There is a myth we tell ourselves—that children are too young to understand, too innocent to weigh in, too fragile to face the truth. So we speak around them. Over them. For them. We choose their treatments, their surgeries, their silences. All with love. All with care. And yet—sometimes, with too little trust.
But children, even the smallest ones, live deep inner lives. They feel things fiercely. They know when something is wrong. They listen when we think they are distracted. They wonder. They fear. They hope. And yes—they have opinions.
Respectful involvement of children in medical decision-making is not about giving them adult burdens. It’s about giving them the dignity of being seen.
A diagnosis may be written in a chart, but it lives in a body—a child’s body. A body that will feel the pokes and prods, the surgeries and side effects, the long hospital stays. And within that body is a mind asking questions: What’s happening to me? Why can’t I go to school? Will this hurt? Will I get better?
To ignore these questions—or worse, to pretend they don’t exist—is to silence the very person we’re trying to help.
Involving children respectfully does not mean giving them the final say. It means giving them a say. It means listening. It means explaining things in ways they can understand. It means inviting their perspective, even if the decision ultimately rests with adults.
A five-year-old may not grasp the mechanics of chemotherapy, but they know what it means to lose their hair. A ten-year-old may not weigh risk like a doctor, but they can tell you what they’re afraid of. A teenager—so often caught between adult expectations and child protection—may understand far more than we think, and feel more isolated than we know.
Respect begins with asking:
— “What have you been told about what’s going on?”
— “What do you think will happen?”
— “What worries you?”
— “What would make this easier for you?”
And then, the hardest part—listening without rushing to fix.
When we include children in conversations about their care, we offer more than information—we offer trust. We help them build agency, resilience, and self-respect. We teach them that their voice matters, even when life feels out of control.
And yet, there is a tenderness in knowing when not to say everything. Some children don’t want to know. Some ask, then withdraw. Some need more time. Respectful involvement is not a script—it is a relationship. It is shaped by culture, personality, trauma, and time. It is an ongoing conversation, not a single moment of consent.
Clinicians must walk this line with humility. Parents must be supported, not judged. And children must be offered space—space to speak, to not speak, to change their mind, to be messy, to be afraid.
Especially in chronic or terminal illness, involving children becomes sacred work. Not because we expect them to carry the weight of final decisions—but because they are the ones living them. And sometimes, a child can show more wisdom in five words than a room full of adults. “I just want to go home.” “Will you be with me?” “I don’t want another needle today.” These are not just requests—they are truths.
To respect a child in medicine is to recognize their unfolding self. To say: You are not invisible. Your fear matters. Your voice counts. And in doing so, we help them carry not only their diagnosis—but their dignity.
This is not just about ethics. It is about love that listens.
So may we learn to speak honestly, kindly, bravely with our children.
May we help them understand, without overwhelming.
May we teach them that their body is theirs, and their thoughts are welcome.
May we create a world where small voices are not hushed, but honored.
And in that world, may children learn—early and often—that even in the hardest moments, they are seen, they are heard, and they are never alone.