Often the outcomes of treatment and a child’s progression are unknown or ambiguous. This can be really difficult for parents and children who often compare progress to children without physical impairments or learning difficulties. As a healthcare professional you often feel like you should have all the answers, it can feel uncomfortable to say you don’t know, but I try to be honest and say ‘we don’t know how far we can get, but let’s focus on the next small step’ so that they have something to focus on. We review the small steps regularly. This shows change and progress, which can reassure parents and children.