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Whilst there is growing awareness of the case for children and young people's participation in health services and health service research, there is limited evidence on how this apparent commitment to children's right to participate translates into practice.

The chapter, co-authored with and young people, draws on examples from the authors' original research and lived experience to consider the impact of the COVID-19 pandemic on children and young people's participation in the United Kingdom (UK) National Health Service (NHS). There is evidence of children and young people in the UK becoming more reliant on parents and carers as conduits for engagement and as sources of information during the pandemic. Additionally, some children and young people with special educational needs and disability and other potentially vulnerable groups have engaged less with health services and have been excluded from participating by a move to digital platforms. Conversely online and phone involvement and consultations have led to higher inclusion for others. Adapting by necessity to COVID-19 has highlighted the potential for doing things differently and developing more participatory and inclusive practice in collaboration with children, in the UK and elsewhere. It is critical that children are involved in shaping the development of participation practice which challenges and reshapes institutional practices in health services and beyond.