Taking the fear out of hospitals for children

The Children in Hospital Ireland organisation wants to turn medical institutions into more child-friendly places – for parents as well as their children

TEENAGE CHILDREN who are admitted to adult wards in Irish hospitals are likely to end up in rooms with elderly people, some of them with dementia, according to an expert group.

The Children in Hospital Ireland organisation (CHI), which has campaigned on this issue for decades, says the age profile of the hospital population makes it inevitable that adolescents in adult wards will be alongside people who are over 50 years of age and often in their 60s, 70s and older.

“We have had a case of a 14 year old in a room with three old men with dementia, who weren’t sure where they were and in some cases kept trying to get out,” explains chief executive Mary O’Connor.

“We have also had young children placed beside people who are dying. We are not suggesting that children don’t die on children’s wards, but obviously in an adult ward the focus will not be on the impact of a death on children who are close by.”

O’Connor agrees that the problem is not as widespread as it was in 1999 when a CHI survey found that more than half of all child admissions were to adult wards.

However, it is a recurring issue, especially for adolescents, and one which she says hospitals sometimes attribute to practical problems such as bed sizes – problems, she believes, which can be easily addressed.

Apart from the obvious child protection issues, it is widely acknowledged that adult wards are not an appropriate environment for under-18s, she adds.

“We had a parent contact us about a 14-year-old girl who was put into a two-bedded room with a man in his 50s. Lack of beds was the excuse and the hospital subsequently apologised profusely, but it was very stressful for the parents, it was dreadful for the girl and I am sure it was very uncomfortable for the man as well.”

O’Connor recalls that in this case the mother took the child home because the circumstances were so upsetting, but was forced to take her back so that her treatment could be continued.

“What we find incredible in this day and age is that there are no standards, no HSE or department rules and regulations governing all hospitals,” says the CHI chief.

CHI has drawn up a charter for children in hospital covering areas such as the rights of children to have their parents with them at all times, of children and parents to be fully informed, rights to play, education and recreation, rights of parents to accommodation in the hospital and the children’s right to be cared for by people with the appropriate training and to be accommodated with other children.

Such a charter should be put in place by the Government, it believes.

It is estimated that there are more than 270,000 hospital visits by children in Ireland each year, that in more than 100,000 cases it is for an average stay of three nights, and that 75,000 child inpatients are under four years of age. Almost all of these enter hospital through A&E, which means the admissions are unexpected and unplanned.

CHI, which provides play facilities in 18 Irish hospitals, also campaigns on behalf of children with special needs, who require admission to hospital, and on behalf of parents who, in many cases, spend lengthy periods there.

In the past, some hospitals restricted parents to regular visiting hours, but while this culture has changed, the accommodation is often unsuitable for parents forced to spend lengthy periods with their child.

“Nowadays parents actually do a huge amount of work, feeding, clothing, entertaining children – the normal parenting stuff,” says O’Connor. “They will be up at night with fretful children but while some hospitals have pullout beds, a high proportion of these parents will sleep in chairs beside the child’s bed, night after night, for prolonged periods.”

O’Connor points out that the new national children’s hospital will provide single rooms for all children and appropriate accommodation for parents.

She is hopeful that this long-awaited development will have a welcome ripple effect, with improved standards throughout the country for child inpatients.

“When Brian Lenihan launched our charter in 2002 as Minister for Children, he expressed the hope that it could be adopted as national policy,” she says.

O’Connor says the play facilities known as Playwell, which her organisation provides in all but six Irish general hospitals, help children to make sense of the world and to make sense of their illness.

“A hospital is an abnormal environment for everyone, but it can be particularly intimidating for children with the strange sights, smells and noises,” she explains.

Playrooms are often a sanctuary within the hospital, and trained play specialists can often help children understand their illness or the procedures they have to go through.

“In the UK system, there is one play specialist for every 10 children, while in Ireland we have 22 for the whole country,” she says.

The CHI charter underlines the need for the dignity and privacy of children to be respected while in hospital.

“Sometimes examinations can be done in a very cavalier fashion,” O’Connor points out. “Children can be terribly modest and private, and this can be forgotten about in hospitals.”

The organisation has also produced guidelines on the care of children with special needs while in hospital. “If, for example, a child with Down syndrome goes into hospital to have their appendix out, staff may not be familiar with Down and may find it difficult to deal with such a child,” says O’Connor.

“Children with mobility issues sometimes find that they are just left in bed and indeed wheelchairs or crutches are often put away while they are in hospital.”

CHI also believes that children with communication difficulties should be catered for . “If they are asked a question, another staff member should not answer for them, and if they need help such as alphabet boards this should be available. Time is often an issue in hospitals, but it is important for staff to realise that it can take longer for a child to answer a question.”

It is 50 years since the Platt Report – The Welfare of Children in Hospital– was published in Britain. A ground-breaking document, it urged that the special needs of children in hospital be met not least by involving the family in a child's care. Central to the report was the recommendation that children should be nursed with children and not with adults.

O’Connor says that with the long-awaited national children’s hospital almost a reality, it is beyond time for the authorities here to introduce the standards set out in that 1959 report and in so many other reports since.