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Child Friendly Hospital Environment: A Demand of Time

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Nobo Krishna Ghosh Sharmin Afroze

Dr M R Khan Shishu Hospital & Institute of Child Health, DHAKA Bangladesh Dr. M R Khan Shishu Hospital & Institute of Child Health
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 REVIEW ARTICLE ISSN (Print) : 2710-3587

Child Friendly Hospital Environment: A Demand of Time

Nobo Krishna Ghosh1, Sharmin Afroze2, Morsheda Khanam3, Azmeri Sultana4,
Ahmed Murtaza Choudhury1

Conflict of interest: There is no

financial conflict of interest relevant to Abstract:
this paper to disclose With the advancement in the health care system over time, perception of the hospital
Funding agency: This research setting has also improved a lot. But little attention has been given to the establishment of
project was not funded by any group or children-friendly hospital environment which has a positive impacts on a child’s physical
any institution
and mental health when they are sick and visit hospital. In this context, a short review is
Contribution of authors: Afroze S
and Khanam M contributed in report
presented here with an aim to discuss the essential features for establishing a child
writing. Sultana A, Ghosh NK and friendly hospital which is a demand of time for ensuring quality care for this special
Choudhury AM have revised the population.
manuscript.
How to cite this article: Ghosh NK,
Afroze S, Khanam M, Sultana A, JMRKSH 2020; 1(2): 62-66
Choudhury AM. Child Friendly Hospital
Environment: A Demand of Time.
JMRKSH 2020; 1 (2): 62-66

Received : 10 October 2020

Accepted : 17 November 2020
Published : 1 December 2020

Introduction: also evident that they have had several bitter

Child health is one of the key indicators of a country’s experiences on hospital visit which make them more
health status. Their physical, as well as mental scared of hospital. They see white gown nurses and
developments are unique and different from adult ones. doctors who give them injections, force them to open
They need more attention during a hospital visit. In their mouths to drop vaccine and other drugs. At their
order to build a special environment in hospital, their age, they don’t have enough strength to protect
themselves but they become afraid of thinking about
physical & mental needs should be met, and their
these situations.4 Thus, to decrease their fear and to
risks for harm should be minimized during health
ensure a better treatment friendly atmosphere, the
service delivery.1This will also ensure the quality of hospital environment needs to be adjusted with the
care and will improve the effectiveness of interventions children’s mind and demand.
for children.
What do children need in a hospital?
Children are special: World Health Organization has declared that, for
According to the World Health Organization (WHO) ensuring quality care in children, every health facility
anyone under the age of eighteen years is termed as should have an appropriate environment for children
Child. The physical, psychosocial, developmental, and adolescents, hospital friendly infrastructures and
communication and cultural needs of children are amenities including adequate water, sanitation,
different from those of adults.2-3 Often their feelings hygiene, fire management, waste management, energy
are ignored and even their problems are not asked for supply, a stock of essential medicines, supplies
or listened to properly when they visit hospital. It is including those for play and learning.1

1. Professor of Pediatrics, Dr. M R Khan Shishu (Children) Hospital & ICH, Dhaka, Bangladesh.
2. Assistant Professor of Neonatology, Dr. M R Khan Shishu(Children)Hospital & ICH, Dhaka, Bangladesh.
3. Assistant Professor of Pediatrics, Dr. M R Khan Shishu (Children) Hospital & ICH, Dhaka, Bangladesh.
4. Associate Professor of Pediatrics, Dr. M R Khan Shishu (Children) Hospital & ICH, Dhaka, Bangladesh.
Correspondence: Prof. Dr. Nobo Krishna Ghosh, Professor of Pediatrics, Dr. M R Khan Shishu (Children) Hospital & ICH, Dhaka,
Bangladesh, Cell: +8801911356523, email:drnkghosh@yahoo.com
Journal of Dr. M R Khan Shishu (Children) Hospital Vol. 1, No. 2, 2020

