Parental perspectives on child participation in prehospital emergency care: A rights-based analysis using Shier's pathways to participation

Children have the right to express their views and to have those views considered respectfully in matters affecting them, as articulated in Article 12 of the United Nations Convention on the Rights of the Child. In emergency care, this right must be balanced with the child's best interests, particularly when illness, distress or developmental or cognitive factors limit a child's ability to participate directly (Article 3). Little is known about how this is implemented in prehospital emergency care. This study explores how children's participation occurs during ambulance care, as perceived by their parents, using Shier's ‘Pathways to Participation’ model. A qualitative study involving semi-structured interviews with 12 parents (nine mothers and three fathers) of 12 children (five females and seven males, aged 0–14) who received ambulance care in Sweden was conducted. A deductive content analysis was performed, guided by Shier's five-level participation model. Ethical approval was obtained. Participation was described at the first levels of Shier's model: children being listened to, supported in expressing their views and having their views considered. Parents described how emergency medical services clinicians used age-appropriate language, adjusted tone and body language and made meaningful adaptations. Preverbal children were included through non-verbal interaction and emotional presence. However, higher levels of participation were absent. Participation appeared relational and dependent on individual clinicians’ communication style. Participation was more likely when time allowed and less likely during urgent interventions. Children's participation in prehospital emergency care is not only feasible but already realised through relational and responsive clinical behaviours. However, participation is inconsistent and dependent on individual clinicians rather than embedded structures. To align practice with Article 12, clinicians should consider implementing training and clinical routines that facilitate child participation. These findings contribute to evidence that child-centred care is possible in fast-paced emergency contexts.