Children as consumers

Children are important users of health services, accounting for up to a quarter of general practitioner consultations1 and 30% of the workload in accident and emergency departments.2 However, their needs are given insufficient priority by policy makers and health service professionals. Last year a report of the British government's health committee stressed that a change in attitude was needed and that it was important to listen to children and to take their views into account.3 Although consumers have an important role in reforming health care,4 the paternalistic attitude still prevailing among health professionals when it comes to consumer involvement in health care and research can make this difficult.5 Patient passivity begins early in life6 so we should not be surprised that adult users acquiesce. In this article we discuss why children should be consulted directly, how this is to be achieved, and finally what may be required to bring about change. #### Summary points Children are major users of health services but are rarely consulted as healthcare consumers Although parents are extensively used as proxies for children, their accounts may not always accurately reflect children's perceptions Large numbers of children are cared for and treated by staff who have no paediatric training and abilities to communicate cannot be assumed Children's concepts of hospital care and illness differ greatly from those of adults Children may be able to express their opinions if they are sought using appropriate methods Staff need to be trained to enable the child's voice to be heard and may need to consult colleagues in departments of child and family psychiatry and clinical psychology and develop closer contacts with teachers and social workers ### Parent as proxy In Britain, although there has been an increasing emphasis on obtaining the views of health service users, children are rarely included. This …