Parler aux petits : Exploration de la communication pédiatrique – Talking with tinies: Exploring pediatric discourse

The speakers and public came from various backgrounds and included parents, researchers in linguistics and philosophy, medics (nurses, pediatricians, GPs), MA students in linguistics and from medical schools, and PhD students in linguistics, psychology and neurosciences. This varied mix was precisely what the organizers had hoped to achieve. With some 50 attendees, the event sparked lively debate and cross-fertilization. Comments such as “I didn’t know that this is what linguists do” and “I wasn’t aware that medics pay so much attention to how they talk to children” underscored the mutual learning and new perspectives gained.

The main questions addressed were: How do adults communicate about and with children in healthcare settings? Do doctors and nurses converse mostly with parents during medical encounters, thereby relegating the child to the role of bystander? Or do they develop verbal and non-verbal strategies to help calm anxious children and to give them a central voice? And how do parents help shape the discursive dynamics of this triad?

The introductory presentation set the scene: the general agenda was explained, the programme of the day announced, and a first part of the PANIC² results presented. The focus was on the vocabulary used by the pediatrician in a consultation that took place in UZGent (Belgium). In a video fragment, the doctor was shown preparing a 5-year-old boy, accompanied by his mother, for an invasive eye laser procedure. It became clear that she used a lot of positive words (fun, cool), avoided reference to pain and things scary, in order not to activate negative emotions. So far, this conforms with what are standard recommendations for medics. But it was shown that her use of modal verbs was also very telling, for instance, in that she never imposed (through the use of have to or must) but rather referred to what the boy could do (can, may) and inquired into what he was willling to do (will), and this way gave him agency.

Bénédicte Lombart (Groupe hospitalier Sorbonne Université, LIPHA, Université Gustave Eiffel) and Lucy Bray (Edge Hill University) are HCPs who are active in initiatives that aim to turn procedures and consultations into better experiences for children. Bénédicte is one of the founding members of Pédiadol. Her talk focused on the concept of transient empathic blindness (cécité empathique transitoire). This concept refers to procedural contexts in which the child temporarily ‘disappears’, in spite of actors nevertheless striving to provide the best possible care: Quand la cécité empathique transitoire des adultes rencontre l’inertie relationnelle de l’enfant. She presented the results of a study in which musicians are present during consultations, in order to test the beneficial effect of music. Musicians trained to work in medical contexts were invited and together with a colleague, Bénédicte examined if and how their presence affected the behaviour or children, HCPs, and parents.

Lucy is one of the driving forces behind the I-SUPPORT project, the International collaborative rights-based standards to SUpport Paediatric Patients during clinical prOcedures by Reducing harm and establishing Trust. She is particularly interested in the education, information needs and preparation of children and their parents. The starting point of her talk was that children not well prepared or informed about what will happen can experience anxiety and distress and may need to be held. She presented the results of a study in which children themselves were asked what questions they had about the procedures and what information they wanted to receive. By listening to the child’s voice about their needs, they can be better prepared and cope with a procedure.

Demi Krystallidou’s (University of Surrey) research is focused on multi-lingual contexts. She investigates consultations in which an interpreter is called upon and how this impacts on the dynamics of the exchange. She presented a case study: “Are you the interpreter, then?” When a bilingual child patient holds the reins of mediated communication in a language-discordant medical consultation. She showed how a bilingual 10-year-old child, who, unlike her dad, was proficient in the doctor’s mother tongue, gradually gained increased autonomy and took control. She described how this resulted in a clash between the two professional authorities (the doctor and the interpreter) and parental authority.

Among the factors that were discussed were the importance of age, and the need to adapt one’s language to the socio-cognitive development of children. At the same time, irrespective of age, as Bénédicte explained, things get out of hand if the child is “out of him/herself with anxiety”, and no longer in the “here and now”. It can be important to simply stop the procedure, tell the parents to take the child for a walk, or simply walk around in the room with the child until they are again ‘present’. ‘How to tell a kid to undress?’ was one of the very practical topics that came up, as well as the crucial role of parents in medical consultations. One medic pointed out that more often than not, it is the parents that are anxious, thereby transferring their anxiety to the children. Parents are often “former traumatized children”, as Bénédicte put it. But things also work out for the best, as became clear when a CHU Lille pediatrician shared a telling anecdote with the audience. She recalled a recent procedure with a 5-year-old, who had a blood sample taken. He left the procedure room but then ran back and cried out energetically: “Having a blood sample taken! How cool is that!” (Une prise de sang, comme c’est cool!).

The workshop was a warm gathering of people who care about pediatric care and are open-minded about sharing experiences and learning from others and other domains, with very constructive interactions resulting. It created a space for fruitful interdisciplinary collaboration and showed that there is still a lot of ground to be covered.

One of the next steps in the IMPACT project is a fully anonymous questionnaire aimed at parents. It is our aim to disseminate it, not in hospitals or GP practices, but rather through non-medical social networks, schools, municipal offices, etc. – any space where parents of children between 3 and 11 years old are likely to be found. So here’s a call for participation! If you have a child in that age range, or if you know people who do, and if you/they have taken your/their child to a doctor in the past two months, please fill in or invite them to fill in the questionnaire. As we aim to collect data in France, Belgium and the UK, there are three versions (French, Dutch, English).

→ French questionnaire

→ Dutch questionnaire

→ English questionnaire