Despite a persistently sluggish environment for hospital capital improvements, children’s projects—from new-build facilities to renovated units—continue to color the healthcare landscape. And while not immune to the industry’s belt-tightening, there’s one unique force that gives them an extra push: philanthropy.

“What’s fueling pediatric projects is the successful ability to raise funds and enact fundraising projects,” says J. Patrick Schultz, director of EwingCole’s Washington, D.C., healthcare practice. “While hospital budgets remain tight, major donors and benefactors will always find a way to donate for children’s facilities.”

And once those funds are in place, the rest all comes down to demand.

Andrew Quirk, senior vice president and national director, Healthcare Center of Excellence, Skanska USA Building (Nashville), says the pediatric population remains underserved in many areas, meaning there’s plenty of opportunity out there for hospitals and health systems willing to dip their toes into the market.

“There are pockets of children’s networks or hospitals around the United States that have a national name or a national brand, but there really haven’t been too many hospitals dedicated to the needs of younger populations,” he says.

While many of these facilities, both existing and planned, are within densely populated urban areas, designers note that projects are moving out to suburbs or even rural areas as pediatric care, like healthcare in general, shifts toward offering more convenient patient access through an ambulatory-based system.

Also influencing growth are advancements in the treatment of certain childhood-onset diseases, like cystic fibrosis, congenital heart disease, or sickle cell anemia—meaning that children who once had a dire health outlook are now able to manage their illness into young adulthood and beyond, says Scott Davis, associate, Hord Coplan Macht (Baltimore).

Because adult practitioners may lack the expertise that pediatricians have in dealing with these conditions, the 5-year-old patient of today may very well be visiting the same facility on into his or her 20s. “We’ve seen that as a big area of growth,” Davis says. “That has a lot of influence on design methodology, because you’re no longer dealing with a primarily infant population. You may be dealing with young adults in the same spaces.” Demand for services is also increasing as more and more children are diagnosed with other chronic conditions, like asthma, diabetes, and obesity.

To get a foothold in the competitive market, facilities are looking to designers to create family-friendly spaces that appeal to young and old, and complement treatment spaces with plenty of amenities and distractions.


Broadening appeal
Just a decade ago, children’s hospitals and pediatric units were rife with primary colors, geometric shapes, and cartoon characters. But all too soon, what had been a great approach for the young patient population became an obvious design miss for just about everyone else who entered these spaces.

When FKP designed an expansion at Nationwide Children’s Hospital in Columbus, Ohio, which was completed in 2012, the team consulted with museum designers Ralph Appelbaum Associates (New York) for a new perspective on how to create a space that would be engaging rather than childish. “It gave the campus a fresh transformation from 10 years ago, when the onset of bright colors became so stimulating. Now you’re seeing another trend evolve with a fresh and timeless feel to it, to really appeal to all ages—and not just through colors and shapes,” says Kristin Ledet, practice leader, FKP Interiors (Houston).

Davis says finding themes and branding concepts that involve elements like nature, wonder, or education are widely accepted as alternatives to more infantile approaches. “Definitely, technology is a major tool to increase appeal to all ages, bringing in video-gaming, large-scale television monitors, and enriched play areas,” he says.

At the Herman & Walter Samuelson Children’s Hospital at Sinai in Baltimore, completed in March 2012, Davis says colors were carefully considered, too. “We used vibrant colors in limited areas to define wayfinding and help comfort patients without using it throughout, keeping the space open and airy, and allowing lots of natural light to come in,” he says.

Beyond the need to design for various patient ages, children’s projects bring with them an inherent design challenge as some families essentially “move in” during the course of a child’s treatment. “They use every amenity at that facility, so you really need an attention to detail throughout the whole hospital, not just in the patient room,” Ledet says, adding that depending on their level of acuteness, patients, too, may be exploring the facility to seek out fresh air or play areas.

As for those all-important amenities, designers recommend everything from coffee shops and food pantries to family lounges and laundry facilities. “It’s a much different application than you might see in an adult unit,” Davis says.

