Children are not being properly protected by NHS trusts across the country, according to a report by the Healthcare Commission.
It says that staff are failing to keep up to date with basic training on child protection, resuscitation and pain management procedures.
In the wake of Lord Laming's report after the Baby P tragedy, the commission says that a quarter of trusts are failing to regularly update staff training.
Three-quarters do not have enough trained staff, 11% have got worse since the commission's last report in 2005/06, and only half have achieved the basic level in pain management.
Meanwhile, 63% of trusts are failing to ensure surgeons and anaesthetists maintain their skills by doing the recommended number of operations on children.
The report concludes: "It is of great concern that the findings from the follow-up review show a consistently low level in the uptake of training in paediatric life-support among key staff, while a high proportion of surgeons and anaesthetists carrying out procedures on children still need to have more work experience to properly maintain their specific skills."