A child friendly health facility should have outpatient, • Privacy will be assured for older children and
inpatient and emergency care areas specified for adolescents (curtain/ walls/ room).
children and young adolescents, separated from the
• Areas will be appropriately decorated and furnished
areas for adults, which are appropriately furnished.
for children’s needs and suited for their
The environment should be clean, comfortable and
developmental age.
logically organized and furnished to maintain continuity
of care and minimize detrimental impact on the • The health facility will have room or screened off
children and their families. This should also offer area in outpatient department to ensure normal
surroundings suited to the age of the young patients conversation without being overheard and for
from birth to adolescence and should allow parents or examination of children unobserved by other
caregivers to remain close to their children.5-6 patients.
• Facilities will have designated areas for playing,
Components of a Children friendly Hospital:
entertainment and education.
A child- friendly hospital must include some key
elements that will play vital role in patient management • Surgery services will include recovery and
as well as in their development. In all health care hospitalization areas for children located close to
settings, other than physical infrastructure, there the children’s wards.
should be ambient environment, safety • Facility for rooming-in mothers or caregivers with
measurements, therapeutic safety to child and they their children 24 hours a day will be available.5
should engage the children in different constructive
activities.7 Ambient environment:
The primary function of the patient room is to provide
a healthy environment. Natural materials, soothing
Physical colors, and adjustable access to natural light can
environment promote healing and a feeling of well-being. Acoustic
panels for inspiring hues and patterns can help to
minimize noise and shape a calm environment.
Child engaging Ambient Besides, plant life (where infection control measures
environment environment are allowed) can add another layer to that peaceful
atmosphere. The ambient environment will include the
following:
• Safe, clean, appropriately lit and well ventilated
wards/rooms
Therapeutic Safe
environment environment
• Adequate power source (solar, generator, grid) that
can meet all the demands of the facility

Fig.-1: Components of a Children Friendly Hospital • Availability of associated infrastructures for

electricity at all times with a back-up power source
• Adequate energy management plan supported by
Physical environment:
an adequate budget, maintained by appropriately
The health facility should have seamless access to
trained staff and regulated by a competent
areas dedicated for the care of children including
authority5,7-8
neonates, children and young adolescents in reception,
triage and assessment areas, outpatient, inpatient Safe environment:
areas and wards, units for neonatal and pediatric Children need to be kept safe from both infections
intensive care, sick neonates and general medical and accidental injuries. This can be achieved by
and surgical pediatric care, treatment rooms and an ensuring a safe environment in the structure as well
isolation area for infectious children. as taking safety measures regarding the use of water,
• The design will include easy observation and sanitation, hygiene etc. The standard measures are
supervision of children all the time. as follows:

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Child Friendly Hospital Environment: A Demand of Time Nobo Krishna Ghosh et al.

(a) General safety issues: children and young adolescents that are
adapted for their use (with smaller seats or
• Clear instructions on safety and security
latrines, child sized bed pans) segregated by
measures
sex for older children.
• Covered electrical outlets
• Dedicated nappy changing station with
• Appropriate window locks and door latches appropriate waste disposal and hand washing
• Operational fire extinguishers for each area and facilities nearby.
floor, a clearly designed plan of evacuation in • Sufficient competent staff for cleaning, operating
case of emergency and sufficient external and maintaining water, sanitation, hygiene and
barriers. waste management.10-13
• Padding of all sharp edges and non-slip, easily
Therapeutic environment:
maintained floor coverings.
Patients of any age, either adult or child, attending
• Facilities will be available for parents and hospital should receive standard treatment. It is their
caregivers so that they can stay with or near right to get the diagnostic and therapeutic services
their children including, a pantry, breast feeding timely and appropriately. In a child friendly hospital,
room, breast milk storage room and a family following criteria should be met to ensure that standard
room for visitors.9 of care.
(b) Safe water, sanitation, hygiene and waste disposal: • Children should receive optimum care when the
• The health facility should have a functioning equipment is specifically designed to meet their
source of water located in the premises that is learning, developmental and recreational needs.
adequate to meet all the demands for drinking, • Basic laboratory and diagnostic facilities must be
personal hygiene, medical interventions (ORS, available 24 hours a day.
nutritional supplements and medicines),
cleaning, laundry and cooking for staff, children • The facility should have a list of essential pediatric
and their families. equipment in clean, secure storage, an efficient
inventory tracking system, guidelines for
• There will be drinking water stations that are appropriate use of equipment and a system for
either low or have a stool for easy reach and regular maintenance and disposal.
small cups are available for children.
• The health facility will have safe, uninterrupted
• The health facility will have leak-proof, covered, source of oxygen and equipment for delivery (age-
labelled waste bins and impermeable sharp appropriate nasal prongs, catheters, face masks)
containers in every treatment area to allow in children’s wards and emergency corners.
segregation of wastes into three categories:
sharps, non-sharps infectious wastes and • Functioning, well-equipped resuscitation trolley for
general non-infectious wastes. pediatric emergency resuscitation and appropriate
equipment: suction device, pulse oximeter,
• According to WHO, at least one functioning laryngoscope, endotracheal tube, bag valve masks,
hand hygiene station per 10 beds, with soap infusion sets should be available in all designated
and water or alcohol-based hand rubs in all areas.
wards, at least one of which is accessible to
children. • Facility will have an updated inventory of medical
equipment with documentation of breakage or
• The health facility has bath and hygiene facilities malfunction and dates of repair or replacement.
on the premises which are appropriately
illuminated, adapted for use by young children • The health facility will have functioning, age and size
and segregated by sex for older children and appropriate beds and furniture (chair, tables) on
caregivers. pediatric wards or areas designated for child care.

