Children shall be admitted to hospital only if the care they require cannot be equally well provided at home or on a day basis.
Before admitting a sick child to a hospital all forms of appropriate care shall be explored whether at home, in a day clinic or comparable forms of treatment, in order to find the most suitable solution.
The rights of sick children must be respected whether they are cared for at home or in hospital.
There should be a regular review of the type of care according to the child's condition so that there is no unnecessary continuation of hospital stay.
All necessary information, assistance and support shall be given to parents if their children are cared for at home or on a day basis.
Children in hospital shall have the right to have their parents or parent substitute with them at all times.
The right of all children to have their parents with them at all times without restriction is an integral part of the care for children in hospital.
If parents are unable or unwilling to take an active role in the care of their child, the child is entitled to receive this care from a suitable substitute carer, who is accepted by the child.
The right of children to have their parents with them at all times, includes all situations where they need or possibly might need their parents, e.g.
- during the night, whether or not the child may wake up;
- while having treatments and/or examinations with or without local anaesthesia, with or without sedation;
- during induction of anaesthesia and immediately upon recovery;
- during periods of coma or semi-consciousness; -during resuscitation, when parents must be offered full support.
(1) Accommodation should be offered to all parents and they should be helped and encouraged to stay.
The staff members responsible for admitting a child shall invite all parents to stay without setting any particular criteria.
Staff members shall advise, encourage and support parents in making a decision about staying in hospital with their child, based on the parents' appreciation of their home situation.
Hospitals shall provide sufficient and suitable space and infrastructure to enable parents to be admitted along with their sick children. This should include the bed space together with bathroom, sitting and dining facilities and storage space for personal belongings.
(2) Parents should not need to incur additional costs or suffer loss of income.
No additional costs shall arise for parents when staying with their child. They should be entitled to - free overnight stay - free or subsidised food.
Parents who are unable to attend work or fulfil duties at home shall not incur any loss of income or incur other costs due to:
- staying in hospital with their child;
- the full-time care of their child in hospital, or;
- the daily care of healthy siblings at home by otherpersons.
Assistance should be provided where financial circumstances prevent a parent from staying with or visiting a child (e.g. travel costs and other expenses).
Parents shall be entitled to leave with pay for the duration of the child's illness to cover the loss of income.
(3) In order to share in the care of their child, parents should be kept informed about ward routine and their active participation encouraged.
The staff shall facilitate the parents' active participation in caring for their child by
- giving parents full information regarding their child's care and about ward routine;
- arranging with parents the elements of care they want to take over;
- supporting the parents in doing this;
- accepting their decisions;
- discussing with them changes needed if their care is not helpful to the child's recovery.
(1) Children and parents shall have the right to be informed in a manner appropriate to age and understanding.
Information for children should:
- be based on age and understanding and take into account the child's level of development;
- understand the child's immediate situation;
- appreciate his capacity to comprehend information and express his views;
- encourage questions, answer the questions raised and comfort children when they express concerns or fears;
- include appropriately prepared verbal, audiovisual and written information, supported by illustrative models, play or other media presentations;
- whenever practicable information should be given in the presence of the parents.
Information for parents should:
- be clear and comprehensive;
- consider the parents' present situation especially their feelings of fear, sorrow, guilt, anxiety or stress regarding their child's condition;
- encourage questions;
- satisfy the need for information by directing parents to extra information sources and support groups;
- provide parents with unrestricted access to all written or pictorial documentation regarding the illness of their child;
- te child or a sibling should not be used as an interpreter for the parents.
Information to meet both the child's and its parent's needs should -
- be provided continuously from admittance to discharge of the patient;
- include information regarding care after discharge;
- be provided in a stress free, secure and private environment without pressure of time;
- be given by experienced staff competent to communicate information in a way which can be readily understood;
- repeated as often as necessary to facilitate understanding;
- be checked by the staff member to ensure that the information given has been properly understood by boththe child and the parents.
Children have the right to express their own views and providing they have sufficient competence to understand the matter, they may veto their parents' access to their health information. In such a case staff are required to proceed with the utmost care to properly evaluate the situation. Protection, counsel and support shall be given to the child. But hospital staff should ensure that the necessary counsel and support are also given to the parents who might be in need of psychological and social help and advice.
(2) Steps should be taken to mitigate physical and emotional stress.
To reduce physical and emotional stress and pain experienced by children preventive measures have to be taken, which should:
- be adapted to the individual needs of the child;
- provide information and programmes to prepare children and parents for a stay in hospital, whether planned or emergency;
- provide preparation information prior to planned procedures;
- encourage continuous contact with parents, siblings and friends;
- offer play and recreation activities suitable to the child'sage and development;
- ensure effective up-to-date pain management to avoid or reduce pain incurred by medical treatment, whether during examination, intervention or pre- or postoperatively;
- grant sufficient periods of rest between treatments;
- support parents whose children are receiving palliative care;
- prevent feelings of isolation and helplessness;
- try to avoid or reduce situations or actions described by the child as stress inciting;
- recognise fears or concerns of the child whether or not explicitly expressed and act upon them;
- be aware that a child may become stressed by being isolated or as a reaction to the condition of other patients and take appropriate action;
- feature stress free and appropriately equipped rooms allowing children and parents the opportunity to retreat;
- avoid use of restraints.
