0–18 years: guidance for all doctors

Communication

14

Effective communication between doctors and children and young people is essential to the provision of good care. You should find out what children, young people and their parents want and need to know, what issues are important to them, and what opinions or fears they have about their health or treatment. In particular you should:

  1. involve children and young people in discussions about their care
  2. be honest and open with them and their parents, while respecting confidentiality
  3. listen to and respect their views about their health, and respond to their concerns and preferences
  4. explain things using language or other forms of communication they can understand
  5. consider how you and they use non-verbal communication, and the surroundings in which you meet them
  6. give them opportunities to ask questions, and answer these honestly and to the best of your ability
  7. do all you can to make open and truthful discussion possible, taking into account that this can be helped or hindered by the involvement of parents or other people
  8. give them the same time and respect that you would give to adult patients.
15

You should make it clear that you are available to see children and young people on their own if that is what they want. You should avoid giving the impression (whether directly, through reception staff or in any other way) that they cannot access services without a parent. You should think carefully about the effect the presence of a chaperone5 can have. Their presence can deter young people from being frank and from asking for help.

16

You should take children and young people’s views seriously and not dismiss or appear to dismiss their concerns or contributions. Disabled children and young people can feel particularly disadvantaged in this respect.

17

Children and young people usually want or need to know about their illnesses and what is likely to happen to them in the future. You should provide information that is easy to understand and appropriate to their age and maturity about:

  1. their conditions
  2. the purpose of investigations and treatments you propose and what that involves, including pain, anaesthetics and stays in hospital
  3. the chances of success and the risks of different treatment options, including not having treatment
  4. who will be mainly responsible for and involved in their care
  5. their right to change their minds or to ask for a second opinion. 
18

You should not overburden children and young people or their parents, but give them information at an appropriate time and pace, and check their understanding of key points.

19

You should talk directly and listen to children and young people who are able to take part in discussions about their care. Young people who are able to understand what is being said and who can speak for themselves resent being spoken about when they are present. But younger children might not be able to understand what their illness or proposed treatment is likely to involve, even when explained in straightforward terms.

20

You should only keep the type of information described in paragraph 17 from children or young people if:

  1. it would cause them serious harm (and not just upset them or make them more likely to want to refuse treatment)
  2. they ask you to, because they would prefer someone else to make decisions for them.
17

Children and young people usually want or need to know about their illnesses and what is likely to happen to them in the future. You should provide information that is easy to understand and appropriate to their age and maturity about:

  1. their conditions
  2. the purpose of investigations and treatments you propose and what that involves, including pain, anaesthetics and stays in hospital
  3. the chances of success and the risks of different treatment options, including not having treatment
  4. who will be mainly responsible for and involved in their care
  5. their right to change their minds or to ask for a second opinion. 
21

You have the same duty of confidentiality to children and young people as you have to adults. But parents often want and need information about their children’s care so that they can make decisions or provide care and support. Children and young people are usually happy for information to be shared with their parents. This sharing of information is often in the best interests of children and young people, particularly if their health would benefit from special care or ongoing treatment, such as a special diet or regular medication. Parents are usually the best judges of their children’s best interests and should make important decisions up until children are able to make their own decisions. You should share relevant information with parents in accordance with the law and the guidance in paragraphs 27, 28 and 42 to 55.

27

If a child lacks the capacity to consent, you should ask for their parent’s consent. It is usually sufficient to have consent from one parent. If parents cannot agree and disputes cannot be resolved informally, you should seek legal advice about whether you should apply to the court.10 

28

The legal framework for the treatment of 16 and 17-year-olds who lack the capacity to consent differs across the UK:

  1. In England, Wales and Northern Ireland, parents can consent to investigations and treatment that are in the young person’s best interests
  2. In England and Wales, treatment can also be provided in the young person’s best interests without parental consent, although the views of parents may be important in assessing the young person’s best interests (see paragraphs 12 and 13)11 
  3. In Northern Ireland, treatment can be provided in the young person’s best interests if a parent cannot be contacted, although you should seek legal advice about applying for court approval for significant (other than emergency) interventions
  4. In Scotland, 16 and 17-year-olds who do not have the capacity to consent are treated as adults who lack capacity and treatment may be given to safeguard or promote their health.12 
42

Respecting patient confidentiality is an essential part of good care; this applies when the patient is a child or young person as well as when the patient is an adult. Without the trust that confidentiality brings, children and young people might not seek medical care and advice, or they might not tell you all the facts needed to provide good care.

43

The same duties of confidentiality24 apply when using, sharing or disclosing information about children and young people as about adults. You should:

  1. disclose information that identifies the patient only if this is necessary to achieve the purpose of the disclosure – in all other cases you should anonymise25 the information before disclosing it
  2. inform the patient26 about the possible uses of their information, including how it could be used to provide their care and for clinical audit
  3. ask for the patient’s26 consent before disclosing information that could identify them, if the information is needed for any other purpose, other than in the exceptional circumstances described in this guidance
  4. keep disclosures to the minimum necessary.
44

Sharing information with the right people can help to protect children and young people from harm and ensure that they get the help they need. It can also reduce the number of times they are asked the same questions by different professionals. By asking for their consent to share relevant information, you are showing them respect and involving them in decisions about their care.

45

If children and young people are able to take part in decision-making, you should explain why you need to share information, and ask for their consent. They will usually be happy for you to talk to their parents and others involved in their care or treatment.