Family Presence Policies in Pediatric Intensive Care Units

Importance Family presence supports critically ill children, yet pediatric intensive care unit (PICU) policies remain inconsistent, creating inequities in access to parents or caregivers. Clear guidance is needed to support equitable, child-centered policy development. Objective To generate evidence-informed and knowledge user–informed recommendations for family presence policies in PICUs. Design, Setting, and Participants This survey study, conducted through surveys and virtual meetings, used a modified Delphi consensus process. Candidate items were derived from family presence guidance documents and PICU family presence research (environmental scan; scoping review; surveys and interviews with patients, families, and health care professionals; and focus groups). Items were organized into themes covering policy priorities; policy-making responsibilities; baseline and emergency policies; and policy communication, enforcement, and revision. From February 2024 to February 2025, panelists completed 2 rating rounds and 1 virtual meeting, with follow-up meetings and member-checking to incorporate input across knowledge user groups. Knowledge users included former PICU patients, family members, clinicians, and policymakers (hospital and PICU administrators and infection prevention and control specialists) from across Canada. Main Outcomes and Measures The main outcome was consensus-derived policy priorities and recommendations for PICU family presence during baseline operations and emergency situations. Results Forty-three knowledge users, including 5 patients, 12 family members, 21 clinicians, and 5 policymakers (35 self-reported women or girls [81.4%]), agreed on 10 policy priorities and 44 recommendations. Key messages included that children should be at the center of policy-related decision-making and always have access to at least 2 primary caregivers; families should determine sibling presence and assume responsibility for it; policies should recognize the importance of visitors beyond family for the child’s well-being; and policies should be flexible, adapting to different situations while adhering to core priorities. Recommendations addressed who should make policies; communication, enforcement, and change processes; number, type (eg, parents or caregivers, siblings, and visitors), and timing of bedside presence; family movement and supports; and approaches to personal protective equipment and infectious symptoms to preserve family presence, including during emergencies. Conclusions and Relevance This survey study with consensus-based recommendations for PICU family presence provided a framework for policy design in routine and emergency contexts. The recommendations emphasized the patient’s best interest and continued access to at least 2 primary caregivers. They supported context-specific and unit-specific policy design and may be broadly applicable across children’s hospitals.