Table 1 Characteristics of included studies

Adeleye et al. (2023)

[27] Nigeria

To assess the knowledge, perception, and practice of child rights among doctors and nurses in Nigeria

Nonprobability sampling

Sample: 821 HCPs

Setting: (not mentioned)

Structured questionnaire (quantitative, cross-sectional)

Relevant laws on child labour*, child adoption*, criminal responsibility**, female circumcision**, and physical punishments**

−50% of HCPs are aware of child rights and adoption laws in Nigeria

−70% of HCPs find no conflict between their beliefs and child rights legislation

Not mentioned in this study

Not mentioned in this study

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Bester et al. (2018) [29] South Africa

To determine practices employed by South African HCPs to obtain consent for treatment from children

Purposive sampling

Sample: N = 24 HCPs, (19 nurses, 5 medical practitioners)

Setting: hospital and primary healthcare clinics

Semi-structured interviews (qualitative study)

Children’s consent**

-Inconsistent implementation of consent laws is due to limited knowledge, misinformation, and personal perceptions

-HCPs explained that their current practices for assessing children's capacity to consent begin with building a trusting relationship and rapport, followed by providing information and conducting assessment practices

Practical barriers include limited time, staff shortages, and the need for multi-professional support and guidelines

Not mentioned in this study

-Increase staffing levels

- Provide multi-professional training

- Develop and disseminate clear guidelines

- Promote team-based care and collaboration

- Utilise supportive technology

- Implement flexible scheduling for decision-making

Bisogni et al. (2015) [24] Italy

To understand the implementation and respect of rights in Italian paediatric hospitals

Sample: 536 nurses

Setting: Paediatric hospitals and peadiatric units of general hospitals

Questionnaire (quantitative, cross-sectional)

Right to parental presence*, proper accommodation* play*, information on condition, assent/dissent, *privacy*, continuity of education*, pain management*

- The most implemented rights were related to parental presence (mean 4.47), play (mean 4.29)

-The lower implemented rights were related to informed assent/dissent (mean 3.01), school education (mean 3.07)

- The most neglected rights: pain treatment (16%), play and recreation (7.6%), treatment information (7.2%), privacy (5.2%)

Not mentioned in this study

Not mentioned in this study

––––

Clarke (2023) [35] United Kingdom

To explore children’s experiences of staying overnight in hospitals from the perspectives of children and nurses

Purposive sampling

Sample: 8 children’s nurses

Setting: Paediatric settings

Semi-structured interviews (qualitative study)

Caring for children hospitalised overnight**

-Three main themes were identified from interviews with children’s nurses: children’s nursing, job pressures, and safe and effective care

- Insufficient resources

- Inadequate staffing levels

- High patient care demands

- Challenges in meeting children’s needs

Not mentioned in this study

- Increase resource allocation

- Hire additional nursing staff

- Implement workload management strategies

- Provide specialised training to better meet children's needs

- Enhance support systems for nurses (e.g. counseling, peer support)

- Utilise time-saving technologies and tools

Coyne (2006) [28] England

To explore children’s, parents’, and nurses’ views on participation in care in the healthcare setting

Purposive sampling

Sample: 11 children, 10 parents, and 12 nurses

Setting: four paediatric wards in two hospitals

In-depth interviews, questionnaires, and observations (qualitative study)

Participation*

- Child’s on participation in care depends on age, attitude, well-being, illness length, mental status

- Children’s participation requires parents’ approval

- Workforce pressures challenge children's involvement in care decisions

Parents’ approval and Workforce pressures

Not mentioned in this study

- For parents’ approval issue:

- Educate parents on benefits of child participation

- Facilitate open discussions between HCPs, parents, and children

- Provide decision-support tools for parents

- For HCPs Workforce Pressures:

- Increase staffing

- Streamline workflows

- Encourage team-based care

Coyne et al. (2014) [18] Ireland

To explore children’s participation in shared decision-making (SDM) from multiple perspectives

Purposive sampling

Sample: 20 children, 22 parents, and 40 HCPs

Setting: one haematology/oncology unit

Structured interview (qualitative study)

Participation in SDM*

- Children’s role in treatment decisions is limited

-Factors such as wellness, development, maturity, personality, emotional state, and disabilities can hinder children’s involvement

- Constraints on children's participation in shared decision-making include:

- Time limitations

- Heavy workloads

- Treatment urgency

- Restricted choices

Not mentioned in this study

- Adapt communication to children’s developmental levels

- Train staff on engaging children with diverse needs

- Allocate more time for shared decision-making

- Optimise workflows to reduce staff workload

- Plan for children’s input even in urgent cases

- Expand available choices for children in decision-making

Georgousopoulo et al. (2023) [25] Greece

To highlight the knowledge of employees in children’s hospitals regarding children’s rights

Purposive sampling

Sample: 251 HCPs

Setting: paediatric hospital

Questionnaire (quantitative, cross-sectional)

Access to health services without any discrimination*,necessary hospitalisation**, play and recreation*, education*, privacy*, pain management*

- The main findings indicate that less than 50% of HCPs are aware of the UNCRC and hospital-specific children's rights charters. Additionally, 53.9% of hospitalisations could have been avoided. A significant 88.3% of respondents support children's right to access information and participate in decision-making. Furthermore, 38.2% believe that gender and privacy are respected in multi-bed rooms. Regarding pain management protocols, 63.3% report partial or full usage, while 24.3% are unaware of them, and 12.4% state they are not followed

Not mentioned in this study

Not mentioned in this study

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Lombart et al. (2020) [32] France

To explore HCPs perspectives on forceful physical restraint in paediatric care

Purposive sampling

Sample: 30 female HCPs

Setting: four paediatric hospitals

Ethnographic (qualitative study)

