Children as a vulnerable population: protected or neglected?

Children are characterised within the healthcare setting as a particularly vulnerable population, and hence in need of protection. However, this well-intentioned protective response has led to a situation where, paradoxically, children can be viewed as neglected; exposed to greater risk and poorer care than adults with similar conditions. This discrepancy can be seen starkly in the area of clinical trials and experimental treatments, where children have traditionally been excluded. The term “therapeutic orphan” was first used in 1968 to describe the effect on children that exclusion from trials had in terms of availability of safe and effective clinical treatment. This situation is slowly changing and there is much talk now of these therapeutic orphans having “found a home” or “been adopted” but what has allowed this change to happen? How has our understanding of the identity of the paediatric-patient developed?In this paper aspects of identity and the subsequent relationship between the paediatric patient and the healthcare profession will be explored. The characteristics of vulnerability, as applied to the paediatric patient, will be outlined and the evolving identity of the vulnerable sick child, along with the healthcare response of protection-exclusion changing to protection-inclusion, will be examined.