Grand Rounds

A Course for Health Professionals
Children’s Rights and Child Health
Grand Rounds
An Introduction to the
UN Convention on the Rights of
the Child
Children’s Rights and Child Health: An Introduction to the
UN Convention on the Rights of the Child
I. Children’s Needs and Rights
The needs and rights of children form the basis for a universal set of standards by
which all children should be treated in order for them to achieve their full potential for
health and development. If there is universal acceptance that there are common
minimum standards that apply to the treatment of all children, it follows that children are
entitled to have these needs met. In other words they have rights, and adults have
obligations to children to ensure that these rights are respected. A framework for the
consideration of children’s needs and rights follows.
Children, by virtue of their humanity, have rights. In addition, children have basic
universal needs.
These needs form a basic set of common standards necessary for optimal health and
Children are entitled to be treated according to these common standards.
These standards impose obligations on adults to ensure their fulfillment.
A commitment to fulfill these obligations creates rights for children to have their
needs met.
These rights have been codified into an international human rights treaty, the UN
Convention on the Rights of the Child. The Convention establishes universally binding
obligations on governments and communities to protect and promote the rights of
children necessary to fulfill their needs.
These needs and rights can be grouped into three broad categories – physical needs,
social, economic and cultural needs, and intellectual, psychological and emotional needs.
Physical needs: shelter, health care, water and sanitation, protection from
environmental pollution, adequate food, adequate clothing, and protection from
violence, exploitation and abuse
 Social, economic and cultural needs: knowledge of and respect for own language,
religion and culture, stable social and economic environment, recognition of and
respect for emerging competencies, access to appropriate guidance and support,
access to play and friendships, respect for privacy, and freedom from discrimination
and prejudice
Intellectual, psychological and emotional needs: a stable and loving family
environment, access to education, age appropriate information, stimulation, and
opportunities to be listened to and taken seriously.
The Relationship between Needs and Rights. A number of consequences follow from
an understanding of children’s needs and rights.
Children’s needs are universal. They apply to children in all socio-economic and
cultural environments. The way in which needs are met will vary in different cultures and
for different children. For example, family structures differ, children start education at
different ages, opportunities for play may be more or less formal, the relationship of
children to work varies, disabled children may need additional support, etc., but their
fulfillment remains necessary.
The fulfillment of all needs is essential for children’s optimal health and development.
There is often a tendency to view physical needs as having priority. However, without
education or play, children’s potential cannot be realized. Without respect and freedom
from discrimination, their psychological and emotional well being will be impaired.
Children’s needs are mutually inter-dependent.
Children cannot fulfill their needs without adult support. The vulnerability and lack of
power inherent in childhood means that they are dependent on the adult world to ensure
that their needs are met. This places obligations on adults to create the necessary
conditions that will ensure this happens. This obligation extends not only to the
fulfillment of needs for individual children, such as family life, access to health care or
education, but also the investment in the broader field of policies that potentially impact
on children’s health and development – housing, transport, environment,
macroeconomics and poverty. This means that government and community policies at all
levels must take active and consistent account of children’s needs.
The Convention elaborates the rights of children and calls on governments and
communities to introduce the necessary measures to ensure that these rights are respected
for all children. It asserts that: a) they are universal, indivisible and inter-dependent, and b)
their fulfilment must be grounded in a commitment to an understanding that children, as
subjects of rights, must be respected, listened to and taken seriously in the exercise of their
rights. In summary:
All children, by virtue of their humanity have rights. In addition, all children have
needs, the fulfillment of which will facilitate their health, development and wellbeing.
Needs extend beyond the physical to encompass social, economic, cultural,
intellectual, emotional and psychological needs.
Children cannot fulfill those needs without adult support.
These needs can only be fulfilled if adults accept responsibility for meeting them.
Acceptance of responsibility by adults gives children an entitlement or right to have
their needs met.
Recognition that children have rights in respect of all their needs demands an
approach in which children become active participants in the decisions and actions
that affect them, not merely recipients of adult intervention and protection.
II. Highlights of the UN Convention On The Rights of the Child
The following principles provide a framework for understanding the UN Convention
on the Rights of the Child. Although the US remains the only country in the world not to
have ratified the Convention, we are a signatory and the articles are as relevant to US
children as they are to children in any other country.
