Preventing Infant/Child
Abduction
Security Awareness for Maternal Child Health
Adapted from National Center for Missing and Exploited Children
Guidelines on Prevention of and Response to Infant Abductions (9th ed.), 2009
1
Infant / Child Abduction Plan
• Sensitive areas because of infants and children.
• Always react as if it is a real alarm
o Everyone assigned to a job must perform their job each time there is an
alarm
• Reduce false alarms
o Majority are caused by human error
• Example – tags in staff’s pockets, tags left on infant at time of discharge,
parents try to take tag as a souvenir, or tag in the trash
• Know the by-pass operation when taking infant/child to
Radiology or other area for testing
o This prevents false alarms
• Report any problems with the alarm system to Security as
soon as known
2
Report Suspicious People or
Activity Immediately
• THE “TYPICAL” ABDUCTOR
o Female of “childbearing” age (range now 12 to 53), often
overweight.
o Most likely compulsive; most often relies on manipulation,
lying, and deception.
o Frequently indicates she has lost a baby or is incapable of having
a baby.
o Often married or cohabitating; companion’s desire for a child or
the abductor’s desire to provide her companion with “his” child
may be the motivation for the abduction.
o Usually lives in the community where the abduction takes place.
3
Report Suspicious People or
Activity Immediately
• THE “TYPICAL” ABDUCTOR
o Frequently visits nursery and maternity units at more than one
healthcare facility prior to abduction.
o Asks detailed question about procedures and the maternity floor
layout.
o Frequently uses a fire-exit stairwell for escape and may also try to
abduct from the home setting.
o Usually plans the abduction, but does not necessarily target a specific
infant/child; frequently seizes any opportunity present.
o Frequently impersonates a nurse or other healthcare personnel.
o Often becomes familiar with healthcare staff members, staff members
work routines, and victim parents.
o Demonstrates a capability to provide “good” care to the infant/child
once the abduction occurs.
4
Report Suspicious People or
Activity Immediately
• THE “TYPICAL” ABDUCTOR
In addition, an abductor who abducts from the home setting:
o Is more likely to be single while claiming to have a partner.
o Often targets a mother whom she may find visiting healthcare
facilities and tries to meet the target family.
o Often plans the abduction and brings a weapon, although the weapon
may not be used.
o Often impersonates a healthcare or social-services professional when
visiting the home.
There is no guarantee an infant abductor will fit this description.
Prevention is the best defense against infant abductions.
Know whom to look for and that person’s mode of operation.
5
Infant/ Child Abductions From
Healthcare Facilities
• While not a crime of epidemic proportions, the
abduction, by nonfamily members of infants, birth through
6 months, from healthcare facilities has clearly become a
concern.
• Typical abduction from a healthcare facility involves an
“unknown” abductor impersonating a nurse, healthcare
employee, volunteer, or relative to gain access to an
infant.
• Because there is easier access to a mother’s room than a
newborn nursery, most abductors “con” the infant
directly from the mother’s arms. This can also happen in
the pediatric department.
6
TOTAL – Abductions of Infants from 1983 -2008: 256
TOTAL – Still Missing: 12
1983-2008
Healthcare Facilities
• 124
•Mother’s Room
•Nursery
•Pediatric Units
•“On Premises” (outside
building but still on
grounds)
• 71 (57%)
• 17 (14%)
• 17 (14%)
Case Status
• Located = 118
• Still Missing = 6
• 19 (15%)
•With Violence to
Mother : “On Premises”
• 9 (7%)
Homes
•With Violence to
Mother
• 99
“Other Places”
•With Violence to
Mother
• 33
• Located = 95
• Still Missing = 4
• 29 (29%)
• 8 (24%)
• Located = 31
• Still Missing = 2
7
The Crimes are not Always
Committed by a “Stranger”
• Offenders make themselves known and achieve some
familiarity with healthcare personnel, procedures and
the victim’s parents.
• Often visits the maternity unit and nursery for several
days before the abduction.
• Repeatedly asks detailed questions about procedures.
• Familiarizes themselves with the layout of the maternity unit.
• Some abductors are former employees, former patients,
or have a friend or relative who was a patient at the
facility where the crime was committed.
8
The Crimes are not Always
Committed by a “Stranger”
• Impersonate nurses or other healthcare personnel
wearing uniforms or other healthcare-worker attire.
• They have also impersonated home-health nurses, staff
with financial-assistance programs, and other healthcare
professionals.
