Final Report > Chapter 29: The Care of Children > The priority given to children's healthcare services > The healthcare needs of children and young people are different from those of adults

The healthcare needs of children and young people are different from those of adults

15 We start with what seems to be a difficulty on the part of policy-makers and health service managers fully and consistently to accept or acknowledge that the healthcare needs of children and young people are different from those of adults. It seems so obvious that it hardly needs to be said: just as children differ from adults in terms of their physiological, psychological, intellectual and emotional development, so they differ in their healthcare needs. They experience and see the world differently. Children are in a constant state of growth and development which creates particular needs and demands which are of a different order from those affecting adult patients. Their relative physical and emotional immaturity, in comparison with adults, has implications for both the treatment which they receive and the physical environment in which they are cared for. Children communicate their thoughts and feelings in a very different way from adults. Effective communication with children as patients (often through a combination of play, one-to-one interaction, and by communication with parents) is seen by professionals involved in paediatric healthcare as crucial to the child's physical and psychological wellbeing. Thus the ability of staff to care appropriately for children is crucial. Skills, understanding and knowledge are required which are different from those of staff who mostly care for adults.

16 There is still a continuing lack of recognition of the need for the holistic, child-centred approach to the care and treatment of children which has been advocated for the past 40 years. Liz Jenkins, Assistant General Secretary of the RCN, told the Inquiry:

`... I do think that the majority of adult qualified nurses and doctors see children as small adults, who simply need smaller beds and smaller portions of food. They do not see them as a client group that have wholly different needs.' [12]

17 Children's needs are ordinarily expressed through their parents, who are usually the primary providers of their care. But there are also important differences between children and their families. Their interests do not always coincide. Equally, children are different at various stages of development: infancy, childhood and adolescence. Thus, although as a group they are different from adults, children and young people cannot be seen as a homogeneous group. In short, a child-centred approach to healthcare is complex.

18 Of the many examples of the complexities of caring for children with their parents we mention just one here: the issue of obtaining consent to treatment. As is well known, the role of a child who is to be treated in the process of gaining consent to that treatment is problematic. As children grow towards maturity, they achieve greater control over what can be done. But until the child reaches adulthood at 18, the law places certain limits, at least on what can be refused, if a parent decides otherwise. We do not wish to review this exceedingly complex area here. We do, however, wish to make some observations. In the case of a baby or young child, there is no question of the child giving or withholding consent. It is the parent who must do so. This is a very heavy burden to bear, particularly when the child is seriously ill. Asking parents' to give their consent on behalf of their child is of a different order than asking them to give their consent for themselves. There will always be agonies of doubt and, if events turn out badly, of self-recrimination. For this reason, the principles which we set down earlier, in Chapter 23 on Respect and Honesty, must be scrupulously observed. Consent by a parent is quintessentially a process. It has little to do with putting a signature on a form, and everything to do with being taken along a journey of information, advice and support which equips the parent as much as possible to make the necessary decision. Nor can there be any justification for holding information back, however well intentioned the motive. This is because it is the parent's responsibility to make a decision which is in the child's best interests. That responsibility falls (and weighs heavily) on the parent, not the doctor, the nurse, or anyone else. To carry out this responsibility the parent therefore needs the fullest possible account of what is proposed, the alternatives, the risks and the possible outcomes. Once informed, of course, the parent may ask for help and should be supported. This is what is meant by the principles of respect and honesty which we referred to earlier. And on this theme of respect, we add one final point. A child may not be sufficiently mature to give consent, but may be able to participate to a degree in the process. All those caring for the child must be alert to this and must involve the child to the extent compatible with the child's capacity to comprehend what is involved.

Footnotes

[12] T34 p.33 Mrs Jenkins