Ayesha Kadir MD Gonca Yilmaz MD, PhD

IntroductionWhat participation means, from the UNCRCArticle 12 and linked articlesThe ladder of participationBarriers to child participationThe benefits of participationWhat can we do as an health care professional?

General discussion and questions

Types Of Rights 54 Articles

Three types of rights Protection Provision Participation

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General Principles Underlying The UN Convention

Article 2 – all the rights in the Convention apply to all children without discrimination on any grounds

Article 3 – in all actions affecting children their best interests must be a primary consideration

Article 6 – all children have the right to life and optimal survival and development

Article 12 – all children, capable of expressing a view have the right to express that view freely and to have it taken seriously, including in judicial and administrative proceedings affecting the child, in accordance with their age and maturity

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Article12 CRC

Where should participation take place?

At hom

e

In scho

ol

In hospita

ls

In courts

In culture and the

arts

In play and

recreation

In local governmen

t

In conferenc

es

In governmen

t policy

In international forums

In local communitie

s

In other words, at all levels of society and in all settings

Child participation

Why does participation matter?

Article 5 implies that health care providers have both an obligation and an opportunity to:

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Participation and the realisation of rights

Participation

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Participation in practice

Alderson and Montgomery (1996) define four levels at which children can

participate;

1. Being informed 2. Expressing a view 3. Influencing a decision 4. Being the main decider

What do you feel are the barriers to greater participation by children in their own health care?

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Arguments against medical child participationChildren lack the competence or experience to

participation.

Adult’s instincts to protect children from distressing information.

İt will infringe upon the rights of parents.

Children’s rights is a Western concept being imposed on other countries.

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What are the barriers facing children?

Attitudes and assumptions

Physical environment

Lack of training and skills

Lack of confidence

Lack of funding

Failure to commit time

Lack of accessible transport

Right To Participation Frequently violated in

paediatric practice: Children often excluded Opinion/consent not

sought Good practice but rare

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At what age do you consider children to be competent to take responsibility for their own health care?

Why?

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Very young children taking decisions that affect their health, examples:Three-year-old Maisie was able to warn her mother

when she was feeling shaky from low blood sugar. Ruby at four years of age could be trusted not to

eat chocolates when her friend did and no adults were present, and by the age of five she was able to test her own blood sugar and decide how much cake she could eat.

Ahmet, a 8 year boy with acute lymphoblastic leukemia(ALL) was able to pay attention to his white blood cell count.

Jill, at 3 years of age, reminds her mother when it was time for her to take her HIV medicines

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What changes might be necessary in your practice or hospital to move toward a culture of greater respect for children’s participation in their own health care?

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Avoid talking over the child’s head: children get distressed when doctors talk directly to their parents without involving them.

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Give children the opportunity to ask questions and explore their concerns and deal with themhonestly and FULLY.

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A 10 year old boy is admitted to the hospital in the middle of the night and prescribed an intravenous infusion.

He refuses.

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A 20 month old boy is about to inhale medicine to expand the bronchi. The first inhalation goes fine, but the next he refuses.

What would you do as an health professional?

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Article 16 – the right to privacy and respect for confidentiality

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Develop policies on confidentiality.

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What about seeing a child on his- her own?

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Develop policies on consent to treatment.

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Medical consent to treatmentSome countries have introduced a fixed age

Age threshold

Combine system

Some countries adopt an approach that gives the parents a gradually decreasing role

No age treshhold21.04.23 29

Consultation Plan

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Child -young person

Waiting room

Communication with the child

Informing children about therapy

Provision of information

Informed consent

Advocacy

Resources Goldhagen, J., Waterston, T. Child Rights Training Programme – available

from ESSOP www.essop.org or: CHILD data set is available at http://www.europa.eu.int/comm/health/ph/programmes/monitor/fp_monitoring_20 00_frep_08_en.pdf .

Simonelli F and Guerreiro AIF (eds); Self-evaluation Model and Tool on the Respect of Children’s Rights in Hospital (2009) an d The respect of children’s rights in hospital: an initiative of the International Network on Health Promoting Hospitals and Health Services . Final Report on the implementation process of the Self-evaluation Model and Tool on the respect of children’s rights in hospital. January 2010, both available:

http://www.hphnet.org/index.php?option=com_content&view=article&id=1551% 3Ahp-for-children-a-adolescents-in-a-by-hospitals-&catid=20&Itemid=95

(last accessed on 23 November 2011) United Nations Children’s Fund. Convention on the rights of the child.

Available at: www.unicef.org/crc

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Cases1 Fatma is an 8- year old girl of an Egyptian family that

lives in Turkey. She is healthy and visited you for a child care visit. Family makes plans for their 8-year old girl to undergo female genital mutilation.

2 A 12 year old girl, Sue, with terminal acute lymphoblastic leukemia(ALL) refuses therapy and wants to go home.

3 A 14-year-old girl, Merry, visits your outpatient clinic. She is anorexic and looks exhausted. Family doesn’t want her hospitalization. When you are talking with her, you learn that she was inseminated by her uncle and became pregnant

4 A 10-year-old boy, Tim, develops enuresis nocturna. You performed all laboratory tests and diagnosed ‘depression’. You sent him with antidepressive drug to home.

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Case 1.Fatma is an 8- year old Egyptian girl, living in

Turkey. She is healthy and visited you for a pre-travel health care visit. While her vital signs were taken, the clinic nurse overheard Fatma’s older sister speaking about plans for Fatma to undergo female genital mutilation.

Which rights are at stake for the child and parent?

What would you do in this situation?21.04.23 33

Case 2.A 12 year old girl, Sue, with terminal acute

lymphoblastic leukemia(ALL) refuses therapy and wants to go home.

Which rights are at stake for the child and parent? What would you do in this stiuation?Who would you go for guidance?

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Case 3.A 14-year-old girl, Merry, visits your outpatient

clinic. She is very thin and tired appearing. And you are concerned about anorexia. You ask to her speak her alone and learn that she has been brought in by her father for medical care because she is pregnant. She tells you that her uncle is father.

Which rights are at stake for the child and parent? Which rights would you prioritize? Why? How would you resolve the potential conflict?

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Case 4.A 10-year-old boy, Tim, develops nocturnal

enuresis. After full evaluation, you diagnose him with ‘depression’ and prescribe antidepressant medication.

Which rights are at stake for the child and parent?

Which rights would you prioritize? Why? How would you resolve the potential conflict?

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Thank you!

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