• Often visit more than one healthcare facility to assess
security measures and explore infants/children, like
“window shopping”.
• May not target a specific infant/child. “Snatches” the
infant/child when an opportunity arises and makes a
quick exit, often via a fire-exit stairwell.
• Often focuses on a Mom’s rooms located near a stairwell.
9
General Guidelines For
Healthcare Professionals
Safeguarding infants and children requires:
• Comprehensive policies, procedures, and processes
• Education
• Coordination
• A multi-disciplinary approach
• Electronic security measures serve as a “back-up” to
policies, procedures, and nursing practice
10
What Can You Do to Prevent
Infant Abduction?
• Be alert to unusual behavior.
• The protection of infants and children is everyone’s job, not
just Security’s.
• One of the most effective means is simply asking “May I
help you” and “Who are you here to visit?”
• Make eye contact when asking questions.
• Carefully observe the person’s behavior.
• Note physical description.
• Follow-up appropriately for the situation.
• Be aware of strategically placed video cameras throughout
the departments (Record 24 hours/day, 365 days a year).
11
Unusual Behavior
• Repeated visiting or requests “just to see” or “hold” infants.
• Close questioning of procedures, security devices, and
layout of the floor such as “Where are the emergency
exits?” “Where do the stairwells lead?” “How late are
visitors allowed on the floor?” “Do babies stay with their
mothers at all times?”
• Taking uniforms or other means of identification.
• Physically carrying an infant/child in the facilities corridor
instead of using a bassinet or wheelchair.
• Transporting infant or leaving with an infant while on foot
rather than in a wheelchair.
• Carrying large packages off the maternity unit, particularly
if the person is “cradling” or “talking” to it.
12
Creating a Diversion
• Be aware that the
abductor may create a
diversion in another area
to facilitate the
infant/child abduction,
including:
o Pulling a fire alarm near
the nursery.
o Threatening argument in
the waiting area.
13
General Guidelines
• Anyone demonstrating suspicious behavior should be
immediately asked why they are in that area of the facility.
• Immediately report the person’s behavior to the charge
nurse, nurse manager/nursing supervisor, and Security.
• Positively identify the suspicious person, write down what
you see, and keep him/her under close observation.
o Age
o Race
o Eye color
o Height
o Weight
o Hair color
o Clothing
o Anything unusual about the individual (limp, birth
mark, glasses, tattoos etc.)
14
General Guidelines
• Suspicious person should be immediately interviewed
by the nurse manager/ nursing supervisor and Security.
• Caution needs to be exercised when interacting with
people who exhibit these behaviors.
15
Proactive Prevention L&D
• Educate the mother/support persons/guardian regarding
all safety procedures and document on the PFER.
• Immediately after birth of the infant and before the
mother and infant are separated, attach identical ID
bands to the infant (2 bands) and mother (1 band) and 1
band to the support person of the mother’s choice.
• The delivery room nurse will write the delivery date,
time of delivery, and sex of the infant on all four
bracelets.
• Educate mother/support persons of the reason and need
for the ID bands.
16
Proactive Prevention
• If the fourth ID band is not used, it will be cut in pieces
and placed in the HIPAA bin.
• An infant’s ID bands must be verified by the mother
prior to the infant leaving the mother’s room for care,
and upon return to the mother’s room.
• The nurse must examine and verify the identification
information on the infant’s and mother’s/ support
person’s ID bands.
• The mother should participate in the identification
process.
• Mother’s first and last name, MRN number and infant’s
birth date are verified.
17
Proactive Protection L&D
• If an infant band is removed for medical treatment or
comes off for any reason, immediately reband the infant
after identifying the infant, using objective means such
as footprint comparisons or blood testing
• Apply new bands to the infant, checking mother’s first
and last name, mother’s MRN number, infant sex, date
of birth, and birth time.
• If the band is cut or entirely removed the mother/
support person should be present at the removal and
replacement.
18
Proactive Protection L&D
• Prior to removal of infant from birthing room or within a
maximum of two hours of the birth:
o Footprint (with emphasis on the ball and heel of the
foot) the infant, making sure the print is clear and
readable.
o Perform a full, physical assessment of the infant, and
record the assessment, along with a description of
the infant in the medical record.
o Identify and document any marks or abnormalities
such as skin tags, moles and/or birth marks.
