HABER, ANGELICA M.

BS ARCH 31E1

Children's hospital

A children's hospital is a hospital which offers its services exclusively

to children and adolescents. Most children's hospitals can serve children from birth up to
the age of 18, or in some instances, children's hospitals' doctors may treat children until
they finish high school. The number of children's hospitals proliferated in the 20th
century, as pediatric medical and surgical specialties separated from internal
medicine and adult surgical specialties.
Children's hospitals are characterized by greater attention to the psychosocial support
of children and their families. Some children and young people have to spend relatively
long periods in hospital, so having access to play and teaching staff can also be an
important part of their care.[1] With local partnerships this can include trips to local
botanical gardens, zoo, and public libraries for instance.[2]
In addition to psychosocial support, children's hospitals have the added benefit of being
staffed by professionals who are trained in treating children. A medical doctor that
undertakes vocational training in paediatrics must also be accepted for membership by
a professional college before they can practice paediatrics. These include the Royal
Australasian College of Physicians RACP, Royal College of Paediatrics and Child
Health RCPCH, and the American Board of Pediatrics. In New Zealand the RACP offers
vocational training in paediatrics. Once RACP training is completed the doctor is
awarded the Fellowship of the RACP (FRACP) in paediatrics.[3] While many
normal hospitals can treat children adequately, pediatric specialists may be a better
choice when it comes to treating rare afflictions that may prove fatal or severely
detrimental to young children, in some cases before birth. Also, many children's
hospitals will continue to see children with rare illnesses into adulthood, allowing for a
continuity of care.

