Children treated with psychotropic medication have regular medication follow-ups with registered nurses (RNs) at the child and adolescent psychiatric outpatient care (CAPOC) unit, where RNs are responsible for ensuring that children can actively participate in their care on their own terms. This study explored how RNs in Swedish CAPOC units promote children's participation in medication follow-ups. Five focus group interviews were conducted with in total 32 RNs, and the data obtained were analyzed by qualitative thematic analysis. Three themes demonstrate how RNs adapt the medication follow-ups to promote children's participation: the first concerns balancing the needs and desires of both the child and the parents; the second involves recognizing each child based on their unique circumstances and interests; and the third theme is about how RNs adjust their communication to ensure that the child is given comprehensible information and has the opportunity to express themself. Our findings highlight how RNs promote children's participation in medication follow-ups and the challenges they encounter in accordance with child-centered care. In this three-way relationship with RNs, the child, and parents, RNs need to balance between the child's perspective and the parents' needs and desires.