19
Proactive Protection L&D
• Prior to removal of infant from birthing room or within a
maximum of two hours of the birth:
o Store a sample of infant’s cord blood until at least the day
after the infant’s discharge.
o Place electronic security tag on infant’s umbilical cord
clamp or leg bracelet after verifying that the tag is
working.
o Log security tag into security system using the correct
infant name and room number.
o Placement of security tag is checked with each infant
assessment and when an infant is transferred to 1B, L&D
or NICU.
20
Proactive Protection -Pediatric
Patient
• Nurse will obtain a two part pre-numbered bracelet set and
write patient information on bracelets.
• ID number is documented in EMR.
• One bracelet placed on the child’s arm or leg and second
bracelet placed on the parent/ guardian’s arm.
• These bracelets are used during the hospitalization period
to match the child with his/her parent(s)/guardian.
• Log security tag into security system using the correct
child’s name and room number.
• A bracelet with a security tag is placed on the child at time
of admission.
• .
21
Proactive Protection- Pediatric
Patient
• Placement of security tag is checked with each pediatric
assessment and when a child is transferred back to the unit
after a procedure/surgery
• If bracelet is removed, a new set of bracelets must be
immediately placed on the child and parent/support person.
The old bracelet set is cut up and placed in the HIPPA bin.
• The security tag is removed immediately prior to discharge.
• The bracelets and numbers of the child and the parent/
support person are verified prior to discharge of the child.
22
Proactive Protection
• Require all healthcare-facility personnel to wear their
name badges above the waist and “face-side” out so the
person’s name and title are easily identifiable.
• All maternal child employees have a pink stripe on their
name badge.
• Mothers and support persons are instructed to only
allow nurses who they know and who also have a pink
stripe on their badge to take their infant/ child out of the
room for tests or procedures.
23
Proactive Protection
• Infant/child transportation within the healthcare
facility
o When an infant/child is transported within the
healthcare facility, he/she must be accompanied by
a MCH nurse who is wearing the authorized pink
striped name tag.
o Mother/support person/guardian is encouraged to
accompany infant/child if taken off of the unit for
testing.
24
Proactive Protection
• Prohibit “arm carrying” infants, and require all
transports to be via a bassinet.
• Always place infant in direct, line-of-sight supervision
either by the mother, support person or staff member.
• Address the procedure to be followed when the infant is
with the mother and she needs to go to sleep/ the
bathroom and/or is sedated.
• Always place the mother’s bed between the infant’s
bassinet and the exit door to the room.
25
Proactive Protection
at Discharge from L&D and 1B
• At discharge nurse compares infant’s ID bands to mother’s
ID band.
• Remove one infant ID band and tape to Hollister Footprint
form.
• Mother signs the Hollister Footprint form to acknowledge
bracelet check.
• Nurse removes infant security tag immediately prior to
discharge.
• Nurse discharges infant security tag from infant security
system.
• Mother is discharged per wheelchair holding infant in her
arms or in a car seat. Support person is not permitted to
carry infant.
26
Proactive Protection in NICU
• Each family member should be positively identified and
documented by nursing staff members.
• Visitors approved by the parents must be carefully
observed and not allowed near any other infants.
• A number of abductions from NICUs’ have involved
family members of infants who were on “court hold” for
such reasons as positive drug screens and custody issues,
infants awaiting adoption and guardian ad-litem
situations.
27
NICU Infant Security Risk Issues
• Potential infant security risk issues:
o Infant care procedures resulting in numerous infant
ID band changes due to reinsertion of IVs’,
edematous extremities, or infant weight gain.
- The removed ID band should be cut up and placed
in the HIPAA bin.
- Reband infant with another ID band that matches
the mother’s/ support person’s ID band.
28
NICU Infant Security Risk Issues
• Potential infant security risk issues:
o Single patient rooms or pods may make it difficult for lineof-sight observation of infants at all times.
o False sense of security that infants are attached to a
monitor.
o False sense of security that NICU babies are not abducted.
o Large, busy unit with multiple caregivers who may not be
familiar with the mother/support persons.
o Security policies and procedures regarding discharge that
are different than L&D – Baby can be carried out in car
seat or in mother’s arms if she is no longer a patient in the
hospital.
29
Proactive Protection
at Discharge from NICU
• Require photo ID of mother/support person prior to
discharge. Place copy on chart.
• At discharge nurse compares infant’s ID bands to mother’s
ID band.
• Remove one infant ID band and tape to Hollister Footprint
form.
• Mother signs the Hollister Footprint form to acknowledge
bracelet check.
