-matching systems. 

To guide security best practices in these sensitive environments, many healthcare organizations rely on the standards set forth by the International Association for Healthcare Security and Safety (IAHSS). The IAHSS Security Guidelines and IAHSS Security Design Guidelines provide comprehensive frameworks for addressing access control, incident response, physical infrastructure, and staff training in pediatric and general healthcare settings. 

According to the National Center for Missing and Exploited Children (NCMEC), there were 140 infant abduction attempts in healthcare settings between 1964 and 2022, with 26% of those occurring within pediatric or neonatal units. 

In response to these risks, many hospitals have reinforced protocols not only to prevent abductions but also to identify signs of human trafficking—an often-overlooked threat that can surface in emergency departments when children arrive under suspicious or unclear circumstances.

These scenarios demand security protocols that align with strict regulatory frameworks, including HIPAA, EMTALA, and the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation for Hospitals. 

In pediatric healthcare, lapses in physical security can have life-altering consequences—making specialized training, proactive risk management, and constant situational awareness essential.

Bottom line: Security professionals working in pediatric care settings must be trained to respond to a wide range of threats, including:

• Unauthorized access during off-hours
• Legal custody disputes, especially where guardianship is contested or unclear
• Behavioral health crises in pediatric psychiatric units
• Human trafficking indicators in ER intakes 

Read more: Switching security providers in healthcare? Here’s what you need to know 

When safety measures conflict with privacy

One of the most challenging aspects of pediatric healthcare security is finding the right balance between necessary safety measures and the preservation of privacy and dignity. 

Children and their families are often navigating highly sensitive medical and personal situations, where security protocols that might be appropriate in other settings can sometimes feel intrusive or counterproductive. For example, questioning a parent or guardian in front of a child can create unnecessary fear or confusion. 

Security professionals must constantly assess risk while minimizing harm. This requires specialized training and collaboration with clinical teams to ensure interventions are safe, appropriate, and respectful.

Here are the key areas of potential conflict:

• Surveillance: Cameras must be limited to hallways, entrances, and common areas. Patient rooms should use electronic monitoring (e.g., staff badges triggering alerts) rather than video unless there's a documented risk. 
• Facial imaging technology: Use AI-enabled access control systems that log patterns of unusual visitor activity without retaining facial image data to stay within HIPAA compliance.
• Visitor screening: Identity verification and custody status must be handled privately, ideally in secure interview rooms away from waiting areas. 
• Behavioral interventions: Officers should avoid physical intervention except in Tier 1 situations (e.g., immediate threat of harm). All responses should be guided by trauma-informed principles, bearing in mind that physical interventions, restraints, or even raised voices can be traumatizing to a child and distressing to families and nearby patients. 

Understanding the risks is just the first step

In pediatric healthcare, the stakes are high—and the risks are varied. But safeguarding these environments goes beyond threat response. It means understanding the emotional context, recognizing the limits of traditional security practices, and aligning every protocol with both compliance and compassion.

In Part 2 of this series, I’ll move from challenges to solutions, sharing best practices for trauma-informed training, physical infrastructure, and collaborative care models that empower officers to become true partners in the healing process. Stay tuned.