Peer-reviewed article
When the Child Is Not Heard: Children's Rights and Epistemic Injustice in Paediatric Nursing Practice.
Georgousopoulou V, Manomenidis G ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This conceptual paper argues that children's dignity in hospital care is harmed when nurses dismiss or fail to recognize children's non-verbal expressions of pain, fear, or distress. The author proposes that epistemic injustice—denying children credibility as knowers of their own experiences—violates their rights to participation, privacy, and respect. Paediatric nurses can repair this harm through practices like credible listening, embodied attunement, and child-centered communication. The analysis reframes dignity protection as something co-produced through relational nursing practices rather than merely procedural compliance.
Key points
- Children's experiences may be expressed through silence, bodily resistance, withdrawal, or hesitation rather than adult-like verbal testimony
- Dismissing these non-verbal expressions as immaturity or non-compliance causes epistemic harm—denying the child status as a knower
- Paediatric nurses are positioned as central agents who can repair epistemic injustice through sustained relational proximity and advocacy
- An epistemic justice practice bundle is proposed: credibility-oriented listening, embodied attunement, developmentally attuned communication, protected spaces, minimal adult substitution, and voice-preserving documentation
- Dignity protection is reframed from procedural compliance to relational co-production that makes children's experiences visible and actionable
Limitations
This is a conceptual and philosophical analysis rather than an empirical study, so it does not provide evidence of whether implementing these practices actually improves child outcomes or nurse behaviour. The paper does not evaluate the effectiveness of the proposed epistemic justice practice bundle in real clinical settings.
Abstract
Children's dignity in hospital care is often framed as a matter of privacy, etiquette, communication, or procedural compliance. A more demanding account is needed. Drawing on the philosophical framework of epistemic injustice, this conceptual article argues that dignity-related harms in paediatric nursing also arise when children are denied credibility, interpretive support, or meaningful authority over knowledge of their own embodied experiences. Children may not always describe pain, shame, embarrassment, fear, or boundary violation through adult-like verbal testimony. Their experiential knowledge may instead appear through silence, withdrawal, humour, bodily resistance, hesitation, gaze avoidance, or apparently compliant behaviour. When such expressions are dismissed as immaturity, difficulty, exaggeration, or non-compliance, the child is harmed not only as a vulnerable patient but also as a knower. This reframing connects paediatric dignity with children's rights to participation, privacy, and respect under the United Nations Convention on the Rights of the Child and the EACH Charter. It also positions paediatric nurses as central agents of epistemic repair because nursing work occurs at the intersection of intimate bodily care, sustained relational proximity, communication, documentation, and advocacy. The article proposes an epistemic justice practice bundle for paediatric nursing: credibility-oriented listening, embodied attunement, developmentally attuned communication, protected communicative spaces, minimal substitution by adult proxies, and voice-preserving documentation. The analysis extends nursing philosophy by showing that dignity is not only protected around the child but co-produced through relational practices that make children's experiences visible, credible, and actionable within clinical care.