| Summary: | <h4>Background</h4>According to Article 12 of the United Nations Convention on the Rights of the Child, therapists are duty-bound to include children in decisions that impact them. Although occupational therapists champion client-centred, collaborative practice, there remains a paucity of studies detailing children's rights and experiences of decision-making in pediatric occupational therapy.<h4>Purpose</h4>This qualitative study described the decision-making experiences of children, parents and therapists in occupational therapy.<h4>Methods</h4>Semi-structured interviews were conducted with 17 participants (six children, five parents and six occupational therapists), and data analysed using thematic analysis.<h4>Findings</h4>Three themes emerged: 1) Goal-setting experiences; 2) Adults: child-rights gatekeepers or defenders? and 3) Decision-making in context. Findings suggest that decision-making is mostly adult directed, and children's voices are subsumed by adult-led services, priorities, and agendas.<h4>Implications</h4>Children's rights need to be embedded as an aspect of best practice in providing services that are child-centred in occupational therapy practices and education.
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