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Repair Windows errors before they cause bigger problemsFix Now →Scan for outdated or missing drivers - takes under a minuteDriver Scan →Good pediatric healthcare design treats the child, family, clinicians and wider community as users of the same environment. HDR’s 11-principle framework, published in Building Design + Construction on August 10, 2016, combines family accommodation, developmental needs, safe circulation, flexible clinical space, operations and community connection. It is a professional planning approach—not a building code, accreditation requirement or clinical guideline. HDR summarizes the desired tone as “Child-friendly, not childish.”
The principles below are most useful at briefing and early design stages. They help an owner and project team test whether a concept supports caregiving and treatment without sacrificing infection control, privacy, staff workflow or long-term adaptability.
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What the 11-principle framework is—and is not
HDR developed the framework from work with clinicians and pediatric specialists. It describes design intentions and planning choices, rather than claiming that a particular finish, room shape or amenity guarantees a clinical outcome. Project teams still need to apply applicable building regulations, fire and life-safety provisions, accessibility requirements, infection-prevention policies, safeguarding procedures and local health-facility standards.
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The framework is broad enough for hospitals, ambulatory centers, outpatient clinics and specialty units. The emphasis changes with age range, acuity, length of stay and family model, but the central question remains constant: can a child receive care in a setting that feels understandable and safe while the family can participate in ordinary caregiving?
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The 11 principles
1. Engage patients and families
Start by treating children and families as participants in planning, not simply occupants of finished rooms. Engagement can include age-appropriate positive distractions, play areas, gathering spaces and opportunities for children to make choices. Form, materials, color and texture can make circulation and destinations easier to understand for both children and adults.
Engagement should be calibrated to developmental stage. A toddler may need visible landmarks and a protected play zone; an adolescent may value privacy, control of lighting and a place to connect with friends. Family members need clear wayfinding, comfortable waiting and places to ask questions without blocking clinical work. Involving patients and families during briefing can reveal practical problems—such as inaccessible storage, confusing check-in routes or nowhere to sit with a sibling—that a purely clinical review can miss.
2. Design with families in mind
Parents and other caregivers are part of the care team in pediatric settings. The plan should support them as people who stay, sleep, feed, comfort, make decisions and manage information over hours or days.
- Provide a credible place for a parent to stay with the child, with enough clearance for staff and equipment.
- Consider family sleep rooms, kitchens, laundry facilities and storage for personal belongings where length of stay warrants them.
- Include technology connections so caregivers can work, communicate with relatives and access school or care information.
- Allow family use of school or learning spaces when treatment interrupts ordinary routines.
These provisions need operational definition. A “family space” requires a location, cleaning responsibility, hours of access, security approach and furniture that can be maintained. Bedside accommodation should be checked against infection-control distances, emergency access and the needs of more than one caregiver.
3. Create neighborhoods
Pediatric units can be organized as smaller, recognizable neighborhoods rather than one long, adult-style corridor. A neighborhood may have a distinct identity, a nearby support point and a scale that children can comprehend. This arrangement can help separate different social and privacy needs while preserving staff oversight.
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Neighborhood planning is not a license to hide patients from staff or create inefficient travel distances. Test sightlines, call systems, medication and supply routes, emergency access and cleaning paths at the same time as the child’s experience. A quiet area for a child who needs reduced stimulation may need a different relationship to play and family spaces than an active area for ambulatory children.
4. Integrate flexible spaces
Rooms and shared areas should accommodate changing families, equipment and activities. Exam rooms may need to support a child, several caregivers, a sibling and a care team without forcing people into circulation paths. Play areas can be planned for different ages, supervised activities and temporary conversion when clinical demand changes.
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1Fix the driver behind crashes, sound loss and screen glitches2Repair Windows errors before they cause bigger problems3Scan for outdated or missing drivers - takes under a minuteHDR also points to acuity-adaptable patient rooms: rooms designed to support changing levels of care so that a child may not need a disruptive transfer when treatment intensifies or stabilizes. Whether that approach is appropriate depends on staffing, medical-gas infrastructure, monitoring, equipment clearances and the organization’s model of care. Document those assumptions in the room data sheet rather than relying on the label “flexible.”
5. Use evidence-based design carefully
Evidence-informed decisions bring the best available published evidence, clinical experience and project data into design. HDR gives standardized layouts and same-handed procedure and care rooms as examples of a strategy intended to make environments predictable and reduce opportunities for error. That rationale should be presented as HDR’s design proposition, not as proof that every standardized room produces the same result.
Standardization works when it is paired with usability testing. Mock up representative rooms, walk typical procedures with nurses and physicians, and check reach ranges, equipment parking, family sightlines and cleaning access. Record where a standard module must be altered for specialty equipment, isolation, bariatric care or age-specific needs. A repeatable layout is valuable only when it remains safe and workable in those exceptions.
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6. Improve processes and operations through design
Architecture can support care delivery, risk reduction, efficiency and staff productivity when it is developed with the actual process. Map arrival, registration, triage, examination, treatment, discharge, cleaning, restocking and waste removal before fixing room relationships.
Use process mapping and technology planning to locate information, supplies and staff where they are needed. Distinguish public, patient, staff and service movement; then test peak periods rather than an average day. A shorter route is not automatically better if it creates crossing traffic, noise or security exposure. The operational brief should state who uses each door, corridor, alcove and work point, and at what times.
7. Build safety into the design
Safety and infection prevention must be designed from the outset, not added as equipment or signage at the end. Plan controlled access, security at public entry points, separation of public and staff/service circulation, and clear responses to unauthorized movement or a missing child.
