Impaired expectations: the challenge of ableism in paediatrics

In the field of paediatrics, the concept of normal (ie, typical)-in contrast to different, special, deviant, delayed, or atypical-has imposed a problematic framework within which people view a child with an impairment. This binary perspective oversimplifies a complex, fluid, and dynamic process encompassing physical, behavioural, emotional, cognitive, social, and communicative development. Furthermore, this approach reinforces the notion of a singular normality, diminishing the value of any variation from this assumed (and usually poorly defined and naive) standard, in a way that speaks of ableism-the normative bias that a standard norm exists and anything other than this standard is inferior. Ableism profoundly affects systems, whether they be clinical or medical, educational, or community-based or research-based. The aims of this Personal View are to (1) examine the evolution of disability definitions; (2) challenge the construct of normal in child health; and (3) review identified types of disability. This Personal View explores the literature on ableism in paediatrics from a global perspective, assessing its effect on children, their parents and families, and on the broader community. We offer a modern perspective on disability, embracing the resilience and adaptations that often emerge, while acknowledging challenges. We aim to provide paediatric learners and health-care professionals with opportunities to improve paediatric care through an inclusionary, strengths-based approach to disability that values diverse developmental pathways and challenges rigid normative expectations.