Hola a todos, mis queridos amigos.

Last week was published in Intensive Care Medicine a new article by the IC-HU Project about restricted visitation policies for children in adults ICU.

Yoana Skrobik, from Canada, was surprised after reading the article, and she sent me an email with her opinion. She has let me share it. In the end, everything depends on where you are living, as we discussed las week talking about the ICU where only “Dad and mom can enter”.

As you can understand, things are on one way or another depending on the part of the world where we work, but in any case, we make it possible. Read this and get your own conclusions:

“Dear Gabi,

I must tell you I am rather taken aback by your attached text.

In 1991, I started working in an intensive care unit in the largest bone marrow transplant centre in Montreal. The patients were often in their 30s or 20s, and so often had young children who wished to come and visit.

At the time, a child psychiatrist told me what has guided my practice ever since.

He explained children have no fear of death and no notion of the consequence of illness and suffering. These notions are adult, and children experience fear only if adults convey it. Having had and raised several children, I agree that the notion of consequence is indeed one we spend much time attempting to instill.

The psychiatrist also said that when a child is small, and even into adolescence, their perception of adults is a perception of a powerful person who makes decisions. In that frame, if the loved adult disappears, the child perceives the adult’s disappearance as having been willed by the adult. The psychiatrist then went on to say that children who are isolated from loved adults who are ill subconsciously or consciously perceive abandonment. He explained that this sense of abandonment is much more damaging to a child then any exposure to illness. In addition, he mentioned that children who are so called ‘protected’ from illness are de facto also completely isolated from the experience that the rest of the family is going through. They never learn how to share sadness and loss, and are perhaps less well equipped when those inevitable moments come later in their own lives.

Since that conversation, I have let children of any age into the intensive care unit if they wish to come. The nurses usually accompany them and explain to them what they will see, so that the parents are not burdened with this.

I have never worked in a Canadian intensive care unit that did not allow children in. In over 20 years of practice, I have never seen a child react badly to intensive care exposure, nor have a parent report later that this visit or exposure was in some way traumatic. Some children do not wish to come in (and I would never force the issue in that case), but most of the resistance comes from adults.

The only exception to limiting children in an ICU I worked in was a brief contained time in which pre-12 schoolchildren in Montreal where the primary vectors for the H1N1 virus. Only then were age restriction policies applied, and they were lifted this soon as it was feasible.

The psychiatrist who was telling me his thoughts smiled at the end of expressing his opinion and said we live in a society that completely isolates the old from the young, the healthy from the sick, and creates artificial divides that do not serve any group well. I agree with him to this day.

I would encourage any revision of policy that isn’t grounded in any data, to better accommodate the wishes of both patients and families.

Yoanna Skrobik
Department of Medicine. Centre Universitarie de Santé McGill

Montreal, Canadá.