Pictorial support in health visits in Child Health Services provides or limits children's space for participation.

backgroundChildren participate in different health care encounters throughout childhood and sufficient information and a sense of security are prerequisites for the child to participate on their own terms. Pictorial support is preferable for providing information and creating a common understanding among children, caregivers and parents. The aim of the present study is to explore five-year-olds' experiences of using pictorial support during health visits in the Child Health Services from a participation perspective.

methodsThis study used a qualitative design with a hermeneutic analysis. Seventeen five-year-old children were observed during ongoing health visits. The children were then interviewed about their experiences of using pictorial support.

resultsChildren's experiences of using pictorial support from a participation perspective are conditioned by the nurses through provision or limitation of space, as their guidance may provide the children with space to enable autonomy and a self-chosen pace or space to develop understanding. The nurse's guidance may also contribute to limitation of space, which develops resignation.

conclusionIn summary, children's experiences of using pictorial support focusing on the child's opportunity for participation seem to be conditional, affected by circumstances in the situation. It is not enough to provide space and let children use their voice through pictorial support if they have no audience willing to listen or opportunities to influence the visit.