Factors That Impact Child Visiting in Adult Critical Care Settings—A Critical Literature Review

Background

Admission to adult critical care is highly stressful for patients and families. Regular visitation is associated with reduced delirium, improved satisfaction and lower anxiety among relatives. However, UK visiting policies remain inconsistent, with child visitors often restricted due to concerns about noise, supervision and infection risks.

Aims

To examine factors influencing children visiting relatives in adult critical care, their psychological and emotional impacts, and the evidence underpinning current practices to inform UK guidance.

Study Design

A critical literature review appraised English-language, primary research studies (2010–2026) from CINAHL Complete and MEDLINE. Quantitative and qualitative studies involving children, adolescents, adults and healthcare professionals were included. Data were independently extracted by two researchers, appraised using the Mixed Methods Appraisal Tool (MMAT) and synthesised using descriptive, thematic analysis.

Results

Eleven studies from the United Kingdom, the United States and Europe met inclusion criteria, including qualitative, survey, observational and quasi-experimental designs. Methodological quality was moderate to high; however, non-probability single-site samples, limited control of confounding, small sample sizes and wide age ranges in child participants require cautious interpretation. Nurses frequently acted as gatekeepers, with visiting decisions often shaped more by personal beliefs than by evidence, although higher educational attainment was associated with more supportive attitudes towards child visiting. Parents sometimes withheld information to protect children; however, children generally wished to be included and reported less distress and greater self-esteem following supported visits. Preparation and follow-up helped make the critical care environment less frightening and more comprehensible.

Conclusions

Supported child visiting appears beneficial and aligns with rights-based, family-centred care. Persistent barriers underline the need for evidence-based policy and implementation.

Relevance to Clinical Practice

UK critical care services should develop child-centred visiting policies, implement structured visitor care plans, update the Step Competency Framework, and integrate child specialists into care delivery.

Impact Statements

What is known about the topic

Child visiting in adult critical care is inconsistent and is often shaped by nurses' beliefs, institutional culture and parental protection, despite evidence that supported visits can reduce children's anxiety and improve understanding.

What this paper adds

This review highlights persistent barriers, clarifies the gatekeeping role of nurses, strengthens rights‐based arguments for inclusion and identifies practical priorities for policy, education and care planning.