Challenges in managing parental expectations in paediatric care.

Given the recent number of controversial cases featured in the media, it is timely to consider the management of parental expectations in paediatric care. What is sadly overlooked in the controversy is the usual excellent working relationship formed by treating child health professionals, parents (those with parental responsibility) and children themselves in tackling really tough situations. We are able to do more and more to tackle previously deadly diseases, and yet the burden of our treatments is undeniably higher. At the same time, social changes and ready access to information have led to a necessary reduction in medical paternalism, and more empowered and knowledgeable patients. We review how things have become very challenging in this arena in the UK over the last decades, and consider the issues surrounding disagreements and conflict. On the background of population shifts, religious diversity and populism, parental expectations now vary dramatically given the same situation. The challenge is still met by communicating, listening with empathy but finally by adhering to the basic tenet of Article 3 of the UN Convention of the Rights of the Child - 'The best interests of children must be the primary concern in making decisions that may affect them.'