Children making their own medical decisions.

[elliejjtiny]

Just wondering when this happens? I thought it was 14-16 or so but yesterday I overheard staff at the hospital trying to persuade a little girl who was about 7ish to have treatment that she didn't want. They ended up going home, with the little girl adamant that she wasn't coming back ever (I wasn't trying to be nosy but she was understandably quite loud in her objections).

It made me worry about my 4 year old who has had multiple medical procedures, operations and general anaesthetics. At the moment I hold him down when he objects and it gets done. When do they start to take his views into account and would I be able to over rule him if we disagree? Or would we have to wait until he got too ill to object and do the procedure as an emergency with more risks involved? Obviously I don't want to make him have this stuff done to him but given the choice of having it done as an elective and having it done when he has got really ill and it's an emergency I would choose the elective option as it's safer for him. He wouldn't be able to understand that though and I can't imagine he would for a long time, I don't think my 11 year old would be capable either.

When they try and persuade young children to agree to medical procedures are they just trying to make the child feel like they have a say but with parents making the decision in the end? I hope so. I've had an operation done without my consent before as an adult so I know what it's like but sometimes parents see the bigger picture. My 4 year old just wouldn't understand why he needs these things doing.

I think though it might depend on how vital and urgent the treatment is.
For example when ds was small I had to hold him while he had a blood test for potential meningitis, and they never gave an option.
With dd2 who was about 8yo they advised a blood test to check cause of tummy aches and she refused so they just said they wouldn't do it at that time.
It was a pain of the neck because when we realised it was necessary she objected strongly saying she'd been told it was her decision.

When my DD was about 10 she had to have a bloody test.
The nurse said she could do it with only my permission but she couldn't hold her immobile and only I could do that.
Now DD is 12 according to my GP the " Gillick competency" rule applies and she may be able to withdraw consent even if I give it

There should be counselling and play therapy available to help with this. Obviously at 4 you can restrain, but you can't restrain a 10 year old. It depends how important the procedure is, there are also medicines to help relax uncooperative children.

My understanding is that just because your child is Gillick Competent to decide to refuse a blood test to discover what blood group they are (for example) doesn't mean they would be deemed competent to decide on more serious things.

I was told that my DD could refuse the HPV jab even though I had given consent- seems logical as I don't see how they would make her. Equally if I didn't give consent she still could
Vaccinations aren't life or death though

Thankyou. He has hydrocephalus which means he sometimes needs fluid drained from the ventricles in his brain. He has it done every 3 months at the moment. It's not an emergency when he has it done but it would become an emergency later. He will need a lot of orthodontic work done later as well, braces and surgery. Now I think of it I remember refusing to have braces on my teeth when I was about 12 and the dentist saying it was my decision. My mum wasn't happy about it.

This area is legally complex and parents attitudes are making it even more so. i know of several colleagues who have had complaints from parents about administering anaesthesia to uncooperative children. This means that many of us are now much more cautious that we used to be. Staff have been accused of assaulting children etc.

The legal position is here: www.medicalprotection.org/uk/resources/factsheets/england/england-factsheets/uk-eng-consent-children-and-young-people

In addition some parents don't help the situation by not preparing their children for a procedure or ever telling them in advance at all (kids in party dresses for dental extractions are not unusual). And some manage to transmit their own fears about anaesthesia to their kids. Many many parents however do a fantastic job and I have read all that you have done previously to help your boy.

I also find that some parents are unrealistic about what is involved in having an anaesthetic - children need to either have a cannula put in to administer drugs through or have a face mask held tightly on their face. I am highly skilled at making both of those a palatable/ pleasant option but I don't have a magic wand nor access to special drugs that render either unnecessary.... I would also say that in older children it is often much easier to put a cannula in the local anaesthetic cream is brilliant and having a face mask held on can be pretty unpleasant and is not the soft fluffy option that most parents assume it to be. For any sensible distractible child of mine older than 4 I would always choose an IV induction.

If I have freaked anyone out or if you coincidentally have children needing a GA increasingly hospitals will have a video about what to expect on youtube designed for children, and the Royal College of Anaesthetists has storybook leaflets designed to be read with children to help talk them through what is going to happen.

Example of prep. video (not from my hospital)

anaesthetic cream is brilliant although ds is quite badly allergic to it so the swelling up tends to be a bit of a problem. Luckily he's very good about taking it without.

The GMC consent guidelines were written with due consideration of Galicia/Fraser. For medical consent to be legal it must be informed and the person must have capacity/be competent to understand and retain information about the procedure, the risks, the benefits and any alternative.
Sixteen is where there is always an assumption the child has is competent and they sign their n consent unless they are perhaps unconscious or have significant SEN and cannot consent. In that case a parent may give consent until they reach 18 years of age. After that there needs to be formal recording of capacity assessment and a best interest decision or referral to Court of Protection.
Under 16 a child may consent if they are competent to do so but the doctor must encourage them to involve their parents. This is particularly important in sexual health ToP services where they might present alone initially. If the continue to refuse parental involvement the doctor can treat and maintain confidentiality.
In truth most children's services involve parents unless the child specifically asks them not to be and most consent forms require parental signature but have space for a child's signature too.
The decision to uphold the children's consent or refusal of consent in the face of parental conflicting view is complex and may need to go to CoP if it can't be resolved through good communication. The more complex the treatment and the younger the child, the greater the onus on medical staff to seek parental consent.
Over 18 nobody can give consent on your behalf. Either you have capacity or there must be a best interest decision. A husband cannot consent for a wife, for example.

@elliejjtiny does he just have hydro or are their other issues at play that could effect his mental capacity? (That has a huge bearing on it)

Just wondering when this happens?

It depends on the child, the medical condition and the understanding of the child both of the treatment and the consequences.

What you are forgetting is that you and or a hospital can also take the case to court if you are ever in the position of him refusing but it being in his best interests to precede with treatment.

|Back i the 1970s my cousins were staying with us and boy cousin fell out of a tree and broke his wrist.

He was taken to the local hospital who wanted to use anesthetic to set it but needed his mother's position. His mother was miles away and unable to get there, she could speak on the phone, my parents were there but only his mother could give permission and that had to be in writing.

They set it with out anesthetic.

Things are so much better now.

Thankyou. He has global development delay and is about 2 years behind his actual age.

opinionated that video is great, thankyou. I've spent so much time trying to decide between gas and cannula anaesthetic. I think the magic cream would upset him as it's a constant reminder of what's coming. We've got a mask and a cannula to play with at home and he screams whenever he sees the cannula. I've tried cannulating his teddy bear but that really upsets him. He's a bit better with the mask. I agree with you though, neither is a fluffy option.

My advice would be to speak to person on the day.
I know what I can achieve with both methods and there are so many variables to involve.
Some kids definitely get scared by the "magic cream" whereas others love to watch!!