The Convention on the Rights of the Child defines the full range of children’s needs
and provides a practical framework for addressing these needs in an integrated and
holistic way.
It poses a challenge to traditional approaches to children that view them as
incompetent, passive objects of adult protective care. Instead, it acknowledges
children as both capable of and entitled to active participation in decisions that affect
their lives.
It is legally binding on all countries that have ratified it. Governments are required
under international law to take all necessary measures to implement its provisions. It
provides a universal set of standards against which to measure and improve the
treatment of children.
Although there are no formal sanctions that can be brought against governments and
communities for failing to comply with its provisions, the process of reporting to the
Committee on the Rights of the Child is an invaluable mechanism for monitoring how
a government and/or community is complying. It provides an opportunity for all those
involved in children’s health and well being to work together toward improving
Implementation of the rights contained in the Convention would herald a fundamental
change in the status of children in all societies in the world and ensure their optimal
health and development and fulfillment of potential.
The UN Convention on the Rights of the Child is an international human rights treaty
that introduces the concept of children as subjects of rights with the same inherent value
as adults. It was drafted over a ten-year period by a working group established by the UN
General Assembly who adopted it in 1989.
The Convention on the Rights of the Child is the most recent of six UN human rights
treaties, the others being the:
International Covenant on Civil and Political Rights (1966),
International Covenant on Social, Economic and Cultural Rights (1966),
International Convention on the Elimination of all forms of Racial
Discrimination (1966),
 Convention on the Elimination of all forms of Discrimination against
(1979), and
 Convention against Torture, and other Cruel, Inhuman and Degrading
 Treatment (1984).
While these treaties do not exclude children, they do not explicitly affirm their rights nor
address the very different situation or status of children as compared with adults.
The Convention on the Rights of the Child promotes a philosophy of respect for
children. While acknowledging that children are entitled to special protection and care, it
also insists that they are entitled to participate, in accordance with their age and
competence, in the protection of their own rights. In other words, the Convention
challenges us to rethink the traditional perception of children as merely recipients of adult
protection and to begin to accept them as social actors with rights to be listened to and
taken seriously in their own right. This challenge has significant implications for adult
relationships with children, as parents, as teachers, as policy-makers and politicians, as
journalists, and of course, as child health and serving professionals.
What rights does the Convention contain? The Convention is a broad-ranging treaty
that contains some 40 “articles” defining the rights of children. These rights include:
Social rights. The right to life and optimal survival and development, to the best
possible health and access to health care, to education, to play, to family life unless not
in the child’s best interests, to alternative care when unable to be looked after by
parents, to family reunification, to promotion of the fullest possible social inclusion for
disabled children, to support for parents in order that they can protect their children's
Economic rights. The right to an adequate standard of living for proper development,
to benefit from social security, to protection from economic exploitation.
Cultural rights. The right to respect for language, culture and religion, to abolition of
any traditional practices likely to be prejudicial to the child’s health.
Protective rights. The right to promotion of the child’s best interests, to protection
from sexual exploitation, from armed conflict, from harmful drugs, from illegal sale
and trafficking, from abuse and neglect, to rehabilitative care following neglect,
exploitation or abuse.
Civil and political rights. The right to be heard and taken seriously, to freedom from
discrimination in the exercise of rights on any grounds, to freedom of religion,
association and expression, to privacy, to information, to respect for physical and
personal integrity and freedom from all forms of violence, torture or other cruel,
inhuman or degrading treatment, to respect for due process in the law, recognition of
the importance of treating the child with respect within the criminal justice system and
respect for the right not to be detained arbitrarily.
These rights are indivisible and universal. There is no hierarchy of importance.
Together they create a holistic framework of rights that, if fully respected, would promote
the health, welfare, development and active participation of all children.
General principles underlying the Convention on the Rights of the Child. The
Committee on the Rights of the Child has identified four key principles that must be
considered when implementing all other rights.
