The Convention on the Rights of the Child acknowledges that the family is the natural environment for the upbringing of a child and that the parents have the primary responsibility for the child's education. However, it also mentions the need to find adequate substitute care whenever the child is temporarily or permanently deprived of his or her family environment, or when the child's best interests cannot be secured within the family environment. This substitute care may include adoption, foster placement or, as last resort, placement in an institution suitable for child care. Although some institutions have high quality standards for child care, this is not always the case.

Institutionalized children are likely to come from unfavourable family environments, where they were victims of multiple psychosocial adversities, and studies show they present high scores of emotional and conduct disorders, together with cognitive problems.

We examined medical files of all the institutionalized children and adolescents who attended the outpatient clinic of the Department of Child and Adolescent Psychiatry in Coimbra, Portugal, between the years 2005 and 2008, in order to characterize this population.

There was a male excess in our sample. The majority of the children and adolescents were institutionalized due to abuse and/or neglect and had conduct or oppositional defiance disorder. A considerable number had cognitive deficits.

Mental health services should work closely with these institutions to identify their strengths and difficulties, facilitating prevention, diagnosis and treatment of psychiatric problems.