This study focuses on one of the strategies that a physician can use as a stepping stone for reducing anxiety and building trust with a young child: getting her involved in conversation. Paediatric encounters usually involve at least three participants: the paediatrician, the child and one parent. This type of multiparty setting can lead to the re/building of different 'participation frameworks' (Goffman, 1981; Goodwin, 2006), involving, more or less directly, two or three participants. From this perspective, paediatric encounters may be challenging in several ways: physicians need to get maximum information in a constrained time frame; child patients may not be (or not considered to be) sufficiently linguistically, cognitively or socially mature to provide the physician with the information in the time given. Parents and physicians may thus run the risk of leading the conversation and relegating the child to the role of bystander.
This study deals with the situation where a pediatrician meets with a 5 year-old child and his mother, in order to prepare the child for a risky medical intervention during which the child will have to remain awake. Based on a 32-minute video-taped interaction, it unveils various linguistic resources the doctor uses in order to involve the child in the conversation: terms of address, pronouns, gaze, gestures, touch, body postures, questions, vocabulary and syntax. It also shows how the physician progressively adapts her building of participation frameworks to the verbal and non verbal cues she obtains from the child feeling more and more engaged and confident.
Getting the child involved in the conversation is part of a more global strategy the paediatrician uses to augment alignment and reduce social distance from the child (Aronsson & Rindstedt, 2011). It enables her to implement myriads of other strategies to build the child's trust, most of which then get easily captured in terms of facework performed by the pediatrician (Goffmann 1967; Brown & Levinson 1987).
The effects of involving the child in her medical visits are well-known: it improves the physician-child bond as well as the child's retention of medical recommendations (Lewis et al., 1991); it enables the child to gain a greater sense of control over her medical care (Sisk et al., 2021), and it helps to socialise the child into the role of patient (Stivers, 2012). This case study enables us to underline the feasibility and the efficiency of this essential feature of paediatric consultations in practice.
Selected references:
Aronsson, K, & Rindstedt, C. (2011). Alignments and facework in paediatric visits: Toward a social choreography of multiparty talk. In C. N. Candlin & S. Sarangi (Éds.), Handbook of Communication in Organisations and Professions (pp. 121-142). De Gruyter.
Goffman, E. (1981). Forms of talk. University of Pennsylvania Press.
Lewis, C. C., Pantell, R. H., & Sharp, L. (1991). Increasing Patient Knowledge, Satisfaction, and Involvement : Randomized Trial of a Communication Intervention. Pediatrics, 88(2), 351‑358.
Stivers, T. (2012). Physician–child interaction : When children answer physicians' questions in routine medical encounters. Patient Education and Counseling, 87(1), 3‑9.