To mitigate unavoidable physical or emotional stress, pain and suffering children and parents should be offered:
- ways of dealing with painful situations or actions experienced as negative;
- support for parents as well as measures ensuring their protection from too much strain while caring for their child;
- contact with social services, psychologists;
- contact when requested with minister of religion, self-help groups, patient / parent-help groups and cultural groups.
(1) Children and parents have the right to informed participation in all decisions involving their health care.
The right to participate in the health care of the child requires from staff members:
- adequate information to the child and the parents regarding their child's immediate health condition, the proposed forms, risks, and merits of a treatment or therapy and its goals as well as the measures to be taken;
- adequate information on alternative forms of treatment;
- advice and support to parents enabling them to evaluate the proposed way of proceeding;
- to appreciate and make use of the child's and parent's knowledge, experiences, descriptions and observations on the general health situation or present condition of the child.
Prior knowledge of all measures that need to be taken is a precondition for the active involvement of children and parents in decision making.
(2) Every child shall be protected from unnecessary medical treatment and investigation.
In this context any form of medical treatment or investigation of a child is unnecessary, if no benefit for the individual child can be derived.
(1) Children shall be cared for together with children who have the same developmental needs and shall not be admitted to adult wards.
The care of children together with children who have the same developmental needs, includes, but is not limited to
- joint or similar activities;
- activities for children of a mixed age group;
- separate rooms and activities according to age and gender;
- particular efforts being made to provide separate accommodation for adolescents;
- protective measures for children with specific illnesses.
The special needs of adolescents should be taken care of by providing appropriate infrastructure as well as recreational opportunities.
Any form of segregation of children must be avoided, in particular cultural segregation.
The care of children together with adults on the same ward is not acceptable, and consequently means:
- children shall not be admitted to or cared for in adult wards;
- adults shall not be admitted to or cared for in children's wards;
- separate provision should be available for the treatment of children and adults in areas such as reception, emergency rooms, surgery, outpatient and day care facilities as well as examination and therapy rooms.
(2) There should be no age restrictions for visitors to children in hospital.
Visiting hours for siblings and friends shall not be restricted based on the age of the visitor, but based on the condition of the sick child and the health of the visiting children.
Children shall have full opportunity for play, recreation and education suited to their age and condition and shall be in an environment designed, furnished, staffed and equipped to meet their needs.
Children have the right to an environment which meets the needs of children of all ages and situations wherever in the hospital they are being cared for. This applies also to day facilities or other areas where children are being treated or examined.
Extensive possibilities for play, recreation and education should
- be available in the form of appropriate play materials;
- ensure adequate periods of time for play seven days a week;
- provide for the abilities of all age groups cared for in the facility;
- inspire creative activities by all children;
- allow for the continuation of the level of education already reached.
Sufficient suitably qualified staff should be available to meet the needs of children for play, recreation and education regardless of the state of health and age of the children. All staff in contact with children should have an understanding of the needs of children for play and recreation.
The architecture and interior design of such an environment must incorporate appropriate features for all age groups and types of illnesses treated in the facility. The environment should be adaptable to the needs of different age groups and not be focused on one particular age group.
Children shall be cared for by staff whose training and skills enable them to respond to the physical, emotional and developmental needs of children and families.
Specific professional training, skills and sensitivity are required for staff caring for sick children. Only on the basis of these qualifications are they able to meet with the special needs of children and their parents.
All hospitals or other health care providers admitting children should ensure that children are examined, treated and cared for by staff with specific paediatric education, knowledge and experience.
If a child needs to be treated by non-paediatric staff, such treatment may only be carried out in cooperation with staff specially trained and qualified to care for children.
The ability and sensitivity of staff shall be maintained at a high level by appropriate training and continuing education.
To know and address the needs of families is a pre-condition for being able to support parents in the care of their child and if necessary organise support or alternative care for the child to relieve the strain on the family
Qualified staff are capable of recognising and reacting in an appropriate way to all forms of child abuse.
Staff members will support parents in particular to cope with critical situations a child might endure. This applies especially to life-threatening situations.
When a child is dying or dies, the child and his/her family must be given whatever support, care and assistance they need to help them cope. Staff should undertake appropriate bereavement training. Information regarding the death of the child should be given sympathetically, sensitively, in private and in person.
Continuity of care should be ensured by the team caring for children.
Continuity of care includes continuity in the provision of the child's treatment and continuity among the staff providing their care.
Continuity of care should apply both in the hospitals and following transition to home or day care. This can be achieved by all those involved communicating and working together as a team.
Team work requires a limited and defined number of persons working together as a group whose action is based on complementary levels of knowledge and consistent standards of care, focused on the physical, emotional, social and psychological well-being of the child.
Children shall be treated with tact and understanding and their privacy shall be respected at all times.
Tact and understanding in dealing with children requires the need to:
- include their right to be a child;
- consider their dignity, view, needs, individuality and their state of development, taking account of any disability or special need;
- make the willingness of the staff for dialogue apparent;
- create a friendly and trusting atmosphere;
- take into consideration the religious belief and cultural background of the child and the family.
Regardless of age or state of development the protection of the privacy of children shall be secured at all times and must include:
- protection against physical exposure;
- protection against treatment and behaviour which diminishes self respect or makes the child feel ridiculous or humiliated;
- the right of personal retreat, to be alone;
- the right of private communication with staff;
- the right of undisturbed association with close family members and friends.