Vulnerable child syndrome, parental perception of child vulnerability, and emergency department usage

Pediatr Emerg Care. 2011 Nov;27(11):1009-13. doi: 10.1097/PEC.0b013e318235bb4f.


Background: Vulnerable child syndrome (VCS) describes children perceived to be at risk for behavioral, developmental, or medical problems. Families with the dynamics of VCS overuse health care resources with frequent visits to doctors' offices.

Objective: The objective of the study was to explore the relationship between VCS, parental perception of child vulnerability (PPCV), and frequency of emergency department (ED) visits.

Design/methods: Parents of patients 1 to 15 years old presenting with nonurgent complaints to a pediatric ED were eligible. Participants completed questionnaires in which the Vulnerable Child Scale was used to generate a measure of PPCV. Primary outcomes included number of ED visits and PPCV assignment. Children were divided into 2 PPCV groups by Vulnerable Child Scale score: less than 40 (high PPCV) versus 40 or greater (low PPCV). The cutoff point was chosen as 1 SD (7.3) from the sample mean (46.8) on the vulnerable end of the scale (low scores).

Results: The mean ages of the 351 parents and children were 30 (SD, 7.7) years and 5 (SD, 3.9) years, respectively; 17% of children had high PPCV. Eleven variables differed statistically between subjects with high and low PPCV including number of ED visits and hospital admissions, excellent reported child health, pregnancy problems, delivery problems, child mental health problems, parent mental health problems, and child developmental problems.

Conclusions: Our results reveal that children with higher PPCV had an increased number of ED visits, and risk factors for higher perceived vulnerability scores were identified. Future investigation on ways to intervene with families with the dynamics of VCS may be warranted.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child Behavior Disorders / epidemiology
  • Child Welfare*
  • Child, Preschool
  • Developmental Disabilities / epidemiology
  • Emergency Service, Hospital / statistics & numerical data*
  • Fear
  • Female
  • Humans
  • Infant
  • Male
  • Mental Disorders / epidemiology
  • Ohio / epidemiology
  • Parent-Child Relations
  • Parents / psychology*
  • Patient Admission / statistics & numerical data
  • Physicians / psychology
  • Pregnancy
  • Pregnancy Complications / epidemiology
  • Severity of Illness Index
  • Social Perception
  • Surveys and Questionnaires
  • Syndrome