Creating a safe place for pediatric care: A no hit zone

Hosp Pediatr. 2014 Jul;4(4):247-50. doi: 10.1542/hpeds.2013-0106.


Objectives: Our goal was to create and implement a program, Kosair Children's Hospital's No Hit Zone, which trains health care workers in de-escalation techniques to address parental disruptive behaviors and physical discipline of children commonly encountered in the hospital environment.

Methods: The Child Abuse Task Force, a multidisciplinary group, along with key hospital administrators developed specific content for the policy, as well as marketing and educational materials. The No Hit Zone policy designates Kosair Children's Hospital as "an environment in which no adult shall hit a child, no adult shall hit another adult, no child shall hit an adult, and no child shall hit another child. When hitting is observed, it is everyone's responsibility to interrupt the behavior as well as communicate system policy to those present."

Results: Via a multidisciplinary, collaborative approach, the No Hit Zone was successfully implemented at Kosair Children's Hospital in 2012. Cost was nominal, and the support of key hospital administrators was critical to the program's success. Education of health professionals on de-escalation techniques and intervention with families at the early signs of parental stress occurred via live sessions and online training via case-based scenarios.

Conclusions: The No Hit Zone is an important program used to provide a safe and caring environment for all families and staff of Kosair Children's Hospital. Demand for the program continues, demonstrated by the establishment of No Hit Zones at other local hospitals and multiple outpatient clinics. This article offers information for other organizations planning to conduct similar initiatives.

Keywords: child abuse; child abuse prevention; crisis intervention; hospital policies; multidisciplinary approach; organizational policy; parental behavior; patient care team; pediatric hospitals; physical discipline; physician-patient relations; staff development.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Child Abuse / prevention & control*
  • Crisis Intervention / education*
  • Hospitals, Pediatric*
  • Humans
  • Organizational Policy*
  • Parent-Child Relations*
  • Parents*
  • Staff Development*
  • Violence / prevention & control*