Caring for more than ‘our bastard children’ in hospitals

Abstract

All countries tell stories of how their inpatient children's hospital services were established. Often contemporary children's hospitals have collated histories of their organisation. Many start with exploring care, and provision, for abandoned children. These histories tell of institutions being established for 'foundling' children. However, these institutions might not be as altruistic as it first appears. Apart from being a moneymaking avenue for wet nurses, foundlings had other potential economic benefits. This included, that once at an appropriate age foundlings could be a commodity to be sold off as part of a workforce or an army (Panter-Brick and Smith, 2000). Despite being a potential investment opportunity, public opinion for a foundling institution was not on Thomas Coram's side when he attempted to establish London's first foundling hospital (McClure, 1981). Early 18th-century English society commonly considered abandoned children as illegitimate, threatening, villainous and amoral (Zunshine, 2005). Thus, foundling equated with bastard; and its repercussion, that bastard equalled a disgrace (McClure, 1981). After a 17-year campaign, and a Royal Charter from King George II, Thomas Coram did establish a Foundling Hospital in Bloomsbury, London. Near to Coram's Foundling Hospital, in 1852, with 10 beds, the United Kingdom's first hospital to offer dedicated inpatient care to children opened. Great Ormond Street Hospital is now just one of hundreds of global children's hospitals, delivering care to millions of children and their families worldwide. Global data on numbers of paediatric hospitals and dedicated paediatric beds are not available. However, in Europe, for the past two decades, there has been an average reduction in hospital beds per person by almost 20% (OECD/EU, 2018). This has been coupled with a fall in average hospital length of stay from 10 days in 2000 to less than 8 days in 2016 (OECD/EU, 2018). In part this reduction can be attributed to improvements in inpatient care delivery. For many countries though, there has also been intentional reduction in hospital bed numbers as community care services are developed. While developments in community care services are important, it is clear that in-hospital improvements are also key to improving healthcare. As our Journal of Child Health Care aims to explore a broad range of health topics from a diverse range of settings for this edition of JCHC, we are focusing on hospital-based care. Jepsen and colleagues (2019) found that hospitalised children face a variety of challenges during admission to the hospital due to acute and/or critical illness. A pressing challenge, which surely would have also faced children admitted to Coram's Foundling Hospital, was that of coping with 'the unfamiliar'. Insecurities and unfamiliar noises abounded, and routines would be as foreign then as they are today. While Coram's children would not have experienced intubation, as