Consequences of empowering children to care for themselves

The social climate of the past 3 decades has resulted in an increased interest in empowering children to participate in their own health care. Research conducted over the past 18 years by the authors suggests that children are quite competent to enter into programs that are child-centered and family-oriented, whose objectives are to teach children decision making, and to transfer increasing control over decision making related to health matters to the child. These studies indicate that children learn decision-making skills, and apply them quite competently, especially when the scope of decision making is clearly defined. Despite the evolution of programs that have been demonstrated by randomized control trials to effectively reduce the utilization of emergency rooms and hospitals by children with asthma, such programs have not diffused widely, not even into pre-paid health plans. Experience with two such programs indicates that the principle resistance to diffusion derives first from physicians, who are reluctant to share power with adult patients, let alone children, and even some of the parents themselves whose roles are threatened by such efforts.