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

The care of children and adolescents in healthcare facilities is a complex task that requires special attention and rigorous protocols. Defined as any person under the age of eighteen, 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 ensure 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 on the Path to Safety

The admission of a minor to a healthcare facility is a critical moment that determines the safety and quality of their entire stay. The HAS (French National Authority for Health) emphasizes two fundamental principles: respect for the legal framework governing parental authority and strict vigilance regarding patient identification. 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), healthcare 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 updated directly, without requiring parental documentation. Teams must adhere to best practices in patient identification vigilance at every 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 departments that are likely to treat minors, whether pediatric or not, it is essential that staff be trained in the specific psychological and emotional needs of this patient population. Furthermore, all equipment must be appropriate for 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 designed for children.

Separation of minors and adults

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

• In the emergency department: A dedicated, 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 appointments 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 ensure their safety. Older adolescents should be able to express their preference regarding which ward they would like to stay in (pediatric or adult).

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

3. Developing a personalized and comprehensive care plan

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

Collecting clinical and psychosocial information

To develop an appropriate care plan, teams must gather as much information as possible when the child arrives. It is essential to:

• Request and review the child's health record and "My Health Space" to view their 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 be familiar with the procedure for reporting such cases to the appropriate authorities. Any suspicion must be reported and investigated. The HAS (French National Authority for Health) supports the existence of Pediatric Reception Units for Children in Danger (UAPED), which provide comprehensive care (legal, medical, and medico-legal) in a single, appropriate 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 ensure continuity of care by referring them to specialized centers of expertise to avoid delays in diagnosis.

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 depends on close collaboration and transparent communication between healthcare providers, the child, and their parents.

Informing the minor and obtaining their opinion

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

The central role of parents

Parents are not merely visitors, but partners in care. The facility must encourage and facilitate their continuous presence with the child, 24/7. This involves providing them with suitable accommodations and equipment (an extra bed, bathroom facilities, and 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 arranged in the treatment areas, particularly to stay with the child until they fall asleep and to be there when they wake up.

Maintaining social connections and health education

Hospitalization, especially if it is prolonged or repeated, should not cut the child off from their daily life. The facility must provide resources to prevent disruptions to family life, social activities, and school, for example, by coordinating with the child’s school. Furthermore, the hospital stay is an opportunity to deliver prevention and health education messages tailored to each age group (screen time, hygiene, vaccinations, and for adolescents: substance abuse, STIs, nutrition, and 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 key criterion for the quality of care, emphasizing the importance of early detection and rapid, effective relief.

Systematic Assessment and Appropriate Tools

Pain must be systematically assessed using validated pediatric scales that are appropriate for the child’s age and communication abilities. Teams must be trained in their use and know how to select the most appropriate scale (for example, facial pain scales for younger children, numerical rating scales for older children). The assessment must be documented in the patient’s medical record.

Parental Involvement and Treatments

Parents play a crucial role in assessing their child’s pain, as they are often the first to notice the signs. Their involvement in this assessment is encouraged. Pain management—whether pharmacological or non-pharmacological (such as a reassuring presence or distraction)—must be implemented promptly, 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 discharge, the healthcare team must ensure that the parents (or those with parental authority) and the child have fully understood the instructions for continuing 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 practitioners, pediatricians), several documents are essential:

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

Support in difficult situations

Unfortunately, discharge does not always mean returning home. In the event of the death of a child or adolescent, teams must have protocols in place to ensure appropriate and respectful care. This includes notifying the family of the death, supporting the family (parents, siblings), and making arrangements for the funeral, which may include specific procedures for transporting the body. Training staff to handle these tragic situations is a key priority 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.