“People are really taking their community experiences and are bringing them into the hospital and integrating them,” Ledet agrees, “because that’s what families are used to having at their fingertips.”

And designers say it’s not just feedback from family advisory groups pushing these trends: The clients, too, are thoughtfully seeking out family-centered design and recognizing its place within the evidence-based design landscape. “With all of our new clients, those are the three words we get asked about all the time: How will our designs respond to evidence-based design?” says Gary Owens, principal and senior project designer, FKP Architects (Houston).


The expanding patient room
While it’s important to create spaces throughout a children’s hospital or unit with an eye toward family-centered design, Davis says it’s also critical to recognize the family’s role in the caregiving process and plan areas that support this inside the patient room. Dedicated family zones should include places to sleep, work, and eat—with plenty of privacy when needed.

Thoughtful touches include storage for luggage, lockable drawers for personal electronics, controls for lighting and entertainment, and flexible seating to allow for in-room family dining. “All of these amenities cater to family and build the family unit, bringing them into the decision-making process,” Davis says.

For the Sinai project, Hord Coplan Macht consulted with a family advisory group to help shape the design, with patient room mockups used to identify ideal placement for headwalls, footwalls, and casework configurations.

However, once family zones are created and space is allocated for caregivers and physicians, modern pediatric patient and treatment rooms become a bit larger than what’s been seen before, Schultz says. “To provide for that kind of appropriate caregiver and family area, we’re noticing that neonatal intensive care units, pediatric intensive care units, or just basic pediatric acute care rooms are increasing in size, anywhere between 280 square feet and 300 squa
re feet, and sometimes that’s a challenge,” he says.

While size increases are more easily accommodated in new projects or major renovations/additions, conflicts do arise in aging facilities, usually those predating the 1980s, where there’s less flexibility in the structural grid.

Though the patient room footprint is ever-expanding to support visitors and staff, Schultz says at the end of the day, it needs to be a space that’s focused on the patient. “A pediatric hospital room should really feel like a bedroom. Patients want to bring personal items from home to soften the edges, and there should be unobtrusive shelving for photos and favorite toys,” he says, adding that technology from flat-screen TVs to gaming systems are beneficial distractions. “When a child is sick or being treated, there’s still a need for play to make it fun.”


Market differentiation
With technology playing a more critical role throughout hospitals—from in-room entertainment options to hybrid operating rooms to electronic health records—and services/retail options becoming an expected norm rather than a nice perk, Quirk says that a keen focus on modernization in design strategies is paramount for differentiation.

“It really is all about innovation and the amenities you offer. The families or patients who are going through treatment want new and attractive spaces that would draw them to Facility A instead of Facility B,” he says.

While there’s been a recognizable thread shared by the children’s projects FKP has taken on over the years, Owens says that for each one, there’s an architectural solution that set it apart from the others—something he finds unique to the niche, as children’s hospitals find creative approaches to capturing market share. “It’s really driven by the aspirations and the vision of each institution’s leadership. They’re not all the same, and they don’t want to be the same,” he says.  

Jennifer Kovacs Silvis is managing editor of Healthcare Design. She can be reached at


ONLINE EXCLUSIVE: 5 design strategies to create competitive children’s facilities
In the highly competitive pediatric market, five healthcare design pros were asked what “must-haves” should be considered when planning a new treatment space. Find out what they said at www.healthcaredesign 

Additional children’s facility projects featured recently in Healthcare Design:

  • Nemours Children’s Hospital, Orlando, Fla.—Nemours Children’s Hospital recreates the garden grounds of its Delaware sister hospital while taking a fresh approach to care delivery and design.
  • Cook Children’s Medical Center, Fort Worth, Texas—The NICU at Cook Children’s Medical Center not only brings improved care to infants in central Texas, it provides insight into the benefits of private-room settings, family-centric amenities, and designing with staff needs in mind.