Article 2. The right to non-discrimination. All the rights in the Convention apply to
all children without discrimination on any grounds. In other words, governments and
communities must take measures to ensure that all the rights in the Convention apply
without discrimination to all children. This means both direct and indirect
Article 3. The duty to promote the best interests of the child. Article 3 of the
Convention places an obligation on public and private social welfare institutions,
courts of law, administrative authorities or legislative bodies, etc., that in all actions
affecting children, the best interests of the child must be a primary consideration. The
article limits the duty to ‘a primary’ and not ‘the primary’ nor ‘the paramount’
consideration. In other words, other considerations can inform actions affecting
Article 6. The right to survival and development. Article 6 of the Convention stresses
the right of every child to life and optimal survival and development. This right
imposes obligations not only to actively provide health services to protect the lives of
children, but also to create an environment in which children’s development can
Article 12. The right to be listened to and taken seriously. Article 12 provides that all
children have the right to express their views on all matters of concern to them and to
have those views taken seriously in accordance with their age and maturity. Only if
children are listened to, can they challenge abuses or neglect of their rights.
Since its adoption by the UN General Assembly in 1989, the Convention has already
achieved a great deal for children.
At the international level, there is far greater awareness of and commitment to end
exploitative child labor, sexual abuse and exploitation of children, discrimination
against girls and disabled children, and the use of children as soldiers.
At the national level, many governments and communities have begun to analyze and
improve their legislation to bring it in line with the Convention’s rights, to establish
independent Children’s Rights Commissioners (Ombudsmen), to raise public
awareness of children’s rights, to develop programs designed to promote the best
interests of children, to end all forms of violence against children, and to divert extra
resources to fulfill obligations to children.
At the national, regional and local levels in many countries, measures have been
introduced to the principle that children are entitled to express their views and have
them taken seriously, to tackle discrimination, to improve child protection measures,
and to encourage breast-feeding.
Is the Convention anti-family or anti-parent? There is often concern expressed that
the Convention, by emphasizing the rights of children, is anti-family and undermines
parental authority. These concerns are based on a fundamental misunderstanding of the
Convention. The preamble of the Convention, as well as many of its articles emphasize
that growing up within a caring family environment is crucial to children’s healthy
Article 5 recognizes parents’ rights and duties to provide direction and guidance to
 Article 9 stresses the right of children not to be separated from their parents unless
necessary for their best interests.
 Article 18 stresses the obligations of governments to provide support and help to
parents in order to help them fulfill their role of promoting and protecting their
children’s rights.
However, the Convention does imply changes to the traditional way in which children
have often been viewed within the family. It requires that:
They are listened to and their views taken seriously,
Increasing recognition is given to their ability to make decisions for themselves as they
grow older,
 Parents consider children’s best interests when making decisions that affect them, and
 Recognition is given to the fact that children’s interests will not always coincide with
those of their parents.
The Convention encourages a culture of respect for children within families as well as
in the wider society. But this does not undermine or diminish the role of parents. Rights
allow children to take part in decisions that affect them, not to take over. They place a
responsibility on parents to provide proper care and protection through listening and
valuing children’s opinions. Parental respect for children is likely to encourage children’s
respect for their parents. However, the Convention does not make assumptions that
children, irrespective of age, will have equal competence to exercise their rights. It
contains recognition of children’s evolving capacities as they mature.
III. Respecting Children’s Rights in Pediatric Practice
The following principles provide insight into the rights of children to engage in
decision making within the limits of their age and competencies.
Children are entitled to be actively involved in decisions related to them from the
earliest possible age.
Involvement means listening to children and taking their views seriously, respecting
their evolving competence to take responsibility for themselves and recognizing the
importance of confidentiality, particularly for adolescents.
Participation of children is important in principle—all people are entitled to be
consulted over decisions that affect them. It also has considerable practical benefits
to enhancing both the quality of care and the child’s general well being.
Implementation of a commitment to involve children will necessitate considerable
changes in practice and programs. It will require training of all health and child
serving professionals and para-professional staff dealing with children, and
necessitate making time available to listen to and talk with them.
Using Health as a “case study,” the following is a demonstration of the relevance and
use of the principles and standards of the Convention to the way that health policy is
developed and implemented. The Convention’s articles can be used as a framework with
which to develop and monitor public policy at all levels. In other words, they provide a
lens through which to evaluate how and what services are provided to/for children.