• Nurse removes infant security tag immediately prior to
discharge.
• Nurse discharges infant security tag from infant security
system.
30
Pediatric Security Risk Issues
• Family abduction is more common in cases involving
custody disputes, child abuse, and Department of
Family and Children’s Services interventions.
• Upon admission nursing staff should ask
parent/guardian if there are any personal circumstances
the facility should be aware of that may put the child,
family or staff at risk.
31
Pediatric Security Risk
Issues
• Special concern should be placed on single persons who
may be involved in a custody dispute or if the mother
has a protective order against the infant’s father.
• 14% of abductions are from pediatric units.
• The constant presence of family should be encouraged
for those patients younger than 12 months.
32
Outpatient Areas – MFC, PCC,
Lactation and PAE office
• Signs should be posted in all waiting areas stating
parents and guardians are not allowed to leave infants
and children unattended in the waiting area.
• All infants/children should be accompanied by an adult
other than the mother.
33
Code Pink
=
Infant Abduction
Call 22222
34
Code Pink Drills
• Code Pink is called. All MCH staff return to the unit.
• Charge nurse will notify Security.
• Security will notify:
o Senior VP of facilities
o Senior VP of hospital
o Edgewood Police
o FBI
o Systems Director for Maternal Child Health
o Nurse manager of area
o Additional management team members (1B, NICU, LDRP)
• Charge nurse assigns staff members to each exit of the unit.
35
Code Pink Drills
• Charge nurse and Security- assign staff members to
search each open/occupied patient room on the unit,
assigns ancillary personnel to assist and search common
areas, lounges, locker area, waiting rooms, storage areas,
and utility rooms.
• All infants are to be accounted for and other areas
thoroughly searched.
• If infant missing, areas are searched. A piece of tape is
placed on the door of each room to acknowledge
the room has been searched.
36
Code Pink Drills
• Nurse assigned to patient remains with the patient to
assure they are assisted during this time.
• Patient may request to be moved, hospital associate is to
remain with family at all times.
• Nothing in the patient’s room should be moved or
removed from the area until Security has given
approval.
• Contact Social Services and Pastoral Care.
• If abduction has occurred, the nurse caring for the
patient will assist with a description of the infant/child
including photos.
37
Code Pink Drills
• Medical Records will be secured
• No one should enter or leave the unit until approved by
Security.
• Names, addresses of all staff, visitors, and patients on
the unit will be obtained an interviews will occur with
all on unit at time of incident.
• All persons entering and leaving the unit will be checked
and verified by the Clerical Coordinator.
• Patient confidentiality should be maintained and no
statements should be given without Security present.
38
Code Pink Drills – Other
Departments
• Support from other departments when a Code Pink is
called overhead:
o Monitor hallways and exits.
o Be aware of suspicious looking individuals.
o Notify Security immediately of any suspicious
activity.
o Assist MCH staff as directed by charge nurse/ nurse
manager/ Security.
39
Key Factors in Helping to
Recover an Abducted Infant
• Mother reports the missing infant immediately.
• Nursing Staff notifies Security, calls a Code Pink and
secures unit.
• Security contacts law enforcement immediately.
• Law enforcement issues a “Be on the Lookout” for
BOLO) report immediately.
40
What Parents Need to Know
• Be deliberately watchful over the infant/child.
• Never leave infant/child out direct line-of-sight even
when going to the restroom, taking a shower, or taking a
nap.
• When possible, keep bassinet on the side of your bed
away from the door(s) leading out of the room.
• Ask questions about routine nursery/pediatric
procedures, feeding times, visitation policies, and other
security measures.
• Do not give infant/child to anyone without properly
verified identification issued by the facility.
41
What Parents Need to Know
• Ask nursing staff what specifies their badges as different
than the rest of the facility.
• Question unfamiliar persons entering your room or
inquiring about your infant/child – even if they are dressed
in the hospital’s attire or seem to have a reason to be there.
• Notify the nurses station immediately if you have any
concerns.
• Determine where infant/child will be taken if he/she must
leave the room.
• Ask what tests are going to be done and how long the
infant/child will be gone.
42
What Parents Need to Know
• Find out who authorized the test/procedure.
• If there is a concern about the infant leaving the room go
with the infant or send a support person.
• Have at least one color photo of the infant/child.
• If a home visit is going to occur, ask for a written set of
guidelines for the visit.
• Do not allow anyone into the home without proper
facility identification.
43