HAS Pediatric Criteria: The Complete Guide for Quality Care for Children and Adolescents

The care of children and adolescents in healthcare facilities is a complex task requiring special attention and rigorous protocols. Defined as any person under eighteen years of age, children constitute a vulnerable population with specific needs related to their age, illness, and development. The French National Authority for Health (HAS) has established a precise framework to guarantee the quality and safety of pediatric care, from admission to discharge. This article details the essential HAS criteria for evaluating the care of children and adolescents, a fundamental issue for their future health.

1. Admission and Identification: The First Step in a Safe Pathway

The admission of a minor to a healthcare facility is a key moment that determines the safety and quality of their entire stay. The HAS (French National Authority for Health) emphasizes two fundamental pillars: respect for the legal framework of parental authority and flawless patient identification vigilance. The Role of Parental Authority and Consent: As a general rule, any request for hospitalization for a minor must come from those holding parental authority. Healthcare teams have a duty to obtain the free and informed consent of these individuals before initiating any care plan. This process must be clearly documented. Exceptions exist, particularly in cases of life-threatening emergencies where necessary care can be provided even if the parents cannot be reached immediately. Another special case concerns voluntary termination of pregnancy (abortion), for which a minor has the right to keep the matter confidential and make her decision alone, provided she is accompanied by an adult of her choice. The National Health Identity (INS): a guarantee of safety. Patient safety begins with correct and unambiguous identification. Each minor has their own National Health Identity (INS), separate from that of their parents. This INS is assigned approximately 8 days after birth. To validate it (i.e., certify it), the teams can use the family record book or a birth certificate via a secure system for the parent. As soon as the child has their own identity document (national identity card or passport), their National Health Identifier (INS) can be completed directly, without parental documentation. Teams must adhere to best practices in patient identification vigilance at each stage of care to avoid any errors. For newborns in maternity wards who do not yet have their final INS, transitional measures are in place to prevent confusion. Verification and correct use of the INS are crucial evaluation points during HAS certifications. 2. A suitable environment: Protecting and reassuring the minor patient. The HAS emphasizes the critical importance of creating a physical and human environment adapted to the specific needs of children and adolescents. The objective is twofold: to ensure their safety and preserve their psychological well-being.

Trained Equipment and Staff

In all services likely to receive minors, whether pediatric or not, it is imperative that staff be trained in the specific psychological and emotional needs of this patient population. Furthermore, all equipment must be adapted to their age and size. This includes:

• Beds, meals, and nurse call systems.
• Assessment tools, such as triage scales in the emergency department or pediatric pain scales.
• Life-saving emergency equipment, which must be specifically pediatric.

Separation of minors and adults

A fundamental principle is to protect minors from potentially traumatic contact with adult patients, particularly in general services such as the emergency department or technical areas. To this end, the HAS recommends:

• In the emergency department: A dedicated and separate waiting room with games, books, and toys, as well as a predictable and specific waiting time for children.
• In technical areas (operating room, imaging): Scheduling that prioritizes children's visits at different times than adults, separate changing rooms, and dedicated areas in the post-anesthesia care unit (PACU) to accommodate parents.
• In inpatient wards: It is preferable to group minors by age group to facilitate appropriate activities and protect them. Older adolescents must be able to express their opinion on the ward where they prefer to stay (pediatric or adult).

Any exception to this rule, such as hospitalization in an adult ward due to overactivity, must be anticipated and strictly managed, guaranteeing a private room and clear information for the family.

3. Developing a personalized and comprehensive care plan

A minor's care plan must be holistic, taking into account not only their pathology but also their living environment, development, and specific needs.

Gathering clinical and psychosocial information

To develop a relevant care plan, teams must gather as much information as possible upon the child's arrival. It is essential to:

• Request and consult the child's health record and "My Health Space" to find medical history, allergies, growth charts, and vaccination status.
• Assess the child's family, social, and school interactions to understand their overall environment.

Detection and Reporting of Abuse

Child protection is an absolute priority. Healthcare professionals must be trained to recognize signs of external abuse and know the reporting procedure to the appropriate authorities. Any suspicion must be reported and investigated. The HAS (French National Authority for Health) values ​​the existence of Pediatric Reception Units for Children in Danger (UAPED), which offer comprehensive care (legal, medical, and medico-legal) in a single, suitable location.

