![Children's Castle (Lastenlinna), a former children's hospital, that preceded the current New Children's Hospital [fr], in Helsinki, Finland The Children's Castle, Helsinki.jpg](http://upload.wikimedia.org/wikipedia/commons/thumb/8/8c/The_Children%27s_Castle%2C_Helsinki.jpg/220px-The_Children%27s_Castle%2C_Helsinki.jpg)
A children's hospital(CH) [2] is a hospital that offers its services exclusively to infants, children, adolescents, and young adults from birth up to until age 18, and through age 21 and older in the United States. [3] In certain special cases, they may also treat adults. [4] [5] The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties.
Children's hospitals are characterized by greater attention to the psychosocial support of children and their families. Some children and young people have to spend relatively long periods in hospital, so having access to play and teaching staff can also be an important part of their care. [6] With local partnerships, this can include trips to local botanical gardens, zoos, and public libraries for instance. [7] Designs for the new Cambridge Children's Hospital, approved in 2022, plan to fully integrate mental and physical health provision for children and young people, bringing together services of three partners: Cambridge University Hospitals NHS Foundation Trust, Cambridgeshire and Peterborough NHS Foundation Trust, and the University of Cambridge with physical and mental health services located alongside research activity. [8]
In addition to psychosocial support, children's hospitals have the added benefit of being staffed by professionals who are trained in treating children. A medical doctor that undertakes vocational training in paediatrics must also be accepted for membership by a professional college before they can practice paediatrics. These include the Royal Australasian College of Physicians (RACP), Royal College of Paediatrics and Child Health (RCPCH), and the American Board of Pediatrics. In New Zealand, the RACP offers vocational training in paediatrics. Once RACP training is completed the doctor is awarded the Fellowship of the RACP (FRACP) in paediatrics. [9] While many normal hospitals can treat children adequately, pediatric specialists may be a better choice when it comes to treating rare afflictions that may prove fatal or severely detrimental to young children, in some cases before birth. Also, many children's hospitals will continue to see children with rare illnesses into adulthood, allowing for a continuity of care.
 | The examples and perspective in this article deal primarily with Western culture and do not represent a worldwide view of the subject.(January 2024) |
Prior to 19th century hospital reforms, the well-being of the child was thought to be in the hands of the mother; therefore, there was little discussion of children's medicine, and as a result next to no widespread formal institutions which focused on healing children.
Dispensaries and foundling hospitals were the earliest forms of what would later become children's hospitals. Florence's Hospital of the Innocent (Ospedale degli Innocenti) was originally a charity based orphanage which opened in 1445; its aim was to nurse sick and abandoned infants back to health. Foundling hospitals such as the Foundling Hospital founded by Thomas Coram in 1741 were created to receive abandoned infants, nurse them back to health, teach them a trade or skill, and integrate them back into society.
Dispensaries funded by donations also provided medicine and medical attention to those who could not afford private care. The Scottish paediatrician George Armstrong, who established the first British dispensary, in 1769, was against in-patient care for sick children. Armstrong stated:
But a very little reflection will clearly convince any thinking person that such a Scheme as this can never be executed. If you take away a sick child for its Parents or Nurse, you break its heart immediately. [10]
Objections to admission were sometimes based on pragmatic reasons, e.g. reducing the threat of cross infection from children with diseases such as typhus, diphtheria and measles, that were a major cause of infant mortality. The voluntary nature of hospitals meant that such outbreaks were very costly.
