Offering realistic choices

Offering realistic choices
Every child needs some measure of autonomy (control) even during procedures that are uncomfortable or painful; the “trick” is to find a positive way for your child to make realistic choices. There are always choices that your child can make. Choose the techniques that suit your child and family best.
If a treatment is necessary (refusal is not an option), do not ask your child if he/she wants the treatment or not. If your child “declines” the treatment but you go ahead and do it, because it is necessary, then your child will feel that his/her answer was not respected; this may be seen as a betrayal by the child. Alert your child to the needed care, set and explain clear limits; then offer a reasonable choice. For example, “You have to change your dressing because it is dirty and no longer protects you well. You need a new dressing. After the dressing is changed, you can finish playing with your game. Would you like to look at a book or watch a movie while I change the dressing?” The choices can be linked to the setting (environment) of care. (See examples below) Provide alternative choices “A” vs “B”. Even choosing between two non-desirable options gives a child choice and autonomy in the decision. Avoid offering too many choices. If your child seems to become more anxious considering options then offer to help your child choose.
Examples of choices linked to the setting of care
Place	Where should we do the care?
When	When do you want to do the care?… before or after…?
Who	Who would you like to be with you during the care? a favourite stuffed animal? another family member?
Awareness	Will you watch or not?
Participation	Would you like to help do the care or not? Which job would you like to do? (eg, “help wipe with the alcohol swab?”)
Distraction	What would you like to do during the treatment? Would you prefer to “A” or “B”? (eg, “hold my hand, read a book, watch a video, play with a toy, sing a song, etc”). See distraction techniques by developmental stage for more ideas.
Position	Which position do you prefer “A” or “B”?

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