# Safety boundary maintenance in consumer AI systems responding to pediatric health queries: a cross-platform benchmark evaluation under naturalistic and adversarially pressured conditions

arXiv: https://arxiv.org/abs/2601.09721 · HTML: https://mlsanity.com/paper/2601.09721/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 30 references that are in the map.
- First posted on arXiv 26 Dec 2025.

## Builds on (most cited first, 14 of 14)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [Constitutional AI: Harmlessness from AI Feedback](https://mlsanity.com/paper/2212.08073/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [ChatGPT Outperforms Crowd-Workers for Text-Annotation Tasks](https://mlsanity.com/paper/2303.15056/) (2023)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [Refuse Whenever You Feel Unsafe: Improving Safety in LLMs via Decoupled Refusal Training](https://mlsanity.com/paper/2407.09121/) (2024)
- [CARES: Comprehensive Evaluation of Safety and Adversarial Robustness in Medical LLMs](https://mlsanity.com/paper/2505.11413/) (2025)
- [Large language models provide unsafe answers to patient-posed medical questions](https://mlsanity.com/paper/2507.18905/) (2025)
- [Language models are susceptible to incorrect patient self-diagnosis in medical applications](https://mlsanity.com/paper/2309.09362/) (2023)
- [People over trust AI-generated medical responses and view them to be as valid as doctors, despite low accuracy](https://mlsanity.com/paper/2408.15266/) (2024)
- [Can Public LLMs be used for Self-Diagnosis of Medical Conditions ?](https://mlsanity.com/paper/2405.11407/) (2024)
- [PediatricAnxietyBench: Evaluating Large Language Model Safety Under Parental Anxiety and Pressure in Pediatric Consultations](https://mlsanity.com/paper/2512.15894/) (2025)

## Abstract (arXiv)

Consumer artificial intelligence chatbots are now accessed by hundreds of millions of users seeking health information, yet systematic evaluation of their safety boundary maintenance under real-world caregiver pressure remains scarce. We evaluated PediatricSafetyBench-v2, a benchmark of 600 pediatrics health queries comprising 300 authentic caregiver queries sourced from the HealthCareMagic-100k-en physician consultation corpus and 300 matched adversarial variants incorporating six operationalized caregiver pressure patterns, across four consumer AI systems (GPT-4o-mini, Gemini-2.0-Flash, Claude-3.5-Haiku, and Llama-3.1-8B). Safety boundary maintenance was assessed using a validated five-component Safety Composite Score (maximum 15 points; safety-appropriate threshold of 10 or above), validated against independent human raters prior to full-corpus application (mean weighted kappa 0.76; Pearson r = 0.88). The overall safety-appropriate rate was 95.5%. Safety-oriented system prompt deployment improved safety-appropriate rates by 5.9 percentage points across all four models. Counter-intuitively, adversarial caregiver pressure was associated with higher rather than lower Safety Composite Score values for all four models across all ten topic categories and severity levels. False expertise claims were the most vulnerability-inducing pressure pattern, whereas emotional escalation was associated with the highest scores. Consumer AI systems maintain safety boundaries in the large majority of pediatrics health interactions. PediatricSafetyBench-v2 is publicly released for longitudinal safety monitoring.