Consent and ethics: children and young people

Published: 13/08/2019

The reluctant child

This is an issue frequently faced by anaesthetists working with children. Great care needs to be taken to maximise a child’s ability to develop their own coping strategies (whether that involves engaging them in their own treatment or using distraction techniques), and to minimise any associated distress.

A good summary of the developmental stages that children go through, along with an example case and suggested strategies to help children undergo anaesthesia can be found in the following article:

Hearst D. The Runaway Child: managing anticipatory fear, resistance and distress in children undergoing surgery (Pediatric Anesthesia 2009;19:1014–1016).

Premedication for anxious children can be very useful to help minimise distress for both a child and their parents as well as to help avoid the formation of negative associations with the healthcare environment that can make future encounters extremely difficult. This article discusses how to identify anxious children coming for anaesthesia as well as management strategies including both psychological and pharmacological:

Tan L, Meakin G. Anaesthesia for the uncooperative child (CEACCP 2010;10:48–52).

The British Psychological Society have also produced a very useful guide with the aim of helping healthcare professionals to minimise distress for children and young people who have to undergo invasive or otherwise potentially distressing procedures. It again emphasises methods to encourage children’s cooperation and to facilitate development of their own coping skills. Its specific aim is to minimise the need for restraint and to identify where help should be sought from other professionals such as play therapists or psychologists:

Evidence-based Guidelines for the Management of Invasive and/or Distressing Procedures in Children 2010

Courses are available to help develop management strategies for use with anxious children, including some specifically designed for anaesthetists such as POEMS for Children*.

Therapeutic holding and restraint

This is an area that rightly causes concern. Restraint should only ever be used as a last resort but where it is deemed necessary to serve the best interests of a child then guidance as to the principles that should govern its use can be found in the BMA’s Children and young people ethics toolkit – Use of restraint to provide treatment

More detailed guidance regarding therapeutic holding and restraint is available from the Royal College of Nursing:

Restrictive physical intervention and therapeutic holding for children and young people 2010
This document is aimed primarily at nursing staff on wards rather than for theatre – but remains useful nonetheless.

You may also find the following course on Safe Restraint procedures useful: CH-3 Skills for Clinical Holding delivered by the Crisis Prevention Institute. You can access the list of dates for their courses and make enquiries here

We have suggested some additional educational resources on consent and ethical issues in our Resources section.


*We would like to share details of courses or events that may be of help/interest in this area, however please note that the RCoA has not approved these events for CPD purposes and therefore cannot endorse their educational content.