Key Questions - Children's health

Polly Lee, MSc, BA, RSCN, DipN, ILTM, RM, RGN, is lecturer in child health, City University, St Bartholomew School of Nursing and Midwifery.

What is family-centred care?

This is a term that has been used in child health nursing in the UK for many years. It recognises the child's unique position within their family and the various influences that the family has on the child, as opposed to 'person-centred care', where nurses take a strong interest in patients' own experiences of health and illness. 

Family-centred care acknowledges the potential for lifetime consequences of a child's separation from parents when children are admitted to hospital or similar stressful episodes in primary care. It also recognises parents' special moral and legal responsibilities.

Why is the emergency assessment of children different?

Children's airways have different anatomical features compared to adults. Their head is large (proportionately) and their short neck means their heads need to be maintained in the neutral position. Infants under six months are nasal-breathers. Their large tongue and horseshoe-shaped epiglottis makes intubation more difficult, and this is best achieved with a straight laryngoscope blade. Infants' narrow airways have potential to become blocked with mucus, whereas their small circulatory blood volume means they can only lose a small amount of fluid before the potential for cardiovascular compromise.

Why is it necessary to communicate with children differently?

A child's ability to communicate depends on both their physical age and cognitive ability. Children have not had the same life experiences as adults and therefore, when faced with health needs, understand the world and what is happening to them differently. Pre-verbal children have little understanding but if parents are relaxed then these children are more likely to be relaxed. Pre-school and infant-school children have a little understanding and can only view the body in terms of its surface. Junior schoolchildren begin to develop the ability to reason, whereas secondary-age schoolchildren have normally developed the ability to think abstractly like adults.

Why is gaining consent from children so important?

Although UK law states who has parental responsibility for children and can therefore sign consent for their surgery, good practice ensures that before a procedure/surgery, children are able to understand what will happen to them in age-appropriate language. If children understand and have agreed to what is going to happen they are more likely to be cooperative. For example, children may be able to state a preference for which hand an IV cannula should be inserted (non-dominant hand) so they can continue to draw/write.

Why are children so vulnerable?

Due to their lack of understanding it is more difficult for children to recognise right from wrong. Consequently, children may easily be dominated by adults, either known to them or strangers. Their safeguarding is therefore key to any setting where children receive services, including health, education and social care. All those who care for children have a responsibility to ensure they are fully aware of local safeguarding procedures.

Suggested further reading

Advanced Life Support Group (2004) Advanced Paediatric Life Support (4th ed) Massachusetts: Blackwell Publishing.

Department of Health (2004) National Service Framework for Children, Young People and Maternity Services. Core Standard 3 – Child, Young Person and Family-Centred Services.dh.gov.uk

Smith, L. et al (eds) (2002) Family-Centred Care Concept, Theory and Practice. Basingstoke: Palgrave.