Infection prevention affects room geometry, hand-hygiene locations, clean and soiled flows, surface selection, storage, ventilation and cleaning access. Coordinate these requirements with clinical engineering and environmental-services staff. A visually welcoming lobby is unsuccessful if its queue blocks emergency access or if family traffic passes through a service route that should remain controlled.
8. Create a healing environment
A healing environment addresses sensory conditions as well as appearance. Consider daylight, noise and acoustics, air quality, privacy, social support and positive distraction together. Views, controlled glare, acoustic separation and calm transitions can be more useful than decorative theming.
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Children with special needs may require low-stimulation environments with reduced noise, softer visual complexity and adjustable lighting. Provide choices rather than assuming one environment suits every child. Outdoor spaces can support therapy and activity when their access, supervision, weather protection, security, planting and maintenance are resolved. Indoor and outdoor destinations should be reachable without compromising infection control or staff observation.
9. Support caregivers
Caregiver support includes family members and the professionals providing care. Respite areas give parents somewhere to pause without abandoning the unit. Staff workspaces should support visibility, bedside time and quick access to supplies while protecting confidential conversations.
Locate decentralized work points only after testing sightlines and noise. A workstation that improves documentation but removes visual awareness of a patient may create a different risk. Provide ergonomic seating, charging and storage where caregivers actually spend time, and define how those areas will be cleaned and maintained.
10. Connect children to social networks
Hospitalization can interrupt friendships, school and ordinary social groups. Plan for children to maintain those relationships through reliable technology connections and places for in-person activity when clinically appropriate.
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Technology spaces need privacy, acoustic control, power, device support and a clear policy for assistance. A school or activity room should be sized and equipped for the ages served, with access that does not expose children to unnecessary clinical traffic. Social connection should remain optional: some children will need quiet or protected contact rather than a busy communal room.
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11. Support population health
Pediatric facilities can connect healthcare with community life. Reserve appropriate space for community organizations and for educational, religious, safety and behavioral-health activities. These uses can support prevention and family education beyond a single episode of treatment.
Shared community functions require an access and governance plan. Decide which areas can operate after clinical hours, how visitors are screened, who provides supervision, and how events are separated from patient-care zones. A multipurpose room is a useful asset only when its booking, storage, cleaning and security responsibilities are assigned.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Turn the principles into a project brief
Use the following planning dimensions to convert the framework into testable requirements. They are lenses for comparing options, not a ranking of one layout over another.
| Planning dimension | Questions to resolve |
|---|---|
| Age and development | Which age groups and developmental abilities must the environment support, and where do their sensory or privacy needs differ? |
| Family presence | How long do caregivers stay, what caregiving tasks do they perform, and what sleep, storage, technology and learning support is required? |
| Privacy and social interaction | Where should children meet others, and where can a child or family withdraw for confidential or low-stimulation time? |
| Sensory conditions | How will daylight, acoustics, air quality, visual complexity and positive distraction be controlled for different needs? |
| Clinical acuity and flexibility | Which rooms must adapt to changing acuity, equipment and family size, and what infrastructure makes that possible? |
| Circulation and security | How are patient, visitor, staff and service routes separated, monitored and connected during routine and emergency conditions? |
| Staff visibility and workflow | Can staff see and reach patients, supplies and work points without creating noise, privacy or infection-control problems? |
| Indoor and outdoor access | Which activities need a protected outdoor setting, and how will supervision, weather, security and maintenance be handled? |
A practical design process
- Define the population and care model. Record ages, conditions, acuity range, expected length of stay, family patterns and community partnerships.
- Map real journeys. Trace arrival, care, family activity, staff work, supply delivery, waste removal and emergency movement on the same plan.
- Write room and space requirements. Specify occupants, equipment, clearances, storage, technology, sensory controls, cleaning method and privacy level for every room type.
- Test alternatives with users. Use full-scale or virtual mock-ups and walkthroughs with children’s clinicians, environmental services, facilities staff, caregivers and, where appropriate, young patients.
- Stress-test peak and exceptional conditions. Check sibling visits, a second caregiver, high-acuity equipment, isolation, nighttime operation, simultaneous arrivals and a security incident.
- Assign operational ownership. Identify who manages play materials, family kitchens, technology, community rooms, outdoor areas, storage and after-hours access.
- Verify compliance and maintainability. Reconcile the concept with local codes, accessibility, fire safety, safeguarding, infection prevention, engineering systems and cleaning procedures before design development.
What current evidence can—and cannot—establish
The 11 principles come from HDR’s 2016 professional article. They are useful prompts for decisions, but the article does not establish a pediatric outcome measure for each recommendation and does not replace current standards.
A 2026 systematic literature review in the Journal of Engineering, Design and Technology identified 169 design prescriptions organized under 12 emergency-department design principles after reviewing literature searched through July 2025. That figure describes the scope and organization of the review; it is not a measured patient outcome, and the review is about emergency departments generally rather than pediatric facilities specifically. It can provide adjacent context for built-environment discussions, but it should not be presented as validation of HDR’s eleven-part framework.
Quick Recap
Common planning mistakes to avoid
- Making “child-friendly” synonymous with theming. A welcoming environment also needs understandable circulation, privacy, acoustic control and robust maintenance.
- Adding family amenities late. Sleep, storage, laundry, kitchens and technology require space, infrastructure, cleaning and security decisions in the early brief.
- Designing only for the average patient. Include siblings, multiple caregivers, adolescents, children with sensory needs and changing acuity in scenario testing.
- Separating aesthetics from operations. Materials, play features and outdoor areas must be safe, cleanable, maintainable and compatible with infection-prevention procedures.
- Assuming flexibility without capacity. An adaptable room still needs the right medical gases, power, data, clearances, equipment parking and staffing model.
- Ignoring staff experience. Visibility, respite, supply access and efficient routes influence whether the planned environment can be operated as intended.
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