Ruthlyn James | When healing environments harm - Rethinking hospital care for neurodivergent children 

At the Bustamante Hospital for Children, there is an opportunity for Jamaica to be a regional leader, to redefine how Jamaica understands paediatric care within a nation that has already committed, both legally and ethically, to the principles of inclusion. It requires rethinking how care is experienced by children whose needs extend beyond what is immediately visible.

Jamaica is a signatory to the United Nations Convention on the Rights of Persons with Disabilities and has enacted the Disabilities Act. These establish a clear national obligation to ensure that persons with disabilities, including children, receive equitable, appropriate and dignified healthcare. This mandate extends across the public health system, including institutions governed by the Ministry of Health and Wellness. The expectation, therefore, is not access alone, but quality of care.

The Bustamante Hospital for Children manages thousands of admissions annually. Increasingly, these admissions reflect not only acute illnesses, but a growing presence of neurological and developmental conditions requiring more nuanced and responsive care approaches.

At a national level, available data suggests that approximately 4 to 6 per cent of Jamaica’s population lives with a disability, with a meaningful proportion identified in childhood. While hospital data is not consistently disaggregated to reflect this population, clinical experience across Jamaica strongly indicates that these children are disproportionately represented in paediatric admissions, not because they are inherently more ill, but because their needs are layered and complex.

A child may be admitted for gastroenteritis, another for asthma complications, and a third for seizure activity. These are standard paediatric presentations. However, for a child diagnosed with autism spectrum disorder or related neurodevelopmental conditions, the clinical picture extends far beyond the presenting illness. There is often a second layer of complexity in the form of comorbidity, where multiple conditions exist simultaneously and interact in ways that influence both behaviour and medical response.

OVERLAPPING CONDITIONS

Many neurodivergent children present with overlapping conditions such as epilepsy, anxiety disorders, sensory regulation challenges and gastrointestinal disturbances. These are not isolated experiences but interconnected realities. Neurological instability may heighten sensory sensitivity, anxiety may intensify behavioural responses, and physical discomfort may present as agitation or withdrawal. The body and brain are in constant communication, and any disruption in one system inevitably affects the other. This integrated understanding is critical when considering how care is delivered in hospital environments.

When such a child is placed within a typical hospital setting, the environment itself becomes harmful and a trigger. Bright fluorescent lighting, continuous television noise intended to comfort other patients, and the unpredictability of alarms, staff movement and physical touch all contribute to a heightened sensory load. These are not neutral environmental features. For a neurodivergent child, they escalate distress rather than support recovery.

For a neurotypical child, these conditions may be uncomfortable but manageable. For a dysregulated brain, however, they can be profoundly destabilising. When overwhelmed, the nervous system may enter a state of crisis, and the child may appear confused, disoriented, or unresponsive. They may engage in repetitive or intense behaviours, withdraw from interaction, or seem unreachable. These responses are not acts of defiance but indicators of neurological distress.

The distinction is critical. Misinterpreting dysregulation as behavioural resistance can lead to inappropriate responses, including unnecessary sedation, restraint, or delays in care. International research has consistently shown that children with developmental disabilities experience longer hospital stays, increased behavioural incidents, and higher rates of pharmacological intervention. Importantly, these outcomes are often linked, not to the severity of the medical condition, but to environmental and communication issues. Extended hospital stays and reliance on sedation are not only clinical concerns. They place additional strain on an already burdened healthcare system.

UNIQUELY POISED

The Bustamante Hospital for Children is uniquely positioned to shift paediatric healthcare by recognising that inclusion within hospital spaces is not simply about admission. It is about designing care environments that align with how children’s brains function. This does not require unattainable resources, but rather a change in perspective and design. A national protocol for neurodevelopmentally informed paediatric care is now required, beginning with our children’s hospital as a pilot site.

Practical adjustments can have significant impact. These include the introduction of sensory regulation treatment rooms within wards, the use of adjustable lighting rather than constant fluorescent exposure, the creation of holistic regulation for recovery, the implementation of structured visual aids and technology supports for communication and targeted staff training to distinguish between a meltdown and a tantrum. These interventions are not luxuries; they are clinical necessities for many children within our healthcare system. Jamaica already possesses the policy framework required to support this transformation. The Disabilities Act mandates equitable access and that the Ministry of Health and Wellness establish national standards for care delivery. 

Across the island, there are emerging models of holistic, sensory-informed environments that demonstrate how balance can be achieved between stimulation and regulation, between treatment and emotional safety, and between clinical care and human dignity. These models illustrate a fundamental truth. When the environment supports the brain, the child is better able to access care. Without that support, care becomes a struggle rather than a pathway to healing. This calls for more collaboration and conversation of stakeholders, as parents are overwhelmed.

It is important that healthcare extends beyond access. It must shape experience, influence outcomes and safeguard our children’s dignity. The measure of a healthcare system lies in its capacity to understand the person experiencing any illness. For many neurodivergent children, that understanding will determine whether hospitalisation becomes a pathway to recovery or a point of further harm.

Ruthlyn James is the founding director of Adonijah Group of Schools Therapy and Assessment Centre. Send feedback to columns@gleanerjm.com