Autonomy*

HCPs experience significant fatigue and emotional strain when involved in restraining children

Fatigue and emotional strain

Not mentioned in this study

- Provide specialised training on managing difficult situations without restraint

- Increase staffing to reduce individual burden

- Implement de-escalation techniques and non-restraint alternatives

- Offer emotional support and counseling for HCPs

- Foster a team-based approach to share responsibility

Lutz (2019) [30] Switzerland

To analyse patients’ and professionals' conceptions of autonomy in childhood obesity management

Purposive sampling

Sample: 8 HCPs, 29 children (aged 7–18 years) and 31 parents

Setting: paediatric hospital

Semi-structured interview (qualitative study)

Autonomy*

- Lack of motivation linked to children's and parents’ attitudes

-Professionals’ expectations of autonomy vary by age

Not mentioned in this study

Not mentioned in this study

––––

Migone et al. (2007) [26] Ireland

To assess perceptions of hospital adherence to EACH for Children in Hospital Charter

Purposive sampling

Sample: 50 children, 111 parents, 61 nurses, and 41 doctors

Setting: Dublin paediatric hospital

Questionnaire (Quantitative, cross-sectional)

The right to be protected from unnecessary medical treatment and investigations**The right of Parental accommodation within hospital settings**, right to be informed in a manner appropriate to their age and understanding*, rights of meeting children’s developmental and emotional needs during hospitalisation**

Many children undergo unnecessary treatments and can be treated at home. The hospital lacks adequate play and education facilities, and there is insufficient privacy on the wards. While over 90% of staff use appropriate language when discussing medical issues with parents and children, only 50% of nurses and 59% of doctors encourage children to ask questions. Additionally, 28% of nurses and 41% of doctors report having inadequate time to build relationships with parents and children

Not mentioned in this study

Not mentioned in this study

––––-

O’Connor et al. (2021) [33] Ireland

To describe perspectives on children’s participation in decision-making in therapy

Purposive sampling

Sample: 7 children, 5 parents, and 6 occupational therapists

Settings: public healthcare services

Semi-structured interview (qualitative study)

Participation in decision-making*

-Factors impacted childern participation in decision- making were as follows: attention/concentration, self-esteem, mental health, intellectual disabilities, speech/language difficulties

- Empowering adults to empower children is crucial

Childern attention/concentration, self-esteem, mental health, intellectual disabilities, speech/language difficulties

Not mentioned in this study

- Use tailored communication aids

- Provide mental health support

- Boost self-esteem with positive reinforcement

- Offer specialised support for intellectual disabilities

Quaye et al. (2021) [34] Sweden

To identify everyday situations illustrating the child’s best interests in medical care

Purposive sampling

Sample: 32 children (aged 2–7 years), their parents, and HCPs

Setting: one paediatric regional hospital and two paediatric units at a tertiary university hospital

Nonparticipant observation (qualitative study)

Best interest of the child*

- Facilitators to the expression of the child’s best interests: Provide introductory, preparatory, and sensory information, minimal parental interruption

- Obstacles to the expression of the child’s best interests: communication barriers, parental interruptions, and lack of preparation time

- Communication barriers

- Parental interruptions

- Lack of preparation time

- Provide introductory, preparatory, and sensory information, minimal parental interruption

- Use clear, child-friendly communication tools

- Educate parents on minimising interruptions

- Allocate dedicated preparation time for HCPs

- Implement structured communication strategies for HCPs and children

Ruiz-Casares et al. (2013) [19] Canada

To assess attitudes toward providing care to undocumented migrant children and pregnant women

Convenience sampling

Sample: 1048 clinicians, administrators, and support staff

Setting: 3 hospitals including 2 major paediatric hospitals and 2 primary care centres

Questionnaire (quantitative, cross-sectional)

Access to health services*

HCPs identified several barriers to providing care for undocumented migrant children and pregnant women. These include language barriers (79.2%), difficulty finding a doctor (72.1%), and fear of reporting to immigration authorities or deportation (59.4%)

-Difficulty finding a doctor

-Fear of reporting to immigration authorities or deportation

Not mentioned in this study

- Create a referral network to simplify finding doctors

- Educate HCPs on the rights and protections of undocumented children and pregnant women

- Implement clear policies to reassure undocumented children about confidentiality

- Offer legal support and guidance for migrant children and pregnant women in healthcare settings

Sahlberg et al. (2020) [31] Sweden

To investigate experiences of children and nurses in paediatric care of caring by the UNCRC

Convenience sampling

Sample: 13 children (aged 4–7 years) and 11 nurses

Setting: three paediatric primary healthcare units

Semi-structured interview (qualitative study)

Caring in accordance with UNCRC*

Nurses noted that investing time in preparing children for procedures facilitates future healthcare encounters. However, emergencies often limit opportunities for children to express themselves, leading to more parent-centred communication. Nurses try to compensate by allowing children to make small decisions related to procedures, such as choosing the colour of a bandage or expressing their fears

Not mentioned in this study

Not mentioned in this study

–––-

Yigitbas & Top (2020) [11] Turkey

To determine midwives’ and nurses’ attitudes toward their roles in implementing child rights in healthcare

Convenience sampling

Sample: 122 midwives and nurses

Setting: public paediatric hospital

Questionnaire (Quantitative, cross-sectional)

Best interest of the child*, Right to life and development

Privacy*, Access to health information*, Parental responsibilities and state assistance*

Midwives and nurses often gauge a child’s understanding of treatment options through the child’s information (31.5%) or facial expressions (58.9%), while 36% believe children should not participate in health decisions. Midwives report higher rates of identifying and reporting suspected violence, abuse, and neglect

Not mentioned in this study

Not mentioned in this study

––––