Background: Children in difficulties are characterized by: chronic neglect; disability; physical, emotional or sexual abuse; HIV or one/both parents with HIV and/or limited socio-economic opportunities.
Objective: To review the current situation by reviewing the incidence of problems affecting children and exploring both potential short-/long-term strategies, including the role of pediatricians.
Material and Method: The authors reviewed the incidence and situations of children in difficulties, did a synthesis of guidelines and made recommendations.
Results: The fundamental causes of difficulties include: failed macro-economic policies; inadequate and inaccessible education system; and weakness of the family unit, which is associated with: separation and divorce; violence between partners and/or toward their children; neglect and abandonment; inappropriate child-rearing; and child exploitation, including trafficking.
Conclusion: GOs and NGOs need to work collaboratively for child protection. Pediatricians can play a vital role in strengthening the family (a) by providing timely, strategic, informal education for parents on healthy child-rearing (b) by being attuned to signs, symptoms and attitudes of children in difficulties from childhood through adolescence and (c) by working interactively with children/teens, their families, teachers and communities. Medical schools need to revise the curricula to include these crucial roles for pediatricians in child and family advocacy.

Keywords: Children in difficulties, child abuse and neglect, child labor, child prostitution, children in slum, street children, children in criminal justice system, children with disabilities