[Quality and safe anesthesia for all children : That is their right!]

In 1989 the United Nations passed the "United Nations Convention on the Rights of the Child" (UNCRC) and, among others, demanded the highest attainable standard of health for children. Safe Anesthesia for Every Tot (SAFETOTS, www.safetots.org ), an association of internationally active pediatric anesthetists, has derived 10 rights, the 10 R's, which are of essential importance for the pediatric anesthetic practice. The first right (R1) postulates: "Children have the right to enjoy the highest possible standard of health. Children below the age of three years in particular should be treated by experienced anesthesiologists with profound and continuous training and regular activity in pediatric anesthesia. Children with significant comorbidities and those who need highly specialized or major interventions benefit from specialized pediatric anesthesia in pediatric centers". The current situation in pediatric anesthesia care in Germany, Austria and Switzerland does not always meet the requirements demanded by the UNCRC. Anesthesia-related complications are approximately 10 times more frequent in children than in adults. In contrast to adults, children who are injured during anesthesia are often healthy. Severe complications in pediatric anesthesia have a mortality that is several times higher than in adult anesthesia. There are hardly any statistics on this for German-speaking countries but corresponding cases frequently occur in the context of expert opinions in liability litigation and in the press. Anesthesiologists are often charged with the anesthetic care of newborns, infants and small children without having sufficient child-specific expertise, which results in morbidity and mortality. In some places, only a few babies per year undergo general anesthesia in clinics without a specialized pediatric anesthesia team or a small number of infant anesthesia cases are divided among a large number of anesthesiologists. These case numbers are not even sufficient to maintain a single pediatric anesthesiologist in training in this age group.Changes are needed to guarantee children the right to enjoy the highest attainable standard of health. We need decision-makers, politicians and professional representatives who rethink and who are willing to implement the UNCRC. This includes changing the current financing of hospitals in order that the quality actually provided is financed. The "pay for performance" must change to "pay for quality". In addition to broad basic pediatric care, all complex forms of pediatric treatment must be carried out in specialized pediatric centers, particularly for small and severely ill children.Significant improvement can be achieved at the local level by reorganization, bundling of pediatric surgical interventions within a clinical unit together with the concentration on a dedicated team.