Guide to children’s participation in decisions about their health  

Helping children express their views

Enabling children to express their views is a very important part of a decision-making process.

The ability of children to express their views and opinions can be influenced by many factors, including their age, capacities and maturity; whether they have or have not had any experience of participation either in health care or other relevant decision-making processes (at home, school or other); the extent to which they understand their situation; and how comfortable and engaged they feel within the decision-making process.

 

To support children in expressing their views, health care professionals should:

Build a trusting relationship to ensure mutual respect, both in the short- and long-term perspectives

Children are more likely to express their views when they trust the person they are talking to. To the extent possible, health care professionals should get to know the child and their personal needs and characteristics; and always be honest. Children may need to be reassured that their opinions and thoughts are important, even “small” concerns that may not seem important to the health professional.

 Consider children’s needs, including privacy and confidentiality issues that are important (but often neglected) for children and particularly relevant for older children.

Privacy is an important issue when working with children, especially when sharing or discussing information concerning their own health. Even with younger children, it may be important, or even necessary, to allocate time alone with the child to provide space for him or her to discuss whatever matters to them. It is critical to discuss confidentiality issues with children, at the outset and allow them time to ask questions. Access to confidential medical counselling and advice without parental authorisation should be ensured, irrespective of the child’s age, where this is needed for the child’s safety or well-being (for instance, in cases of suspected child abuse and maltreatment).

 Useful tips

  Make sure you introduce yourselves by name and talk to the child using their name.

  Support and invite the child to talk about to what extent they wish to participate, in what way and when.

  Ask if the child prefers to talk with you in the presence of parents or alone.

  Play  while talking. This helps reduce the stress of discussing difficult topics and helps speaking more freely.

  Practice both active questioning and active listening.

  Check that the child understands the information given.

 

  Ask the child what they think. This gives permission to express. Do not assume that a child will share thoughts voluntarily.

  Encourage the child to ask questions and reply.

  Avoid making judgements in all interactions.

  Allow more time for the child to think, if they want and need it.

  Respect a child’s silence while ensuring that the child has opportunities at later stages to express their views if they wish to do so.

  Take into account the child’s biological rhythm, tiredness and length of appointments.

 All healthcare professionals working with children must be trained, including on communication skills.

Training and practices should involve all team members and a continuum should be ensured, for example, with good communication between nurses, doctors or other professionals involved. 

In some national contexts, health workers with a specific training, such as health play specialists or Child Life specialists, positively reinforce teams, supporting children and families by using age and developmentally appropriate methods to help them better understand and cope with health care situations and treatments, and by being a learning resource for other health professionals to develop similar skills.

 The physical environment can also play an important role.

For example, ensuring that children can express their views in a private office or room or that there are no interruptions, such as a support or other professionals often coming into the office or room. For younger children, a more friendly environment can also help them to feel at ease (i.e. a room with toys, sitting down on the floor or other strategies).