• Adequate sanitation facilities (e.g., Pans, • The health facility will have on-site pharmacy with
toilets, latrines) on the premises for infants, trained pharmacist or dispensers.

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Journal of Dr. M R Khan Shishu (Children) Hospital Vol. 1, No. 2, 2020

• Health facility will have supplies of emergency and rest, an attractive waiting room and television with kid
pre-referral medicines that are readily accessible friendly channels. There was a significant increase in
for severely ill children. the satisfaction rate from pre-intervention (68%) to post
intervention phase (90%). Around 95% of the hospital
• The health facility will have essential medicines
staffs were found to be very positive with the effects of
as well as vaccines available at all time for the interventions taken.16
management of children.14-15
Another survey was conducted by the Council of
Child engaging environment: Europe to explore the children’s experiences of health
A child-friendly hospital will provide a rich and care in certain parts of the council of Europe. Children
educational environment containing a variety of stimuli were asked about their age, their last visit in the
and activities.It is important to design environments hospital, waiting time to meet the physician and how
at the hospital where children can stay similarly was their experience during hospital stay. The majority
of the respondents were between the age of 13-15
engaged and active like at home. A family zone can
years.Eighty four percent children were accompanied
be arranged, where children can sit with their parents,
by their parents or family members. Few were brought
play small indoor games, draw and care for plant life.
with teachers from school. Around 40.8% children told
There should be age-appropriate toys, games, books that waiting time was short. But during the waiting
and facilities for playing and entertainment of children time for appointment they felt bored (37.5%).17 From
on wards and in game and recreational areas. Walls this survey, conclusion came that hospitals and
of children wards, vaccine corners can be painted with pediatric units should include place to relax, walls
cartoon characters to attract them as well as to should be bright and colorful, should have televisions,
engage them during procedures. By creating dedicated toys, play zone and areas enabling families or parents
play areas, kids can enter their own world. The play to stay with their children.
corners will be free of cost and children of any age will
Conclusion:
get an easy access there. Playing will make them
In reality, all of these components are not always
more comfortable and it is often used as a way of
possible to be arranged in all levels of health care
communication during treatment. This will stimulate
delivery points at a time. Furthermore, in developing
a child’s creativity also. To help health care providers countries like Bangladesh, these facilities cannot be
make better connection with the children and provide availed due to limited resource and financial constrain.
additional comfort during treatment, game products But for elevating the standards, countries should try
can be kept within the consultation areas: recognition to establish a uniform health infrastructure where
of the graphics from play areas inside treatment and children’s physical and mental health will be focused.
recovery rooms will help kids relax as they become A small initiative is required only to address the
familiar with the colors, shapes and textures. Besides emotional needs of patient that can bring a huge
the structural change, gentle behavior and friendly talk difference in their health condition and will bring a
of the doctors and nurses with kids will further engage positive outcome for the country.
the child in the therapeutic process easily.5
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