History[edit]
Early Voluntary Care[edit]
Prior to the 19th century hospital reforms, the well-being of the child was thought to be
in the hands of the mother; therefore, there was little discussion of children's medicine,
and as a result next to no widespread formal institutions which focused on healing
children. There were however centres which focused on helping abandoned
children and offering care in hopes that these children might survive into adulthood.
Some examples include orphanages, dispensaries, and foundling hospitals. Florence's
Hospital of the Innocent (Ospedale degli Innocenti) was originally a charity based
orphanage which opened in 1445; its aim was to nurse sick and abandoned infants
back to health. A later example and better established institution whose goal it was to
help rehabilitate infants was the Foundling Hospital founded by Thomas Coram in 1741.
Foundling hospitals were set up to receive abandoned infants, nurse them back to
health, teach them a trade or skill, and integrate them back into society. Coram's
foundling hospital was revolutionary because it was one of the United Kingdoms first
children charities.[4] Moreover, it was largely made successful by the powerful people
who donated money to the hospital.[5] Coram's hospital would eventually be faced with
the fact that the number of infants needing care outweighed their hospitals capacity. In
order to accommodate the number of children in need, there were attempts to set up
similar hospitals throughout the UK; they ultimately were unsuccessful due to the lack of
funding.[6] Simultaneously, dispensaries which were also funded by donations were
being opened in order to provide medicine and medical attention to those who could not
afford private care. Dispensaries and foundling hospitals were the earliest forms of what
would later become children's hospitals. The establishing of the Foundling Hospital by
Thomas Coram was a direct response to the high infant mortality rate in London,
England. Although foundling hospitals acknowledged the high infant mortality rate,
infant mortality would not be addressed in a wide spread way until the early 19th
century when children's hospitals would begin to open in Vienna, Moscow, Prague,
Berlin, and various other major cities throughout Europe.[7]
19th-century models[edit]
In America, by the mid-19th century middle-class women and physicians became
increasingly concerned about the well-being of children in poor living conditions.
Although infant mortality had begun to decline, it still remained a prominent issue. Social
reformers blamed the emergence of the industrial society and poor parents for not
properly caring for their children.[8] In response, reformers and physicians founded
children's hospitals across the country. Early children's hospitals were set up in
converted houses not only to help the children transition from leaving their home to
being in a hospital, but also because it was often the only space available. [8] Early
children's hospitals focused more on short-term care and treating mild illnesses rather
than long-term intensive care. Treating serious diseases and illnesses in early children's
hospitals could result in the disease spreading throughout the hospital which would
drain their already limited resources. A serious disease outbreak in a children's hospital
would result in more deaths than lives saved and would therefore reinforce the previous
notion that people often died while in the hospital.[8]
Like those found in the United States, children's hospitals in the United Kingdom in the
19th century often resembled middle-class homes. British children's hospitals
introduced rules to which patients and their families were expected to adhere; these
rules carefully lined out middle-class values and expectations.[7] British children's
hospitals, like their American and Canadian counterparts, relied heavily on donations
from the rich. Donations came in the form of money, food, toys, and clothes for the
children. The United Kingdom's children's hospitals were soon faced with the reality that
their small and vulnerable patient would soon outnumber their resources. [7] In order to
maintain the cost of running these new hospitals throughout the United Kingdom, the
upper classes needed to market their hospitals as centres for reform. In order to brand
themselves as reformers, they had to contrast themselves against the parents; this
meant they had to portray the poor parents as incompetent.[7] Despite their mission to
save children, hospitals in Britain and Glasgow rarely admitted children under the age of
two; such children were deemed costly and needed constant attention.[7] Similar to the
American hospitals, those located in Europe were also hesitant to admit children who
required long-term care in fear that those lives would be lost or that long-term care
would block beds for those in immediate need.[7] The intentions of the hospitals built in
Europe were to provide care for those who could not afford care. Care was primarily
provided to those who met the age requirements and were willing to adhere to the
hospital's rules. Since early children's hospitals relied on donations, they were often
underfunded, overcrowded, and lacking medical resources.
The first formally recognized paediatrics hospital was the Hôpital des Enfants
Malades in Paris, France, which opened in 1802. The United Kingdom was slow to
follow and established The Great Ormond Street Hospital in London, England, in 1852,
which marked the opening of the first British children's hospital.[9] The United States
would soon follow and established The Children's Hospital of Philadelphia in
Pennsylvania in 1855.[10] Canada established their first children's hospital in 1875; The
Hospital for Sick Children in Toronto, Ontario, along with the latter all remain open
today.[11] By the end of the 19th century, and the during the first two decades of the 20th
century, the number of children's hospitals tripled in both Canada and the United
States.[8] The first children's hospital in Scotland opened in 1860 in Edinburgh.[12]
Professionalization of Children's Hospitals[edit]
In the 19th century, there was a societal shift in how children were viewed. This shift
took away some of the parents' control and placed it in the hands of medical
professionals.[13] By the early 20th century, a child's health became increasingly tied to
physicians and hospitals. Unlike the professionalization of nursing, the medical field
professionalized at a greater speed.[14] This was a result of licensing acts, the formation
of medical associations, and new fields of medicine being introduced across
countries.[14] These new areas of medicine offered physicians the chance to build their
careers by "overseeing the medical needs of private patients, caring for and trying new
therapies on the sick poor, and teaching medical students."[14] In order to raise their
status further, physicians began organizing children's hospitals; by doing so, it also
brought attention and importance to their speciality in the modern health care
system.[8] This idea brought about the creation of children's hospitals
in Philadelphia, Boston, Washington, D.C, and San Francisco – all which emphasized
children as their focus.[8] Along with specialized physicians, the 20th century brought the
removal of voluntary or religiously associated female care and replaced it with
professionally trained nurses.[15] In addition to separate institutions for children and a
professional staff, both medical and technological advancement helped solidify
children's hospitals as centres of physical healing. The discovery of vaccines,
anaesthetics, and surgical improvements made children's hospitals more reliable and
more effective in the treatment of childhood disease and illness.

Utilization[edit]
Using hospital discharge data from 2003-2011, the Agency for Healthcare Research
and Quality (AHRQ) studied trends in aggregate hospital costs, average hospital costs,
and hospital utilization. The Agency found that for children aged 0–17, aggregate costs
rose rapidly for the surgical hospitalizations and decreased for injury hospitalizations.
Further, average hospital costs, or cost per discharge, increased at least 2% for all
hospitalizations and were expected to grow by at least 4% through 2013. The exception
to this was mental health hospitalizations, which saw a lower percentage increase of
1.2%, and was projected to increase only 0.9% through 2013. Despite the rising
aggregate costs and costs per discharge, hospitalizations (except for mental health
hospitalizations) for children aged 0–17 decreased over the same time, and were
projected to continue decreasing.[16]
In 2006-2011, the rate of ED use in the United States was highest for patients aged
under one year, but lowest for patients aged 1–17 years. The rate of ED use for patients
aged under one year declined over the same time period; this was the only age group to
see a decline.[17]
Between 2008 and 2012, growth in mean hospital costs per stay in the United States
was highest for patients aged 17 and younger.[18] In 2012 there were nearly 5.9 million
hospital stays for children in the United States, of which 3.9 million were neonatal stays
and 104,700 were maternal stays for pregnant teens.[19]