I am a pediatric nurse, and I was just worrying the other day about the message I was sending to a four-year-old girl during a treatment. She very clearly said “no,” but of course it was necessary for us to treat her (nasal suctioning — totally not fun!).
I like the idea of explaining what is necessary and why, and also at the same time encouraging kids to voice their feelings and their needs. It’s really difficult to help patients, especially children, maintain their autonomy over their bodies in a hospital setting. But I sure don’t want the side effect of a prolonged hospitalization to be that a little girl learns that adults don’t listen when she says no.
I would love to hear more suggestions from parents about what works when it is necessary to overrule a child’s wishes about their bodies. -M
You are really in a tough position. I think as parents we can make choices about whether or not to grab or touch or commander our kids when we think it’s right, but you don’t have a choice about what you do to kids (which sounds harsher than I mean it).
I think that an important part here is the opportunity to process
After the procedure is over, giving her some time to both be mad about it, and to really explain why you had to do what you had to do. I think that sometimes a huge part of what drives kids “nos!” is fear. Once the situation isn’t so scary, they can understand why it had to be done.
And obviously not to minimize their own feelings about it
For example, if a kid is insisting that a shot really really really hurt, saying “it wasn’t that bad” isn’t going to help. And it just sounds like you know better than they do about what’s going on with their own body. Saying, “I’m really sorry, I really didn’t want to hurt you. It’s my job to keep you healthy,” explains why you did what you did while also acknowledging the child’s feelings.
Depending on the context, you could give them some secondary autonomy
For example, after you do the nasal suctioning, you could say “do you want me to help you wipe your nose, or do you want to do it yourself?” (If that’s even an option). If she says no to both, so what? She’s got a little snot on her face.
A lot of times we send mixed messages to kids. I know that my daughter feels mercilessly bossed around even though I try very hard to let her make independent choices around her own body. I think that, at the end of the day, if we give kids space to feel heard about being bossed around, sometimes that will have to do
Comments on When it’s necessary to overrule a child’s “no touching” requests
I believe it was here that I saw an article about body autonomy for children — but the thing that stuck with me was being very clear that you heard and acknowledged they said no. “I understand you said no/don’t want to be touched but for these reasons I have to do x,y,z.”
I’m not a parent so that may affect my perspective but honestly I think it’s just as important for kids to learn that other people won’t always respect their decisions, because that’s how life goes. They’re going to have to keep their fingers out of plug sockets even if they really want to stick them in, to eat things they don’t like (or not eat things they do like), stay in school when they want to go home, and one day they’re going to get over-ruled on which jobs they get, which political party gets into power, and yes, they’re going to have to receive medical treatments they don’t enjoy.
Obviously body autonomy is a little different to going to class or eating vegetables, but as your dilemma shows exactly the same is true there. Sometimes there are bigger concerns than what you want to have happen.
So I don’t think there’s anything fundamentally wrong with doing it even if the kid has asked you not to. It’s not like you really had any choice either.
I like your idea of explaining why it has to happen. I think it would be really helpful if you could arrange to do this beforehand, and with the parents there (as they will know their kids better than you do) because as Rilan said a lot of children’s objections come from fear so if you can reassure them in advance I think things would go a lot easier for everyone.
I think the concern is not that kids will or won’t learn that they’re in charge of their life… I think the concern is that kids aren’t able to tell the difference between an adult touching them for a valid reason to take care of them, and an adult abusing them while telling them it’s for a valid reason.
The tack I’ve taken with my kids is more about secrecy than bodily autonomy. If someone touches you in a way you don’t want to be touched, you can always tell a trusted adult, or lots of trusted adults, and they will help you figure out what to do. I never, ever tell my kids how they should feel about someone touching them. I want them to believe it is always okay to tell me if they feel sad or scared or angry when someone touches them, even if that someone is a doctor or their great-grandma. If we have a conversation and I’m pretty sure they feel sad or scared or angry about normal, non-abusive things, we’ll talk about what they can do to make it easier next time or how I can help them.