Children’s right to the best possible health. Key articles in the Convention explicitly
deal with health. Together they place a high priority on investment in health care services
designed to promote children’s health and development. Article 6, the right to life and
optimal development was described previously.
Article 24. The right to the best possible health and access to health care. This
article stresses that governments have a responsibility to ensure that no child is deprived
of their right of access to health care services. It goes on to stress the need to take action
to end traditional practices prejudicial to the health of children.
Article 2. Non-discrimination. Every child has the right to equal respect for all the
rights contained in the Convention. In practice, it is rarely the case that all children have
equal access to health care. For example: (a) disabled children, (b) ethnic minority or
indigenous children, (c) poor children, (d) adolescents, (e) incarcerated children.
Article 3. The obligation to promote the best interests of children. Article 3 of the
Convention states that “in all actions affecting children, their best interests must be a
primary consideration.” Article 3 does not require that children always be the paramount
consideration. However, it does mean that health authorities and professionals must
always consider all their actions to assess their potential impact on children and seek to
ensure that children’s interests are given serious attention.
What implication does this have for health policy and services? In practice, it means
that: a) services must be developed and organized for the benefit of the child rather than
for the convenience of providers and administrators, and b) providing training for
students and/or creating research opportunities must not be the priority for children’s
services. For example:
Article 12. Listening to children and taking them seriously. The principle that
children have the right to be listened to and taken seriously is central to the
Convention on the Rights of the Child. However, the principle does not just apply
only to individual children. Equally important is the need to consult with groups of
children and young people in the development of health services, their operations and
to determine what services are needed. Listening to children is not just right in
principle, but it is one of the most effective means of ensuring that children’s rights to
the best possible health are fulfilled.
The Convention contains many other rights that, if respected, will result in better
health and development for children.
The right to protection from all forms of violence and sexual abuse. There must be a
community standard to ensure that children are safe.
The right not to be separated from parents. Every effort must be made to enable
detained children to maintain contact with their parents, and children should not be
institutionalised and denied their right to family life as a result of either physical or
intellectual disability.
The right to education and play. All children have the same right to education and to
play, and all efforts must be made to provide opportunities for children to maintain
their education and to be able to play.
The right to protection from arbitrary detention. Children should not be forcibly
detained in mental health institutions unless doing so is absolutely necessary for their
protection and safety, or the protection and safety of others. When it is necessary, there
must be effective safeguards, time limits and rights of appeal.
The right not to suffer cruel or inhuman treatment or punishment.
The following is a sample charter of Children’s Rights that could be used and displayed
in programs and facilities
An Outline for a Charter of Children’s Rights
The following is a draft outline of suggestions that could be included
in a charter of children’s rights. In developing such a charter, it will
be necessary to consult with children themselves on what they feel
should be covered and how they would like it to be worded.
If I am seeking, needing or receiving health care, I have a right to the following.
I have the right to the best possible treatment and care.
I have the right to be listened to and have my views taken seriously.
I have the right to be given information that will help me understand my treatment.
I have the right to ask for advice, information and support.
I have the right to be asked before anyone touches me.
I have the right to respect for my privacy.
I have an equal right to treatment and care, regardless of my sex, abilities or disabilities,
color, race or religion.
I have the right not to be hurt or humiliated.
IV. Health Policy and Health Services
The following comments relate to the implications of children’s rights for health
Children have the right to life and the best possible health and the right to access to the
best possible health care services.
It is not enough simply to assume that services are promoting children’s health and
development. It is necessary to scrutinise services to ensure they actually protect and
promote children’s rights.
Key principles in the Convention can be used as a means of monitoring whether
standards are being met for all children.
Giving consistent priority to promoting the best interests of children can be helped by
introducing and institutionalising systems for raising standards throughout the service
delivery system, including training, consultation, analysis of budgets, integrated
planning of services, etc.
The principles and standards of the Convention have significant implications for the
way that health policy is developed and implemented. The Convention’s articles can
be used as a framework with which to develop and monitor health policy at all levels.
In other words, they provide a lens through which to evaluate how and what services
are provided to/for children.
