When children are involved in decisions about their health
In modern pediatric practice, it is becoming increasingly evident that the quality of care depends not only on diagnosis or treatment, but also on how the child is involved in decisions that affect his or her body and well-being. Listening to them, informing them and allowing them to participate is not a gesture of courtesy, but a clinical, ethical and emotional necessity that strengthens trust, improves therapeutic adherence and reduces anxiety. Understanding the child as an active subject of his or her own health process is a decisive step towards truly humanized care.
The Convention on the Rights of the Child, adopted by the United Nations in 1989, enshrines the child's right to be heard and to have his or her views taken into account in accordance with his or her age and maturity. This principle, known as the right to participation, is not limited to school or social life: it also extends to the health field. Allowing a child or adolescent to intervene in decisions about his or her health means recognizing him or her as a person with a progressive capacity to understand, give opinions and make decisions. This does not imply transferring adult responsibility, but accompanying their process of understanding and autonomy with empathy and accessible language.
Studies in pediatric psychology show that when children are actively involved in choosing tests or treatments, they experience less anxiety and a greater sense of control. That sense of control contributes to their emotional and physical well-being, and has a direct impact on treatment adherence. In other words, the child who understands what is happening to him and feels that his opinion matters cooperates better, recovers more serenely and develops a positive attitude toward medical care.
In the clinical setting, three concepts are used that must be understood in a complementary manner: parental permission, child assent and mature adolescent consent. Parental permission is the legal authorization given by the representatives. Assent, on the other hand, is the affirmative agreement of the child, depending on his or her degree of understanding. It is not a signature on a piece of paper, but a process of dialogue in which the physician explains, answers questions and validates the child's understanding. Finally, consent is applied when the adolescent demonstrates sufficient maturity to understand the implications of his or her decision and can assume it responsibly. This scheme seeks to balance respect for family authority with the progressive autonomy of the minor.
The role of the pediatrician and the healthcare team is essential for this participation to be real. It involves talking to the child in a language he/she can understand, using visual aids or everyday examples, and allowing him/her to express doubts or fears. It is not enough to explain: it is necessary to verify understanding, give space for questions and offer alternatives whenever possible. Participation should be gradual and adapted to age: in preschoolers it can focus on simple choices («do you want me to listen to your chest or your back first?»); in schoolchildren, on concrete decisions and more detailed explanations; and in adolescents, on conversations where they can become involved in an informed and responsible way.
When the child feels that his or her voice counts, the dynamics of the therapeutic relationship change. They are no longer «obedient patients», but active participants in their own care process. This approach strengthens the alliance between doctor, patient and family, favors communication and reduces conflicts arising from fear or misunderstanding. In addition, it prepares children for self-management of their health in adult life, an essential learning in times when medical information is available to all, but critical understanding remains a challenge.
Respecting children's right to participate in decisions about their health is a concrete way to promote their overall well-being. It involves recognizing that they are capable of thinking, questioning and deciding within the limits of their maturity. Every consultation conversation can be transformed into an educational, emotional and ethical opportunity to teach them how to take care of themselves. Listening to them is not only a professional duty: it is a way to build confidence, alleviate fears and prepare citizens who are more aware and responsible for their own bodies.
Today's pediatrics is not only measured in technological advances, but also in the ability of professionals and families to listen and accompany with respect. Allowing children to participate in the decisions that concern them is to lay the foundations for a more solid emotional health and a more empathetic society. Caring for them also means giving them a voice. This is the medicine that heals and teaches: the one that turns each consultation into a space of trust, dialogue and shared growth.