(And as one side note, at least in the US, competent adults have the legally affirmed right to refuse any medical treatment for any reason. Which, sadly, is a right too often impinged upon people who believe they have to do whatever the doctor tells them, even if they don’t want invasive and painful treatment.)
I don’t have kids but I am a Certified Professional Governess. I think communication with the child beforehand goes a long way. Explaining exactly what is going to happen, who will be in the room when it is happening and why something is happening is really important. Having parents or a trusted adult in the room also helps set the tone, they can help their child understand what you are saying. Also telling a kid if something is going to hurt when it does in fact hurt. I never tell a child that something isn’t going to hurt when I know damned well it is going to hurt. That is just lying to them and then they get angry with you. Also offering choices where you can. Can they bring a favorite toy with them to hold during the procedure (obviously that is not always an option depending on procedure)? Can they chose the color of bandage that they get? Things like that give them a feeling of autonomy when choices are limited. And also just saying there are some things in life that we just don’t want to do. I year ago I had stitches in my finger, I didn’t want those stitches and I internally hated the woman for putting them in my finger but I womaned up and did it. Kids need to learn those lesson, it is important because we aren’t raising kids we are raising adults.
I’m also a Peds/PICU nurse and I tell people that 50% of my job is spent holding children down. Starting IVs, suctioning, changing dressings, giving medicine, etc. are almost always done against the will of the child. I’m also a fierce advocate for bodily autonomy in children. If the child is old enough I’ll explain what I’m going to do and what we can do when we’re over. I also explain to the parents and give them the option to leave the room so a) they don’t have to see their child upset and b) they can come in and be the “rescuer” from the nurse.
Sometimes children don’t get a choice even outside of emergency situations, such as brushing teeth, getting dressed, riding strapped into a car seat, or getting nails trimmed. It’s sad and it’s scary but parents are the adults in charge of wellbeing. It’s a really tough part of being a parent.
I am an early childhood educator. I took part in a training on sexual abuse prevention. The trainer, who knew her stuff, basically said that kids should have bodily autonomy and be taught to say no to things they do not want, and adults should respect that whenever possible. However, she also said it is important to teach kids that no one can touch them unless they say ok, with the important exception of parents/teachers/doctors in the limited circumstances where those trusted adults need to “help them get clean or stay healthy.” This was something I struggled with, too, as a teacher whose students did not always want to be fully cleaned after a diaper change. But that is important to keep them clean and healthy! I did my best to make them feel heard, help them understand WHY I had to do what I was doing, and give them as much control as possible.
I have to say to be careful about those exceptions. A friend of mine was badly traumatized by a molesting doctor. She had been a measles-baby, with multiple deformities and vulnerabilities, and had been told repeatedly that her life depended on her letting doctors do anything they said they had to, and so didn’t know that she had a right to object. This piece of work not only molested her, he repeatedly made her sick so that she would have to keep coming back! Finally her mother got suspicious and started going into the room with her daughter–and she suddenly got well. Except, of course, for lifelong PTSD.
Always be present or ask for the presence of a nurse at a child’s treatment.
I’m not a parent, but I am a counsellor in training and have worked with kids in some respect for over ten years. So I mean, take what I say with a grain of salt, of course, but I thought I would throw my two cents in.
Some of the posts in this thread have admittedly given me pause, through no real fault of the commenters, particularly around the things kids don’t want to do — like brushing their teeth or eating their greens or putting their hands in sockets, for instance.
There’s a great concept in Adlerian parenting called “natural consequences.” It refers not to punishment, but to the consequences that naturally occur when a kid doesn’t do something you ask them to. For instance, a natural consequence of not brushing your teeth is bad breath, and a natural consequence of bad breath is that your friends might not want to hang out with you until your breath doesn’t stink. Likewise, a natural consequence for sticking your hand in a socket or onto a hot burner is that it hurts. The point is that natural consequences are really, really effective teachers.
