Children Need Their Own Hospital Wards

The Age

Monday December 15, 2008

DAVID BENNETT - Professor David Bennett is national president of the Association for the Wellbeing of Children in Healthcare and head of the NSW Centre for the Advancement of Adolescent Health, The Children's Hospital at Westmead

Treating children as little adults means they come off second best.

THERE has been widespread concern about the overcrowding and underfunding of public hospitals, but one issue that has not received much publicity is the disappearance of children's wards. This development is of grave concern to doctors and should also worry the public because it affects the quality and safety of the treatment of children and young people in Australia.

In a national survey of about 200 public hospitals, the Association for the Wellbeing of Children in Healthcare found that the number of children's wards fell by 30per cent between 1992 and 2004 and that 35per cent of hospitals did not routinely house children and adolescents separately from adults.

This practice of accommodating children with adults has many potential risks. Children are not little adults. For hospitalisation to be safe and appropriate, their particular emotional, social and educational needs must be taken into account.

Otherwise, we run the risk of returning to the bad old days when children were left in hospital without parental support and at risk of physical, psychological or sexual harm from other patients and, in the absence of opportunities for play, leisure and education, interruptions to normal development.

Also, children may be exposed to unnecessary trauma from witnessing distressing sights and sounds, a not-uncommon occurrence.

When adults and children share resources, children frequently come off second best. The quality of care and treatment of children and young people is compromised when it is provided by personnel who are disinterested or lackg the requisite education and training, or if the available equipment is inappropriate in size or design.

On the other hand, adults who are ill may be disturbed by noisy children or the continued presence of a child's family, a key component of family-centred care. It may then be impossible to provide the family support and involvement in care, which is such a high priority for children.

According to reports received by AWCH, the children's ward in one hospital was so full of adult patients that a seriously ill child had to wait in the emergency department for eight hours before a bed became available. Other very young patients and their families have been sent to other hospitals, or surgery has had to be cancelled, because children's beds were occupied by adults.

Children's wards are important because they provide a safe and supportive place for sick children and their families. Specially designed spaces for play and recreation (important for adolescents, too) have an important role in a child's recovery from illness and hospitalisation.

In a child-friendly environment, a child about to undergo surgery can better understand what is happening to them when encouraged to role play with a teddy bear, join other children of a similar age in the play room after their operation and be supported in a speedy recovery. Consider, too, what this means to a family already stressed by their child being in hospital.

Provision of specially trained staff is important. Tragedies involving compromised health care have occurred when staff were unable to recognise life-threatening symptoms until it was too late. In one case, this resulted in the death of a child.

Why are children's wards disappearing and why are those that remain accommodating adult patients? Unprecedented pressures on beds and budgets in the current climate provide the obvious context, but attitudes have also changed.

We know that hospital systems work best with about 85per cent bed occupancy, allowing "room to move" with new admissions. At higher levels -the current norm - the few spare beds in a children's ward (where they exist at all) are more likely to be used for the overflow of adult patients. There is also a trend towards shorter hospital stays for all patients.

Possibly also at play are outdated bed management and discharge practices. Whatever the underlying reasons, it is clear that children's needs are not always given priority in the competing demand for beds.

What will happen if we are unable to reverse the prevailing trend involving closure of pediatric units and co-location of children with adults in our hospitals?

The answer is both simple and alarming - we are forgetting all that we learnt in the 1970s and '80s. We thought we had won these battles.

Having created one of the best health-care systems in the world, admissions for children in Australian hospitals are becoming ever more likely to involve separations from family, developmental disruption, exposure to potentially traumatising environments, less-than-optimal care and unacceptable levels of risk. A strong and strategic response is required.

With increasing pressures on the health system from an ageing population, it is more important than ever that we prioritise the needs of children and young people. Doing nothing is unacceptable and, ultimately, too costly.

Professor David Bennett is national president of the Association for the Wellbeing of Children in Healthcare and head of the NSW Centre for the Advancement of Adolescent Health, The Children's Hospital at Westmead.

© 2008 The Age

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