In the mid-19th century western world, middle-class women and physicians became increasingly concerned about the well-being of children in poor living conditions. Although infant mortality had begun to decline, it still remained a prominent issue. Social reformers blamed the emergence of the industrial society and poor parents for not properly caring for their children. By the 1870s, the prevalent view among doctors and nurses was that children were better off by being removed to hospital, away from the often poor, unsanitary conditions at home. [11] In response, reformers and physicians founded children's hospitals. [12]
By the early 19th century, children's hospitals opened in major cities throughout Europe. [13] The first formally recognized paediatrics hospital was the Hôpital des Enfants Malades in Paris, which opened in 1802. Great Ormond Street Hospital was established in London in 1852, and was the first British children's hospital. [14] The Children's Hospital of Philadelphia in Pennsylvania was created in 1855. [15] The Royal Hospital for Sick Children, Edinburgh was the first children's hospital in Scotland and opened in 1860. [16] The Hospital for Sick Children in Toronto, Ontario was the first Canadian children's hospital and opened in 1875. [17] By the end of the 19th century, and the during the first two decades of the 20th century, the number of children's hospitals tripled in both Canada and the United States. [12] From the 1850s to around 1910, most cities in the UK had built children's hospitals, which included a large number of prestigious hospitals such as the Royal Hospital for Sick Children, Glasgow, Great Ormond Street Hospital and the Royal Manchester Children's Hospital. [11]
Early western children's hospitals were independent institutions funded by voluntary donations, and from research. [13] Often, children could only be admitted if they were sponsored by a letter of recommendation from a hospital affiliate. The "undeserving poor" were sent to workhouse infirmaries, whilst middle class children were generally cared for, and indeed operated on, at home. [18] Hospitals set their own rules and had their own way of working, including regulating admissions. They often excluded children under the age of two on humanitarian and pragmatic grounds and were often hesitant to admit children who required long-term care in fear that those lives would be lost or that long-term care would block beds for those in immediate need. [13] [11]
Early children's hospitals focused more on short-term care and treating mild illnesses rather than long-term intensive care. Treating serious diseases and illnesses in early children's hospitals could result in the disease spreading throughout the hospital which would drain already limited resources. A serious disease outbreak in a children's hospital would result in more deaths than lives saved and would therefore reinforce the previous notion that people often died while in the hospital. [12]
In the 19th century, there was a societal shift in how children were viewed. This shift took away some of the parents' control and placed it in the hands of medical professionals. [19] By the early 20th century, a child's health became increasingly tied to physicians and hospitals. [20] This was a result of licensing acts, the formation of medical associations, and new fields of medicine being introduced across countries. [20] New areas of medicine offered physicians the chance to build their careers by "overseeing the medical needs of private patients, caring for and trying new therapies on the sick poor, and teaching medical students." [20] In order to raise their status further, physicians began organizing children's hospitals; by doing so, it also brought attention and importance to their speciality in the modern health care system. [12]
Voluntary or religiously associated female care was often replaced by care provided by professionally trained nurses. [21]
Historically, many children's hospitals limited the ability of children and parents to interact, such as by limiting visiting hours. This approach was criticised for decades before shifts in practice occurred.
Surgeon James Henderson Nicholl of the Glasgow Hospital for Sick Children, who pioneered day surgery procedures such as Hernia and cleft palate, stated in 1909 that: '[I]n children under 2 years of age, there a few operations indeed that cannot be as advantageously carried out in the out patient departments as in the wards.' Nicholl believed that hospitalisation wasn't necessary, and children were better cared from in their own home by their parents and by nurses making daily visits. Nicholl argued that "separation from mother is often harmful". [22]
During the interwar period, leading up to World War II, psychiatrists expressed concerns about children being away from parents, such as during hospitalisation. Harry Edelston, a Psychiatrist in Leeds, detailed that children were emotionally damaged by their stay in hospital. [23]
In the post-war era, critiques became more widespread and studies were conducted to examine potential harms. René Spitz, an Austrian-American psychoanalyst, published an article in 1945 in which he noted deleterious effects of hospitalisation, based on his research with institutionalised children. [24]
L.A. Perry wrote a 1947 Lancet article that protested the restrictions of parental visits on hospitalized children. However, Edelston wrote in 1948, that many of this colleagues still refused to believe in hospitalisation trauma [23] Bowlby studied 44 juvenile thieves and found that a significantly high number had experienced early and traumatic separation from their mother. In 1949, he used the data to write a report for the World Health Organization's on the mental health of homeless children in post-war Europe. [23]
With the introduction of penicillin into the majority of the medical community by the 1940s, the major objection by doctors and nurses, that visits by parents into hospital wards introduced cross infections had been removed. A major review in 1949, over an 11-month period, showed that children admitted to 26 wards in 14 hospitals showed no correlation between visits and cross infection from parents to children. By that time, the working practices of doctors and nurses, still posed the main objection to visiting. [25] A.D. Hunt reported that:
The hospitalised child was considered essentially a biological unit, far better off without his parents who, on weekly or bi-weekly visiting hours, were fundamentally toxic in their effect, causing noise, generally disorderly conduct, and rejection by hospital personnel. [26]