In terms of things that are more serious, like health or safety where the “natural consequences” are worse than a scrape, cut, bruise, or small burn… I think the OP is asking a really important question. As little people, children totally have the right to bodily autonomy. But as adults, we also have a legal responsibility to ensure their safety, health, and well being — emotionally and physically.
All that being said, I think for me, I would start by explaining just that to the kids: that while they have the right to say no to being touched, you have a responsibility to take care of them, and explaining exactly what that means. I think it would also be really important to explain the limits to your own responsibility vs their autonomy, because as another commenter has already touched on, not all adults are looking out for the well being of the child.
I’m also a big fan of trying to find a second or third option. I got sick a lot as a child, and I absolutely hated being forced to take medication that I didn’t want to. I still can’t eat anything grape flavoured without vomiting (stimulus generalization, anyone?). Eventually, my parents and doctors started offering me choices about how to deal with my own health, and I finally started to be able to take medication without screaming, crying, or throwing up.
Kids don’t get a lot of choice — they often don’t get to choose where they live, what they eat, where and when they go to school, and sometimes whether or not they get touched by adults who are for all intents and purposes strangers. I think giving choices and explaining natutal consequences, as well as what exactly you’re doing, why, and the limits of your own authority may begin to make a difference in allowing them their own power and autonomy.
I would like to add the importance of reflecting the positive effects of unpleasant procedures. I am a nurse, but this comes from my experience as a Mom of a kid who was very very sick when she was five.
Explain what will happen, aknowledge their refusal to have it done. Stress that you need to do this for X reason, be very matter of fact about it. There is no secracy here, as would be the case for abuse. Give them options on how it will happen (which side they will lie on, do they want a teddy? Can they count to ten for you, or blow through a tube etc) Then plug you ears and do what you need to for the health of the kid.
If there are some particularly unpleasant things that don’t actually hurt, if you have time these can be explored together before. Example with a loud suction machine; have them suction out teddy’s ear and complain of the noise.My kid has multiple oversensitivities. It took a while to realize the strong smell of alcool freaked her out before anything actually happened, and having her bury her face in a pillow helped.
But the most important thing is after. Stress how X helped the kid, especially with ones a bit older, maybe four and up. The parents can help re-inforce this. “Whew, that nasal suction is awful. But OMG do you breathe better! Take a good breath through your nose, isn’t that awesome!” “You were such a champion taking that medication! The fever is almost gone, it doesn’t hurt so much anymore does it?” “Remember that awful blood test? Now the doctor has the results and we know what is wrong with you!”
My daughter will still explain how that time when she had to have her blood drawn every ten minutes for an hour (so six needles… fun huh?) is when the doctor’s found the issue. Believe me; she screamed bloody murder when the needles were going in. But she is not traumatized, she knows no-one had a choice in this and that the ultimate goal was to help her.
Same goes for big things too. It is not fun to undergo surgery. She will explain that when they put her to sleep, she was cold and scared and she threw up after and had to have her hand in a cast. (It was to support the iv line not an actual cast, but it agravated her to no end; much more than the actual surgical wound and bandages!) But now they have undone the twist in her intestines and there is no more pain in her belly.
Help them make the connection between the result and the procedure. It is what makes it ok for you not to respect their body autonomy after all!
For my generally healthy preschooler, knowing some anatomy and physiology in general (well before any specific medical intervention is looming) really helps her be calm and participatory during medical treatments. Kid level books about how her body works and especially The Magic School Bus taught her about antibiotics, digestion, blood cells, stitches, vaccines, etc.
Her own scientific expertise lets her participate, allowing her to be an informed part of the medical team taking action, rather than feeling like others are just doing something to her body. Even if she gets scared, afterward she can explain why we did the shot or blood draw or whatever and she feels that it was a real reason. She has the vocabulary to talk about it.
Bodies are definitely that combination of amazing and gross that can really appeal to a lot of kid scientists. I don’t know how well this applies to chronicly sick children, many of whom I think are already knowledgeable about their conditions, but for healthy kids, I think a cool body science approach can be empowering.
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