Children are let down by the general care they receive in hospitals across England, a critical report by the health watchdog has found.
Nearly one in five hospitals fail to provide sufficient life support care for children at night, and child protection is still largely overlooked, the report said.
The Healthcare Commission says that 75% of the hospitals examined only scored fair or weak for the overall service provided for children - a figure that has prompted "serious concern".
The study also found that surgeons in 8% of hospital trusts do not operate on enough children to keep their skill levels up, and 16% of paediatric inpatient units do not carry out enough work to reach the minimum recommended professional level.
The commission says its report is a "wake-up" call for hospital trusts that do not put the health of children first, and pledges to put pressure on the worst hospitals to improve.
The commission praises the work of the majority of paediatric inpatient departments, with 70% ranked either good or excellent, but says the overall service is less impressive.
The report found 1.8 million children attended mixed adult-child A&E departments, 2.5 million children went to mixed adult-child outpatients and 62,000 children were classed as day cases.
It highlights the eight best and worst trusts as well as the eight hospitals that did not provide sufficient life support cover for children.
The best include Great Ormond Street Hospital for Children NHS Trust, the Royal Liverpool Children's NHS Trust and Sheffield Children's NHS Trust.
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The worst include Brighton and Sussex University Hospitals NHS Trust, County Durham and Darlington Acute Hospitals NHS Trust and Scarborough and North East Yorkshire Healthcare Trust.
