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Encourage autonomy

What is autonomy?

Autonomy is the ability of a person to act on their own free will. When a child has autonomy, even in small ways, it helps build his confidence, self-esteem and independence.
Autonomy is a critical part of learning for all children.

In most children (even toddlers and preschoolers), key ways to encourage autonomy include:

  1. explicitly role modeling desired tasks,
  2. encouraging your child to try tasks that he/she has not done before,
  3. offering realistic choices,
  4. respecting their efforts to complete the task.

But what about the child who has special medical needs?

Building autonomy is especially important for the child with chronic health issues or care needs. This child may feel powerless because he/she has to follow so many “rules” set by others, like his/her parents, nurses and doctors. If we let this child participate in his/her care, he/she has the chance to learn and understand the care better. This helps him/her feel more in control and helps build self-esteem. Ultimately, these are the characteristics of a resilient child, one who can face new challenges in a positive way.

For the child that must have certain regular care (eg, tracheostomy or gastrostomy care), you can offer choices related to the care (see table below for more details) and perhaps, just as importantly, you can offer your child lots of reasonable choices in the other areas of their daily life (eg, which toy do they wish to play with, which pair of socks to wear, etc).

Some children do have limited autonomy, usually because they are unable to understand or because they do not have the motor control or strength to carry out tasks; even so, these children can be offered realistic choices in a way that matches their abilities.

Have a look at some of the examples below to get you started. Talk to your health care team to find specific suggestions for your child.

 


Encouraging autonomy: some examples by developmental stage

Young infants

Role modelling tasks

Obviously, young infants cannot do any of their own care. However, parents can start “teaching” their infant by using predictable routines (eg, tracheostomy care always after the morning bath) and by talking to their infant in simple language (eg, “Now it’s time to suction your tracheostomy”). Read “preparation” in the Pediatric approach for more details.

Encouraging participation in tasks

A young infant may “participate” by staying in a certain position so that care can be provided easily (eg, lying swaddled on their back and sucking on a soother).

Offering reasonable choices

Parents make choices on the behalf of their young infant (eg, choosing a positioning method or choosing a distraction method.

Parents can set the stage for their child’s next developmental stage by exploring different choices of distraction and talking to their child in simple language about the choice (eg, “Let’s try using the soother today while I hook up your central line”).


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A collaboration of clinical experts across Quebec has taken every care to ensure that the information contained in this document is accurate, complete, and reflective of evidence-based practices. However, “Complex care at home for children” collaboration cannot and does not assume any responsibility for application of the content of this document or for any information that may be present in the websites cited as a reference. These web sites are provided for informational purposes only and do not represent the collaboration endorsement of any companies or products. Always consult your child’s physician and/or a qualified healthcare professional to learn more about recommendations specific to your child’s health needs.

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