Researchers have studied the positive effect of healing outdoor environments on hospitalized children, their family members and staff's health and mood. Consequently many modern hospitals dedicate portions of their space to healing outdoor environments. However, these amenities are underutilized due to various design barriers. This research aimed to identify barriers to garden visitation and introduce design guidelines that encourage garden visitation in pediatric hospitals for all groups. Five Texas pediatric hospital gardens were selected to examine the impact of availability of shade, quality and availability of seats, and presence of the healing nature on user satisfaction and garden use. Behavioral observation, surveys, interviews, and site evaluations were conducted. Gardens were ranked based on design qualities, user satisfaction, and frequency and duration of garden visitation. The primary conclusion of this study was that garden visitors' satisfaction with design is positively correlated with presence and quality of hypothesis variables. Duration and frequency of garden visitation also increased in gardens with better shading, seating options, and planting. Other factors identified as influential in increasing garden use included availability of amenities for children and playfulness of design layout. The research findings were instrumental in introducing new design guidelines for future hospital garden design projects. In addition, they served to statistically support design guidelines suggested by previous researchers.