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PEDIATRICS Vol. 102 No. 3 September 1998, pp. 563-568

Children's Contributions to Pediatric Outpatient Encounters

Received Nov 17, 1997; accepted Feb 17, 1998.

Alexandra Maria van Dulmen

From the Netherlands Institute of Primary Health Care (NIVEL), Utrecht, the Netherlands.

Objective.  Generally, increasing attention is being paid to the quality of doctor-patient communication. However, children's contributions have been, until now, primarily ignored in communication research, although there are indications that considering their views increases satisfaction and compliance. In the present study, we examined how children contributed to communication during outpatient pediatric encounters and what factors were associated with children's contributions.

Patients.  Twenty-one consulting pediatricians videotaped a total of 302 consecutive outpatient encounters.

Design.  Multilevel analysis was used to take into account the similarity among encounters with the same pediatrician.

Results.  Children's contributions to the outpatient encounters were limited to 4%. Pediatricians directed one out of every four statements to the child. Although pediatricians asked children a lot of medical questions (26%), only a small part of the medical information (13%) was directed at the children. Apart from social talk and laughter, the amount of pediatrician-child communication increased with children's age. Communication with children suffering from disorders of the nervous system seemed to differ from that with children suffering from other diseases. Allowing children more room in the medical visit did not seem to increase the duration of the visit.

Conclusions.  Although recent legislation requires children to be adequately informed, in pediatric outpatient encounters information still tends to be directed primarily at the parents. Children do get the opportunity to talk about social and psychosocial issues. Pediatricians may need to acquire similar communication skills to discuss medical-technical issues with the children. conversational contribution, information exchange, pediatrician-child communication, social talk, video recordings. .




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