HAS criteria for pediatrics: The complete guide to quality care for children and adolescents

Caring for children and adolescents in healthcare establishments is a complex task, requiring special attention and rigorous protocols. Defined as anyone under the age of eighteen, children constitute a vulnerable population with specific needs linked to their age, pathology and development. The French National Authority for Health (HAS) has drawn up precise guidelines to guarantee the quality and safety of pediatric care, from admission to discharge. This article details the essential HAS criteria for assessing the care of children and adolescents, a fundamental issue for their future "health capital".

1. Admission and Identification: The first step in a secure journey

The admission of a minor to a healthcare establishment is a key moment which determines the safety and quality of the entire stay. The HAS insists on two fundamental pillars: respect for the legal framework of parental authority and flawless identity surveillance.

The role of parental authority and consent

As a general rule, any request for hospitalization of a minor must be made by the person with parental authority. Care teams have a duty to obtain the free and informed consent of these persons before initiating any care project. This process must be clearly documented. Exceptions exist, notably in cases of life-threatening emergency, where the necessary care can be provided even if the parents are not immediately contactable. Another special case concerns the voluntary termination of pregnancy (IVG), for which a minor has the right to maintain secrecy and make her decision alone, provided she is accompanied by an adult of her choice.

The National Health Identity (INS): a guarantee of security

Patient safety begins with correct, unambiguous identification. Every minor has his or her own National Health Identity (INS), distinct from that of his or her parents. This INS is assigned around 8 days after birth. To qualify it (i.e. certify it), the teams can use the family record book or a birth certificate via a secure device for the parent. As soon as the child has his or her own identity document (national identity card or passport), the INS can be qualified directly, without the need for a parental document.

Teams must follow good identity surveillance practices at every stage of care to avoid any errors. For newborns in maternity wards who do not yet have their definitive INS, transitional measures are put in place to prevent confusion. Verification and correct use of the INS are crucial evaluation points for HAS certification.

2. A suitable environment: Protecting and reassuring minor patients

The HAS stresses the vital importance of creating a physical and human environment adapted to the specific needs of children and adolescents. The aim is twofold: to ensure their safety and preserve their psychological well-being.

Trained staff and equipment

In all departments likely to receive minors, whether pediatric or not, it is imperative that staff are trained in the psychological and emotional specificities of this patient group. In addition, all equipment must be adapted to their age and morphology. This includes :

• Beds, meals and nurse call systems.
• Assessment tools, such as emergency triage scales or pediatric pain scales.
• Vital emergency equipment, which must be specifically paediatric.

Separating minors from adults

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

• In emergencies: A dedicated, secluded waiting room, with games, books and toys, and a specific, predictable waiting time for children.
• On technical platforms (operating room, imaging): A schedule that allows children to pass through at separate times from adults, separate changing rooms, and dedicated areas in the post-interventional surveillance room (SSPI) to welcome parents.
• In hospital wards: It's best to group minors by age group, to encourage appropriate activities and protect them. Older teenagers should be able to give their opinion on which ward they prefer (pediatric or adult).

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

3. Drawing up a personalized, comprehensive care plan

A minor's care plan must be holistic, taking into account not only his or her pathology, but also the context in which he or she lives, his or her development and specific needs.

Gathering clinical and psychosocial information

To build a relevant care plan, teams need to gather as much information as possible as soon as the child arrives. It is essential to :

• Ask for and consult your health record and "My Health Space" to find out about your history, allergies, growth curves and vaccination status.
• Assess children's family, social and school interactions to understand their overall environment.

Detecting and reporting abuse

Child protection is an absolute priority. Healthcare professionals must be trained to spot signs of external abuse, and be familiar with the procedure for reporting it to the appropriate authorities. Any suspicion of abuse must be reported and investigated. The HAS promotes the existence ofUAPED (Unités d'Accueil Pédiatrique pour Enfants en Danger), which offer comprehensive care (legal, medical, medico-legal) in a single, appropriate location.

The use of experts and continuity of care

The care plan must be drawn up with the support of pediatric specialists (pediatricians, child psychiatrists) and experts in fields such as pain, palliative care, addictology or antibiotic therapy. For children suffering from rare diseases, the establishment must guarantee continuity of care by referring them to specialized reference or competence centers, to avoid diagnostic wandering.

4. Involving minors and their families: key players in the care project

The HAS places patient and family involvement at the heart of its quality approach. Successful care depends on close collaboration and transparent communication between caregivers, the child and his or her parents.

Informing and obtaining the minor's opinion

It is essential toinform minors about their state of health and their care plan in a way that is adapted to their age and level of understanding. This can be done using playful tools or specific welcome booklets. The child's opinion, if he or she is capable of expressing it, must be sought and recorded in the child's file.

The central role of parents

Parents are not just visitors, but partners in care. Their continuous presence with the child, 24 hours a day, must be encouraged and facilitated by the facility. This means providing them with suitable premises and equipment (extra bed, sanitary facilities, access to meals). Their knowledge of the child is invaluable, and they should be involved in certain aspects of care, such as assessing pain or administering treatments, if they so wish. Their presence is also organized on the technical platforms, in particular to accompany the child until he or she falls asleep and to be present when he or she wakes up.

Preserving social ties and health education

Hospitalization, especially if it is long or repeated, must not cut the child off from his or her life. The facility must put in place resources to prevent family, social and school disruptions, for example by coordinating with the child's school. In addition, the stay is an opportunity to deliver prevention and health education messages adapted to each age group (use of screens, hygiene, vaccinations, and for teenagers: addictions, STDs, nutrition, sport).

5. Pain management: an absolute, systematic priority

Pain in children has long been underestimated. The HAS has made it a central criterion of quality of care, insisting on its anticipation and rapid, effective relief.

Systematic assessment and appropriate tools

Pain must be systematically assessed usingvalidated pediatric scales, adapted to the child's age and ability to communicate. Teams must be trained in their use, and know how to select the most appropriate scale (e.g., face scales for younger children, numerical scales for older children). The assessment must be recorded in the patient's file.

Parental involvement and treatment

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 treatment, whether medicinal or non-medicinal (reassuring presence, distraction, etc.), must be implemented promptly and its effectiveness regularly reassessed. Minor patients have the right to receive care aimed at anticipating or rapidly relieving their pain.

6. Preparing for discharge and continuity of care: Ensuring a smooth return home

Discharge from hospital is just as important as admission. It must be carefully prepared to guarantee continuity and safety in the child's care.

Information and liaison documents

Before departure, the care team must ensure that the parents (or guardians) and the child have fully understood the instructions for further care. This includes the dates of follow-up appointments, the treatments to be continued, and the contacts to be reached in the event of a problem.

To ensure a smooth transition with healthcare professionals in town (GP, pediatrician), several documents are essential:

• The discharge liaison letter: This must be complete and given to the patient to ensure continuity of care.
• Updating the child's health record: The health record must be updated with information useful for monitoring the child.
• Updating "Mon espace santé" (DMP): Relevant information must be uploaded.

Support in difficult situations

Unfortunately, discharge does not always mean going home. In the event of the death of a child or teenager, teams need to have protocols in place for appropriate, respectful care. This concerns the announcement of the death, support for the family and friends (parents, siblings) and the arrangements for the funeral, which may include special arrangements for the transfer of the body. Staff training in these tragic situations is a point of focus for the HAS.

In conclusion, the HAS criteria for pediatrics provide a demanding but indispensable roadmap for guaranteeing high-quality, safe and humane care. They remind us that caring for a child is much more than treating an illness: it's about supporting a developing being, protecting their vulnerability and working closely with their family to build a healthy future.

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