Rights of the Child (10Rs)

Children’s rights are human rights. In 1989 the United Nations declared the Convention of the Rights of Children¹, promoting the rights and the protection of children to develop their full potential, free from hunger and want, neglect and abuse.

Article 24 of the UN’s Convention of the Rights of Children addresses the rights and the special demands of children in health care institutions recognizing that children are especially vulnerable.

The EACH Charter (1988)³ recognizes and endorses the rights of the child as stipulated in the UN Convention on the Rights of the Child (UNCRC), and in particular the key principle that, in all situations, the best interests of the child should prevail (art.3).

As commitment to the Convention of the Rights of Children and The EACH Charter the Safetots.org initiative adjusted this to the perioperative situation and issued the following 10 Rights (10 R).

Right to enjoy the highest attainable standard of health

“Children have the right to enjoy the highest attainable standard of health. Specialist pediatric anesthesia care should be provided for all children. Particularly children aged less than three years should be treated by experienced staff that follows continuous education, regular training and updates to maintain their competencies. Children who have significant co-morbidity and those who requiring highly specialized or major surgery benefit from specialized anesthetic care in dedicated pediatric centers.” ¹“

Right to non-discrimination

“All children should be treated in a respectful and empathic way, whatever their race, religion or abilities; whatever they think or say, whatever type of family they come from. It doesn’t matter where children live, what language they speak, what their parents do, whether they are boys or girls, what their culture is, whether they have a disability or whether they are rich or poor. No child should be treated unfairly on any basis.” ¹

Right to be protected from economic exploitation

“Children need to be protected from any economic exploitation in health care. Profit-motivated treatment of children in hospitals and medical institutions of low quality should be avoided.” ³

Right to be protected from unnecessary treatment and investigation

“Children need to be protected from unnecessary treatment and investigation. That includes any potential harm and burden associated with their involvement in research, teaching or training of medical staff.”³

Right to avoid pain, fear and stress

“All children should be treated without suffering from pain, fear and unnecessary stress. They should benefit from all forms of anesthesia and procedural sedation whenever they or their caregivers ask for. Children should have full access to pain therapy and palliative care.” ³

Some pain, fear and stress may be inevitable but all efforts should be undertaken to minimize this.

Right to have their parents with them

“Children have the right to have their parents with them during the induction of anesthesia and during recovery.” ³

Although this may not always be possible or appropriate, the view of the child and the caregiver should always be taken into account.

Right to privacy

“The privacy of children should be respected at all times during induction and maintenance of anesthesia and recovery. This includes also: protection against exposure during physical examinations and personal, hygiene activities, e.g. dressing, toileting and bathing; protection against treatment and behaviour which diminishes self-respect or makes the child feel ridiculous or humiliated.” ³

Right to be informed

“Children and adolescents have the right to information on all aspects of health which enables them to make informed choices. They have the right to get and share information about treatment and procedures during anesthesia, sedation and pain-therapy in a manner appropriate to age and understanding as long as the information is not damaging to them or others. Participation in decision making requires advance information about all measures that need to be taken.”³

Right to be heard

“Children have the right to be heard and to express their wishes, concerns and fears. According to age, understanding and level of development they have the right to be involved in and contribute to the medical decision-making process in anesthesia, sedation and pain-therapy.” ³

Right to be cared for together with children who have the same developmental needs

“Children have the right to receive treatment during anesthesia, sedation and pain-therapy in a child-friendly environment where they can enjoy emotional and physical stimulation suited to their age and condition. These measures help to minimize anxiety and normalize what can be an abnormal situation.” ³

References

UN Committee on the Rights of the Child (CRC), General comment No. 15 (2013) on the right of the child to the enjoyment of the highest attainable standard of health (art. 24), 17 April 2013, CRC/C/GC/15. https://www.ohchr.org/Documents/Issues/Women/WRGS/Health/GC15.pdf (last accessed 2/2019)
UN Committee on the Rights of the Child (CRC), (art. 32). https://ohchr.org/Documents/ProfessionalInterest/crc.pdf (last accessed 2/2019)
European Association for Children in Hospital (EACH), EACH-Charter (art. 2). https://www.each-for-sick-children.org/each-charter/each-charter-annotations (last accessed 2/2019)
Markus Weiss, Andreas Machotta. [Quality and safe anesthesia for all children : That is their right!]. Anaesthesist 2022 Apr;71(4):255-263. doi: 10.1007/s00101-022-01111-0. Epub 2022 Mar 28.
Kristian Noerholm Jensen, Tom Giedsing Hansen. Children undergoing anaesthesia: what are the rights of the child? Signavitae Vol.17, Issue 4, July 2021 pp.203-207. doi: 10.22514/sv.2021.059. Signavitae Open Access
Machotta A, Hansen TG, Weiss M; on behalf of the Safetots Initiative. Children’s rights – the basis of quality in pediatric anesthesia. Curr Opin Anaesthesiol. 2023 Jun 1;36(3):295-300.