The pediatrician’s office: how to talk with a child and parent

Three perspectives

In a pediatric consultation, three people may describe the same problem from different perspectives. The parent knows how the illness has progressed, observes the child at home and may have concerns of their own. The child experiences the symptoms, even if they cannot always describe them as an adult would. The doctor brings the information together and is responsible for the diagnosis. It is therefore worth asking the child how they feel in an age-appropriate way, then asking the parent separately what they have observed. A review of 21 studies of conversations between doctors, children and parents shows that children’s participation varies with age and circumstances. What the parent says is valuable, but does not always replace the child’s own answer. Even a brief question addressed directly to the young patient helps establish what comes from their own experience.

Starting the visit

The start of the visit can make room for both the child and the parent to speak. Even when the parent explains the reason for the consultation, the doctor can greet the child first and explain in simple terms what will happen. The doctor can then agree with the parent which issues are most urgent today, so their concerns are not left unanswered. Before taking the history, the doctor can tell the child what they will ask and give them time to answer. Only then need they ask the caregiver to fill in the history or correct details. This order does not silence the parent; it lets the doctor hear how the child describes the problem before the adults steer the conversation. If the child cannot answer, the doctor can simplify the question or rely on the parent’s account for the rest of the history.

When the parent answers for the child

When a parent quickly answers every question, the doctor need not turn it into a dispute. The caregiver may know important details the child cannot remember, but it helps to distinguish their observations from the young patient’s own words. If the child can answer, the doctor can calmly return to them with a simpler question: where it hurts, when they feel it or what they are worried about. With an older child, it may help to explain the order: “First I’ll ask you how it feels, then I’ll ask your mum for the details.” The parent still has room to describe how the symptoms developed. The aim is not to pit the child against the parent in front of others, but to gather both accounts without attributing words to the child that they did not say.

Anxiety and difficult news

Anxiety may be about the examination or about what the family will hear during the visit. Before examining the child, the doctor can explain in simple language what they will do and what the child can expect. It is also worth asking both child and parent what worries them most, as their answers may differ. Before sharing difficult news, it helps to check what the child already knows and which words they use themselves. If the child can take part in the conversation, their concerns need not be discussed only with the parent. The review of 21 studies of three-way communication offers no single approach for every age group. That is a reason to tailor explanations to the particular child and situation, rather than assume in advance how much the child wants to hear.

Decisions and the child’s involvement

When the conversation moves from explanations to decisions, the child’s involvement still needs to match their age and abilities. The doctor can explain to the parent why they are asking for the child’s view, while making clear to the child what the caregiver and doctor are responsible for. Any required consent must be handled according to the applicable practice; asking about the child’s experience or preference does not replace it. A systematic review of 79 studies on shared decision-making in pediatrics highlights, among other factors, the importance of time, emotions, power dynamics and the quality of information. The studies were too varied, however, for a meta-analysis or a ranking of the most effective ways to communicate. The aim, then, is to provide understandable information and room for questions without promising a single solution for every family.

When a separate conversation is needed

Not every subject is easy to discuss with everyone present. A doctor may notice that a child falls silent when an embarrassing topic comes up and ask whether they would prefer another way to talk about it. But the doctor should not assume that every family wants the same division of time and opportunity to speak. The child’s age and safety considerations matter when planning the rest of the visit. If some time alone with the parent or teenager is needed, it is worth explaining the purpose and limits of confidentiality beforehand. That way, separating the conversations does not feel like excluding someone from a decision. Afterwards, the doctor can return to what has been agreed together, to an extent appropriate to the situation and clear to those involved.

A summary for two audiences

At the end, one version of the instructions may not be enough. The child should hear in simple words what will happen next and what they can do or report. The parent needs a care plan, guidance on when to get in touch and warning signs to watch for. Rather than stopping at “Is everything clear?”, the doctor can check separately what each has taken away. The child can be asked to explain the next step in their own words, and the parent to describe the instructions and when they should get in touch again. If their answers differ or anything remains unclear, there is still time for a brief explanation. Closing the visit this way gives both a chance to leave with a plan suited to their roles.

A parent knows the child’s medical history, while the child can describe their symptoms. A pediatrician needs both perspectives, although the child’s involvement should depend on their age and the situation.

Empatyzer in conversations with children and parents

Before a visit, a pediatrician can talk with Em to prepare two ways of explaining the same examination: short, age-appropriate sentences for the child and fuller information for the parent. They can also plan an opening that addresses the child and caregiver in turn, rather than directing every question to the adult from the outset. The “About me” feature can help the doctor notice a tendency to leave the child out of the conversation; it cannot replace seeing how this particular child responds in the office. When preparing to close the visit, Em can help frame separate questions for the child and parent to check their understanding of the plan, along with one summary both can follow. Micro-lessons can reinforce the habit of checking understanding this way. This is preparation for a conversation, not a fixed script: during the consultation, the doctor adapts their words to the child’s age and answers, the parent’s concerns and how the examination unfolds.