Access to Experts and Continuity of Care

The care plan must be developed with the support of pediatric specialists (pediatricians, child psychiatrists) and experts in fields such as pain management, palliative care, addiction medicine, and antibiotic therapy. For children with rare diseases, the institution must guarantee continuity of care by referring them to specialized reference or expertise centers to avoid diagnostic delays.

4. Involvement of the Minor and Their Family: Key Stakeholders in the Care Plan

The HAS places the involvement of the patient and their family at the heart of its quality assurance process. Successful care relies on close collaboration and transparent communication between caregivers, the child, and their parents.

Informing and gathering the minor's opinion

It is essential to inform the minor about their health condition and care plan in a way that is appropriate to their age and level of understanding. Playful tools or specific welcome booklets can be used. The child's opinion, if they are able to express it, must be sought and recorded in their file.

The central role of parents

Parents are not simply visitors, but partners in care. Their continuous presence with the child, 24/7, must be encouraged and facilitated by the facility. This implies providing them with suitable premises and equipment (extra bed, bathroom facilities, access to meals). Their knowledge of the child is invaluable, and they should be involved in certain aspects of care, such as pain assessment or administering treatments, if they so wish. Their presence is also organized in the technical areas, particularly to accompany the child until they fall asleep and to be present when they wake up.

Preserving social connections and health education

Hospitalization, especially if it is long or repeated, should not cut the child off from their life. The institution must put in place resources to prevent family, social, and school disruptions, for example, by coordinating with the child's school. Furthermore, the stay is an opportunity to deliver prevention and health education messages adapted to each age group (screen use, hygiene, vaccination, and for adolescents: addictions, STIs, nutrition, sports).

5. Pain Management: An Absolute and Systematic Priority

Pain in children has long been underestimated. The HAS (French National Authority for Health) has made it a central criterion for the quality of care, emphasizing its anticipation and rapid and effective relief.

Systematic Assessment and Appropriate Tools

Pain must be systematically assessed using validated pediatric scales, adapted to the child's age and communication abilities. Teams must be trained in their use and know how to choose the most appropriate one (for example, face pain scales for younger children, numerical rating scales for older children). The assessment must be documented in the patient's file.

Parental Involvement and Treatments

Parents play a crucial role in assessing their child's pain, as they are often the first to detect the signs. Their participation in this assessment is encouraged. Pain management, whether pharmacological or not (reassuring presence, distraction, etc.), must be implemented quickly and its effectiveness must be regularly reassessed. The minor patient has the right to receive care aimed at anticipating or quickly relieving their pain. 6. Discharge Preparation and Continuity of Care: Ensuring a Smooth Return Discharge from the hospital is as important a step as admission. It must be carefully prepared to guarantee the continuity and safety of the child's care pathway. Information and Liaison Documents Before leaving, the healthcare team must ensure that the parents (or those with parental authority) and the child have fully understood the instructions for the continuation of care. This includes follow-up appointment dates, treatments to continue, and contacts to reach in case of problems.

To ensure a smooth transition with community healthcare professionals (general practitioner, pediatrician), several documents are essential:

• The discharge summary: This must be complete and given to the patient to ensure continuity of care.
• The updated health record: It must be completed with information useful for the child's follow-up.
• The updated "My Health Space" (DMP): Relevant information must be entered.

Support in difficult situations

Unfortunately, discharge is not always a return home. In the event of the death of a child or adolescent, teams must have protocols in place for appropriate and respectful care. This includes announcing the death, supporting the family (parents, siblings), and the arrangements for mourning, which may include specific procedures for transferring the body. Training staff to deal with these tragic situations is a key focus for the HAS (French National Authority for Health). In conclusion, the HAS criteria for pediatrics outline a demanding but essential roadmap to guarantee high-quality, safe, and compassionate care. They remind us that caring for a child is much more than treating an illness: it is about supporting a developing individual, protecting their vulnerability, and working closely with their family to build a healthy future.