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:

explicitly role modeling desired tasks,
encouraging your child to try tasks that he/she has not done before,
offering realistic choices,
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

School-aged children

Role modelling tasks

While medical play is still very useful in this age group, as children mature, you can use direct modeling more and more. For example, for the child who needs intermittent urinary catheterization, the parent could use the materials included in care practice and go through it with their child to explain the procedure. A good rule of thumb is to keep explanations simple and as visual as possible; this is helpful even for adults.

Encouraging participation in tasks

As your child participates more and more with his/her care, your child gains a sense of being more in control. This helps reduce stress and build confidence.

Continue to engage your child in the needed care, adding tasks and responsibilities slowly and with positive feedback along the way.

Don’t be discouraged if it takes your child some time to master tasks. Each child develops at their own pace and every step forward builds self-esteem.

Offering reasonable choices

Continue to offer realistic choices to your child, both as part of their medical care and in their regular activities.

Children in this age group learn powerfully from consequences: that is, if they choose option A, then X is likely to happen; if they choose option B, then Y is likely to happen…

You can start to highlight the connection between choices and consequences, that is, the pros and cons of decisions. This teaches children problem solving skills that they will use throughout their lives.

https://complexcareathomeforchildren.com/prepare-your-child/encourage-autonomy/

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