How to implement the right to the best possible health. Consistent and effective
consideration of children’s rights in the development and delivery of health and human
services will not happen by chance. There are many competing interests and more
powerful voices than those of children. Rather, it is necessary to introduce systems to
ensure that as services are developed, they are scrutinized from the perspective of
whether they will promote and protect children’s rights. There are a number of processes
that can be built into the development and delivery of services in order to achieve this
Formally “adopt” the UN Convention on the Rights of the Child as a framework for
developing policies and practice.
Develop systems for consulting with children and young people in the development,
delivery, monitoring and evaluation of services.
Work with staff, parents and children in developing a Children’s Charter establishing
what children are entitled to expect when they need and seek health care.
Develop systems for analyzing the degree to which health service expenditures
benefit children and whether they reflect their assessed levels of need.
Establish effective collaborative planning to ensure
comprehensiveness in the development of services for children.
Provide training for all relevant staff on children’s rights and the implications of the
Convention on the Rights of the Child.
Encourage the appointment of an independent children’s commissioner or
ombudsman who can monitor how effectively children’s rights to health are being
V. The Health Professional As Advocate
Consideration of children’s rights has compelling implications for the generation of
public policy related to the health and well being of children.
Children’s rights cannot be fulfilled simply through the provision of effective services.
The social, economic and physical environments in which they live can and do have
powerful influences on their well-being.
Children lack the democratic rights available to adults with which to protect their
rights. Accordingly, they need adults willing to act as advocates on their behalf.
Child health and serving professionals have insight and experience with respect to
how children’s lives and their rights are affected by their environment, and how the
actions and inactions of governments and communities contribute to the failure to
protect their rights.
By advocating as a body, professionals can tackle the barriers to children’s rights,
rather than simply treating the consequences.
Children themselves have a contribution to make to their own protection in
conjunction with adult advocates.
A greater recognition of children’s rights in: a) individual professional practices and
programs, b) the delivery of services and c) public policy are needed if the optimal
health, development and well-being of all children are to be protected and promoted.
A large percentage of children in our society are denied the right to optimal health and
development, either as a result of public policies that impact directly or indirectly on their
lives, or as a failure to take the action necessary to provide them healthy and safe
environments. Because of their youth, children are disproportionately vulnerable to the
harmful effects of such policies.
Child poverty has a profound impact on children’s physical, mental, emotional and
psychological well-being. The impact of inadequate diets, overcrowding, unsanitary
housing, lack of education, etc. can extend well beyond childhood to impair longterm life chances.
Childhood accidents are far more common among poor children and can be
exacerbated by the priority given to motorists than pedestrians, by failure to invest in
safety programs, lack of attention to safety in design of public spaces, etc.
Environmental pollution is damaging the health of millions of children through toxic
emissions, widespread use of chemical pesticides, exposure to landfills and other
sources toxic substances differentially disposed in core urban and rural areas, etc.
The fashion industry is encouraging increasing numbers of young girls to aspire to
images of thinness which cannot be attained while eating a normal diet, resulting in a
high prevalence of bulimia and anorexia.
Food advertising targeted at children encourages a desire for foods that are high in
fat, sugar and salt, leading to a greater incidence of obesity and other chronic
Violence is disproportionately targeted at children. The risk of homicide for babies
under one year is many times greater than the risk for any other age group. Physical
punishment remains legal in the US and is widely used and tolerated despite the
growing body of evidence of its harmful impact on children.
In these and many other ways, public policies influence whether children’s rights are
being protected and promoted in our communities. Too often, the best interests of
children are subjugated to other more powerful or influential interests. Health and other
child serving professionals deal daily with the consequences of the failure to respect the
rights of children to the best possible health, to an adequate standard of living, to a safe
and healthy environment and to life itself. More than any other professionals, they can
bear witness to the detrimental impact of public policy on the lives of children. Through
their involvement with individual children, they are able to document the cumulative
consequences of social and environmental factors that are harmful to their well-being.
This provides them with the evidence with which to advocate for the changes necessary
to prevent harm to children, rather than simply to intervene and treat once the harm has
The need for advocates for children. Children are relatively powerless in advocating
for protection of their rights. They lack access to the channels that adults use to influence
public agendas and debates. As a group:
They cannot vote,
They rarely have access to the courts,
They are not members of trades unions or professional associations,
They have little or no access to the media, and
They do not have powerful lobbies acting on their behalf to counter the wellresourced and sophisticated corporate lobbies that increasingly influence
It is therefore most important that those adults, who are informed about the situation of
children and committed to promoting greater respect for their rights, are willing to
become advocates for them. In so doing, it is important that they also work with children
to help them articulate for themselves their concerns and priorities for change.
