Intensive care for critically ill children in Europe can be greatly improved when children are not referred to an adult Intensive care, but admitted to a dedicated paediatric intensive care unit (PICU), cared for by paediatric staff, skilled and experienced in paediatric medical and nursing intensive care.
The European Association for Children in Hospital (EACH) notes with concern that the care of critically ill children in many countries in Europe is not realizing the ‘Right of the child to the enjoyment of the highest attainable standard of health’ as laid down in the General comment No.15 on art 24 UNCRC rights and is therefore not ‘in the best interests of the child’.
Children are not small adults. They are different in many aspects: physiological, anatomical, functional, developmental and psychological. On an IC for adults staff lack the knowledge and the experience in caring for children in different stages of development.
IN THE BEST INTERESTS OF THE CHILD
Key focal points
In a dedicated Paediatric Intensive Care Unit (PICU):
- medical staff is specially trained in paediatric intensive care and nurses are trained paediatric critical care nurses, familiar with the complexity of paediatric physiology and age-specific medical conditions. The skills and experience of the medical and nursing staff can optimize the chances of critically ill children to survival and can prevent long-term consequences after intensive care;
- staff has the opportunity to form a multidisciplinary team together with specialists in paediatric anaesthesiology, psychologists, child life workers, social workers and other professionals who work collaboratively to provide comprehensive care. This includes effective pain management strategies to minimize discomfort. The team-based approach ensures that the physical, emotional, and psychosocial needs of the child are addressed;
- children have access to specialist equipment for children of different ages. A great deal of the critically ill patients are very young;
- the importance of the family in the child’s healing process is recognized and encouraged. In a PICU parents and the child (matching the child’s developing abilities) take part in the decision-making process of the child’s treatment and care. Family support services are offered, parents are encouraged to stay with their child (rooming in) and parental involvement in the child’s care supported. There are overnight facilities and the hospital offers catering facilities (reduced prices or preferably free of charge);
- the rooms are designed to create a child-friendly and developmentally appropriate environment. Children should be protected from upsetting sights. The rooms are also designed for the needs of the parent. Single-bed PICU rooms are more effective against infections, secure more privacy and are less stressful and noisy than open-bay wards;
Intensive care in a dedicated PICU can not be provided in every hospital. To keep the skills and experience of the medical and nursing staff up to date, a high volume of patients is needed. This asks for centralisation of PICU facilities. As a result, a dedicated PICU might be on quit a distance from where the child got ill. Save transport of the child and the parent is important. If parents have to travel in order to be able to stay with their critically ill child, efforts should be made to compensate their costs. Children and their parents should have equal access to a PICU, regardless of where they live.
EACH endorses the view of the Committee on the rights of the child in the introduction to the General comment No.15 that most mortality, morbidity and disabilities among children could be prevented if there were political commitment and sufficient allocation of resources directed towards the application of available knowledge and technologies for prevention, treatment and care.
 General Comment No.15 on the right of the child to the enjoyment of the highest attainable standard of health. Adopted by the Committee on the Rights of the Child at its sixty-second session ( 14 January – 1 February 2013)
 Key principle linking to all UNCRC
 introduction to General Comment No.15, on the right of the child to the enjoyment of the highest attainable standard of health. Adopted by the Committee on the Rights of the Child at its sixty-second session ( 14 January – 1 February 2013)