British Psychiatrist John Bowlby, who had previously criticised World War II evacuation schemes separating parents and children, [27] and his research assistant at the Tavistock Clinic, James Robertson, a Scottish social worker and psychoanalyst, researched the separation of young children from their parents during hospital stays and criticised the negative impacts on the children of policies of limited visiting. [28] [29] [30]
By the 1950s, British politicians were concerned enough about the impact of children's hospital policy to create a committee to research the welfare of sick children in hospital. This committee produced the Platt Report of 1959, recommending that children should have more access to their parents while ill. The Report had effects on hospital care of children in the UK and New Zealand, Australia, Canada and the United States. [31]
Using hospital discharge data from 2003 to 2011, the Agency for Healthcare Research and Quality (AHRQ) studied trends in aggregate hospital costs, average hospital costs, and hospital utilization. The Agency found that for children aged 0–17, aggregate costs rose rapidly for the surgical hospitalizations and decreased for injury hospitalizations. Further, average hospital costs, or cost per discharge, increased at least 2% for all hospitalizations and were expected to grow by at least 4% through 2013. The exception to this was mental health hospitalizations, which saw a lower percentage increase of 1.2%, and was projected to increase only 0.9% through 2013. Despite the rising aggregate costs and costs per discharge, hospitalizations (except for mental health hospitalizations) for children aged 0–17 decreased over the same time, and were projected to continue decreasing. [32]
In 2006–2011, the rate of emergency department (ED) use in the United States was highest for patients aged under one year, but lowest for patients aged 1–17 years. The rate of ED use for patients aged under one year declined over the same time period; this was the only age group to see a decline. [33]
Between 2008 and 2012, growth in mean hospital costs per stay in the United States was highest for patients aged 17 and younger. [34] In 2012 there were nearly 5.9 million hospital stays for children in the United States, of which 3.9 million were neonatal stays and 104,700 were maternal stays for pregnant teens. [35]
Every year U.S. News & World Report ranks the top children's hospitals and pediatric specialties in the United States. For the year 2010–2011, eight hospitals ranked in all 10 pediatric specialties. The ranking system used by U.S. News & World Report depends on a variety of factors. In past years (2007 was the 18th year of Pediatric Ranking), ranking of hospitals has been done solely on the basis of reputation, gauged by random sampling and surveying of pediatricians and pediatric specialists throughout the country. The ranking system used is currently under review. [36]
Pediatrics is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the age of 18. The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25. Worldwide age limits of pediatrics have been trending upward year after year. A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παῖς and ἰατρός. Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties.
Palliative care is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Within the published literature, many definitions of palliative care exist. The World Health Organization (WHO) describes palliative care as "an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain, illnesses including other problems whether physical, psychosocial, and spiritual". In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients.
Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. Doctors in this specialty are often called intensive care physicians, critical care physicians, or intensivists.
Ambulatory care or outpatient care is medical care provided on an outpatient basis, including diagnosis, observation, consultation, treatment, intervention, and rehabilitation services. This care can include advanced medical technology and procedures even when provided outside of hospitals.
Against medical advice (AMA), sometimes known as discharge against medical advice (DAMA), is a term used in health care institutions when a patient leaves a hospital against the advice of their doctor. While leaving before a medically specified endpoint may not promote the patient's health above their other values, there is widespread ethical and legal consensus that competent patients are entitled to decline recommended treatment.
Neonatology is a subspecialty of pediatrics that consists of the medical care of newborn infants, especially the ill or premature newborn. It is a hospital-based specialty and is usually practised in neonatal intensive care units (NICUs). The principal patients of neonatologists are newborn infants who are ill or require special medical care due to prematurity, low birth weight, intrauterine growth restriction, congenital malformations, sepsis, pulmonary hypoplasia, or birth asphyxia.
Pediatric nursing is part of the nursing profession, specifically revolving around the care of neonates and children up to adolescence. The word, pediatrics, comes from the Greek words 'paedia' (child) and 'iatrike' (physician). 'Paediatrics' is the British/Australian spelling, while 'pediatrics' is the American spelling.
Home health is a nursing specialty in which nurses provide multidimensional home care to patients of all ages. Home health care is a cost efficient way to deliver quality care in the convenience of the client's home. Home health nurses create care plans to achieve goals based on the client's diagnosis. These plans can include preventive, therapeutic, and rehabilitative actions. Home health nurses also supervise certified nursing assistants. The professional nursing organization for home health nurses is the Home Healthcare Nurses Association (HHNA). Home health care is intended for clients that are well enough to be discharged home, but still require skilled nursing personnel to assess, initiate and oversee nursing interventions.
Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety with mobile health apps being a growing area of research.
An intensive care unit (ICU), also known as an intensive therapy unit or intensive treatment unit (ITU) or critical care unit (CCU), is a special department of a hospital or health care facility that provides intensive care medicine.
Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma.
Children's Mercy Kansas City is a 390-bed medical center in Kansas City, Missouri providing care for pediatric patients. The hospital's primary service area covers a 150-county area in Missouri and Kansas. Children's Mercy received national recognition from U.S. News & World Report in 10 pediatric specialties. The hospital was the first in Missouri and Kansas to receive Magnet Recognition for Excellence in Nursing Services from the American Nurses Credentialing Center and has been re-designated five times.
A hospital is a healthcare institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emergency department to treat urgent health problems ranging from fire and accident victims to a sudden illness. A district hospital typically is the major health care facility in its region, with many beds for intensive care and additional beds for patients who need long-term care.
A pediatric intensive care unit, usually abbreviated to PICU, is an area within a hospital specializing in the care of critically ill infants, children, teenagers, and young adults aged 0–21. A PICU is typically directed by one or more pediatric intensivists or PICU consultants and staffed by doctors, nurses, and respiratory therapists who are specially trained and experienced in pediatric intensive care. The unit may also have nurse practitioners, physician assistants, physiotherapists, social workers, child life specialists, and clerks on staff, although this varies widely depending on geographic location. The ratio of professionals to patients is generally higher than in other areas of the hospital, reflecting the acuity of PICU patients and the risk of life-threatening complications. Complex technology and equipment is often in use, particularly mechanical ventilators and patient monitoring systems. Consequently, PICUs have a larger operating budget than many other departments within the hospital.
Family-centered care or Relationship-Centered Care is one of four approaches that provides an expanded view of how to work with children and families. Family-centered service is made up of a set of values, attitudes, and approaches to services for children with special needs and their families. In some family-centered settings such as the Hasbro Children's Partial Hospital Program, medical and psychiatric services are integrated to help teach parents and children methods to treat illness and disease. Family-centered service recognizes that each family is unique; that the family is the constant in the child's life; and that they are the experts on the child's abilities and needs. The family works with service providers to make informed decisions about the services and supports the child and family receive. In family-centered service, the strengths and needs of all family members are considered.
The Healthcare Cost and Utilization Project is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
The Association for the Wellbeing of Children in Healthcare is an Australian-based voluntary organisation that gives non-medical attention and support to hospitalised children and their parents. Formed in 1973, the group changed its name from Association for the Welfare of Children in Hospital to Association for the Welfare of Child Health in 1993 and then to Association for the Wellbeing of Children in Healthcare in 2007. In 2008, the association co-wrote "Standards for the Care of Children and Adolescents in Health Services," a set of guidelines for treating children and teenagers in wards that are separate from adults. As of 2007, the association was based in Gladesville, New South Wales.
Cook Children's Medical Center is a not-for-profit pediatric hospital located in Fort Worth, Texas. One of the largest freestanding pediatric medical centers in the U.S., Cook Children's main campus is located in Tarrant County. The hospital provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults aged 0–21 throughout the Dallas-Fort Worth metro and the greater region. Cook Children's also has an ACS verified level II pediatric trauma center. The hospital has a rooftop helipad for the critical transport of pediatric patients to and from the hospital.
The Platt Report, formerly known as the Welfare of Sick Children in Hospital , was a report that was the result of research into the welfare of children who were undergoing medical treatment within the UK and to make suggestions that could be passed on to the hospital authorities that would improve their welfare during hospital visits. The report was named after Sir Harry Platt, who was the President of the Royal College of Surgeons. Platt produced the report at the behest of the Ministry of Health in the UK government. The recommendations in the Platt Report, provided the means by which a child trauma ward of a hospital should be planned for children. Established on 12 June 1956, the committee that was to produce the report defined their remit as:
To make a special study of the arrangements made in hospitals for the welfare of ill children – as distinct from the medical and nursing treatment – and to make suggestions which could be passed on to hospital authorities.
The Children's Healthcare of Atlanta - Scottish Rite Hospital is a nationally ranked, freestanding, 319-bed, pediatric acute care children's hospital located in Atlanta, Georgia. It is affiliated with the Emory University School of Medicine and the Morehouse School of Medicine, as a member of the Children's Healthcare of Atlanta (Children's) system. The hospital provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults age 0–21. The hospital features a state verified level II pediatric trauma center, one of two in the state. Its regional pediatric intensive-care unit and neonatal intensive care units serve the region. The hospital also has a rooftop helipad for critical pediatric transport.