There are many ways in which child health and serving professionals can seek to
use their expertise and knowledge of what is happening to children as a consequence of
public policy. The issues of primary concern will vary from community to community, and
there will invariably be more issues than there are time and resources available to commit.
Criteria for determining where to focus energy are useful.
The scale and degree of harm. How many children are affected and with what degree
of severity?
The degree of urgency. Is it an issue that should be addressed urgently if many more
children are not to be affected?
The potential for enlisting broad public support. A campaign is more likely to be
successful if you can attract other partners to support the cause?
The topicality of the issue. If the issue has attracted media attention, or public
interest, you can capitalize on its topicality to promote the case from a children’s
rights perspective.
The current political environment. You can exploit windows of opportunity, for
example, when a relevant bill is passing a legislative body that could be amended to
introduce better protections for children, or a general election where you can lobby
political parties to take your issues of concern seriously.
The likelihood of success. It may be a better investment of time to focus on policy
issues that are attainable in the short-term, as well as other more challenging longterm goals.
Tools for advocacy. The first task in seeking to advocate improvements in children’s
rights to optimal health and development is to identify what changes will be necessary.
Will it require legal reform, additional resources, a change of policy, or a shift in public
attitudes? Can change be achieved locally or does it require state or national reform? For
example, the introduction of a safe route to school to reduce traffic accidents and promote
children’s opportunity for physical exercise could be lobbied for locally. A change in the
law to limit corporal punishment would require a state or national campaign and legal
reform, as would the introduction of stricter controls on advertising junk food during
children’s television viewing times.
Once the required/desired change has been identified, appropriate action can then be
taken to highlight issues of concern and campaigns for change. The following are some
steps to consider.
Gather evidence from other practitioners in the field, and from children
themselves on the extent and nature of the problem.
Commission and undertake specific research into the issue.
Publish articles, both in professional journals and also in the popular media,
highlighting the impact of a particular public policy on children’s well-being.
Seek other partners and stakeholders, including parents and children to press for
Organize conferences to gather experts together to share and exchange evidence
and strategies for achieving change.
Look internationally for evidence of how comparable issues are addressed.
Lobby government and legislators to introduce the changes necessary to protect
children’s well-being, using the evidence gathered from all sources.
Identify possible legislation into which changes could be introduced to achieve
the changes being sought.
Issue press releases whenever an opportunity arises to link your issues of concern
to topical news items.
Highlight how the government is failing to comply with its legal and ethical
obligations to protect the rights of children.
Gather evidence from children on their experience of the issues of concern.
Involve them in conferences and articles, and use direct quotes from their
The plight of children living in poverty is an example of a set of issues faced by child
health and serving professionals every day. Children living in privately rented
substandard multi-occupied housing are disproportionately vulnerable to accidents, fire,
food poisoning, respiratory disease and infestation. In such environments, they are denied
many possibilities of respect for their right to the best possible health and other elements
of well-being. If professionals are witnessing a consistent pattern of problems related to
the environment, e.g., asthma, lead poisoning, accidents, etc., the only way they can
protect these children’s rights is to focus on the cause of the problem.
The intent of this overview has been to introduce professionals to the relationship
between children’s rights and the health and well-being of our communities’ children.
Insight into how the Convention and children’s rights can be used as a framework for
structuring our work together will hopefully serve as a catalyst for fundamental changes
in how we conceptualize children and childhood, how they are treated, how we structure
our society and how we as professionals do what we do. Unless we look beyond the
perimeter of our own programs and traditional approaches to ensure the well-being of all
children, and examine how the social, economic and physical environments in which
children develop can deny them the right to fulfill their optimal health and development,
we will never achieve the outcomes we all seek. An understanding and use of children’s
rights and the Convention provides the promise of a vision of an optimal state of wellbeing for all children.
Power Point Presentation
Grand Rounds
An Introduction to the UN
Convention on the Rights of the