A 2 1/2-year-old boy in Boston dies of a bowel obstruction, having been treated by prayer rather than medicine. A 23-month-old girl dies of pneumonia in Celina, Ohio, that same month -- April 1986 -- after her parents decide for religious reasons not to seek medical treatment.

The American Academy of Pediatrics has concluded after a two-year examination that more children than is commonly thought die because their parents' religion discourages medical help. In a report in the January issue of Pediatrics magazine, the academy's bioethics committee puts much of the blame on child-abuse laws, now on the books in 44 states, that limit investigation and prosecution of these parents.

The laws the academy wants changed are essentially the result of regulations issued in 1974 by the Department of Health, Education and Welfare. HEW required states to write religious exemptions into their child-abuse laws or risk losing federal funds. About 10 years later, HEW's successor, the Department of Health and Human Services, dropped the requirement, but the exemptions remain in most states.

The committee recommends that its roughly 34,000 physician members work to amend those laws by testifying before state legislatures and by increasing public awareness. It is the first body of physicians to make such a recommendation. And its report bolsters the argument of those prosecutors, judges and medical practitioners who contend that parents should be required to seek medical attention for sick children regardless of religious persuasion.

Beginning in 1984 in Indiana with two well-publicized convictions of parents who belonged to the Faith Assembly, a 1,500-member group, officers of the courts have generally been successful in prosecuting parents who refused treatment for severely ill children who died.

But prosecutors have been less successful in cases where the children did not die. Religious groups that believe in healing through faith, including Christian Scientists and Jehovah's Witnesses, have argued against prosecution on the principle of the separation of church and state. They have used similar arguments to persuade state lawmakers that they should be exempt from statutes on child abuse and neglect.

The pediatrics academy recognizes in its report that serious ethical and legal considerations arise when a child is ordered to undergo medical treatment. Parents have a constitutional right to practice their religion free from state intervention, the doctors write, but the state also has a responsibility to protect the lives of those who cannot protect themselves.

Dr. Norman Fost, chairman of the bioethics committee, said the courts in recent years have made a distinction between the adult who rejects medical help and the adult who rejects such help for a child.

The major lobbying group behind HEW's original regulations was the Church of Christ, Scientist, a denomination of 2,800 churches that teaches that healing can come through prayer and living a spiritual life. Christian Scientists eschew medical diagnosis and treatment. This week officials at the denomination's Boston headquarters released a statement decrying the academy's position.

"Christian Scientists are as committed as the {academy} to the health and well-being of children," said spokesman Nathan Talbot. "If medical treatment had been 100 percent successful, and if all spiritual healing were as unsuccessful as the {academy} suggests, this position would be more just. But since neither of these 'ifs' is true, we must respectfully disagree with the organization's effort to rule out responsible spiritual care for children's health."

A former Christian Scientist's testimony two years ago mobilized the academy to intensify its inquiry, Fost said. Rita Swan told the bioethics committee that she lost her 16-month-old son to the most common form of meningitis after a Christian Science practitioner advised her not to see a doctor.

Following her appearance, the committee did a cursory survey of similar deaths "and we came up quickly with 12 cases in 2 years," Fost said. "The problem is, many cases never come to the authorities' attention."