Spotlight on Developmental Care: Hospital Spaces

When a child has a complex heart defect, their primary experiences and environments are often disrupted. Instead of being at home in their neighborhoods, they may be in a hospital, where they can experience stressors such as:

• bright lights

• beeps and other noises

• many caretakers

• painful and uncomfortable procedures

• separation from a parent 

Developmental Care practices aim to create a more typical experience for a developing baby or child.  They focus on the universal rights and unique needs of each child and family. When hospitals use Developmental Care, babies are usually healthier and happier.

When a hospital practices Developmental Care, they do their best to arrange the physical space to welcome and support families.

In many cases, hospitals are unable to create the perfect Developmental Care nursery right away. Creating new spaces takes time and money. However, when hospitals are committed to Developmental Care, they generally work to follow as many Developmental Care guidelines as possible in designing their spaces.

When families and providers understand the principles of Developmental Care, they can work together to create spaces that are as supportive as possible of children and their families.

In order to best serve families and children, hospital care units should strive to be:

• Convenient to get to, with accessible travel and parking

• Easy to find within the hospital

• Close to the labor and delivery room (if the unit is for newborns)

• Welcoming, warm, and friendly when families arrive

• Comfortable for families, with services they need

• Equipped to transfer patients to and from other hospitals quickly, comfortably, and safely

When a hospital unit is designed according to Developmental Care, it often has:

• Soft colors and furniture

• Gentle lighting with dimmer switches

• Carpets in many areas

• Comfortable parent furniture

• Bed spaces designed for the needs and preferences of each child

• Plants

• A home-like feeling

When a hospital uses Developmental Care, children's rooms are designed to feel friendly and familiar for children and their families. This often means:

• No more than two child beds per room, and individual rooms if possible

• Plenty of space between beds, with spaces for parents to sit and sleep

• A private bathroom with a shower and tub

• Room for the family to rest and play together

• Secure, convenient, ample spaces for families to store their belongings

Developmental Care describes how hospital units can promote rest, healing, and growth. With thoughtful design, care spaces can make it easier for adults to respond flexibly to children's evolving needs.

Babies and young children require a lot of sleep, especially when they are sick. When hospital units promote rest, they often have:

• People moving calmly and slowly

• No strong smells

• Good ventilation

• A comfortable and consistent temperature

• Dim, indirect light

• Low volume in the room

• Sound insulation in the walls

• Staff using quiet voices

• Nothing bright, fast, scary, or exciting near a child's face

When a child is awake and alert, they. may be ready to play, learn, and interact. Hospital units can serve children's need for stimulation with:

• Play spaces for children and families

• Easy access to children's beds

• Safe, age-appropriate toys and books

• Interesting pictures and mobiles

• Chairs and beds with room for parent and child

• Music and audiobooks

Hospitalized children often spend a lot of time in and around their bed. Well-designed bed spaces can meaningfully promote children's well-being. For example, a development-driven bed space could:

• Integrate medical equipment with other furniture

• Have some things for a child to look at, such as pictures of the parent’s face, that are chosen carefully, and available when the child is ready

• Not have many lights, colors, and complicated patterns near a child’s face

• Make it easy for people to get close to and touch the child

• Have comfortable spots for adults to sit and sleep

• Include a parent bed that is wide enough for the parent and child

• Have objects from home (for older children), or objects that smell like the parent (for babies)

Reduce bad sound:

• Turn off ringers and alarms on phones, watches, and other devices

• Speak in a quiet, calm, slow voice around the child

• Use sound insulation

• Use earplugs or sound-protecting earmuffs for older children

• Offer children individual rooms, and have no more than 2 children per room if needed

• Turn off unnecessary alarms, and/or move alarms to the nurse's station

• Enforce quiet hours on the hospital floor

• Use headphones when listening to music or videos

• Use white noise

Provide good sound:

• Encourage family members to talk, sing, and read to the child regularly, in a quiet and calm voice

• Play recordings of a parent's voice when they cannot be present

• Play music for the child, and make music together with the child

• For older children, play audiobooks, guided meditations, and age-appropriate podcasts

• Play quiet sounds that the child finds calming (waves? wind? rain?)

Reduce bad visual experiences:

• Keep bright lights away from the child's face and rest area

• For babies, reduce bright colors and complex images near their faces and rest areas

• Remove or cover objects, images, or signs that might scare an older child

• Reduce colored and flashing lights

• Cover windows at night, and open them in the morning

• Keep lights dim at night and during naps

• Turn off TVs and other screens at night and during naps

• Try to prevent children from witnessing other people who are in distress

Provide good visual experiences:

• Provide windows with a view of the outdoors

• Decorate the room in calm colors, with plants and soft fabrics

• For babies, offer interesting mobiles, toys, and pictures of their family to look at when they are calm

• For children, decorate the space with favorite pictures, blankets, and toys

• Read picture books

• Provide opportunities to make visual art

Reduce bad taste:

• Disguise the taste of medicine

• Give medicine with milk, formula, apple sauce, or pudding

• Give medicines all at once

• Consider how medicine is delivered, and if a child might do better with a different formulation or delivery. method (pill, liquid, chewable, injection, tube)

Offer good taste:

• Milk, colostrum, or formula for babies

• A pacifier dipped in sugar water

• Favorite foods and drinks for older children

• Popsicles or Jell-O

• Lollipops, mints, and hard candy for older children

Reduce bad and strong smells:

• Use unscented cleaning products

• Clean up messes quickly

• Avoid perfume and strong-smelling cosmetics

Provide good smells:

• Let babies smell milk, formula, or food

• Give babies a blanket or shirt that smells like their parent

• Give children a calming scent they like (a sachet of lavender? a vanilla lip balm?)

• Use body care and laundry soap from home, if possible

Reduce bad touch:

• Find and remove anything that rubs or itches

• Use the most comfortable version of all necessary medical equipment

• Avoid painful procedures when possible

• Use pain management

• Cluster uncomfortable procedures all at once, rather than spread out over a day

• Change the child's position frequently

• Keep the child clean and dry

• Warn the child before they are touched

Provide good touch:

• Use soft, gentle fabrics

• Provide soft toys

• Stroke, hug, and hold the child

• Gently rub the baby's head

• Hold the child’s hand

• Offer a warm bath or warm blankets

• Hold the baby skin-to-skin

• Gently massage children

• Provide toys with interesting textures when the child is awake and engaged

When hospital units follow the principles of Developmental Care, they are designed to meet the needs of the whole family. This can mean:

• Space for family members to sleep, sit, and shower in their child’s room

• A comfortable family lounge

• A family kitchen and dining room

• Washers and dryers

• Staff who can help families with tasks such as finding housing, parking, or childcare

• Spaces for siblings to play

Developmental Care is based on a simple principle: children are still children, even if they are sick. They have the same needs, rights, and desires as any other child, and their care is centered within their family, culture, and community. When caretakers keep this principle at the front of their mind, they are much more successful at building spaces and providing care that promote the well-being of the whole child.

Developmental care is best when it is local. Families local to Boston can receive care from the Cardiac Neurodevelopmental Program (CNP). Families from other regions can use the link below to find their local care team.