Involving Nonspeaking and Speaking Children in Clinical Encounters: An Observational Study of Real-World Clinical Encounters

Aim: This study aimed to identify diverse ways nonspeaking and speaking children are involved in clinical encounters. Methods: The study analysed video recordings of paediatric palliative care encounters in Australia. Conversation analytic coding methods were used to identify embodied (e.g., gesture) and vocal (e.g., grunting) modes of interaction used by all children and lexical verbalisations (i.e., words) used by speaking children. Analysis focused on interactions between children and adults (both family members and clinicians). Results: A total of 38 child patients (seven speaking, 31 nonspeaking), 56 family members and 50 clinicians participated across 60 video-recorded encounters with the child patient present. Analysis identified 1737 spates (i.e., periods) of interaction with child patients. Nonspeaking children were involved in a median of 38.0 spates of involvement per hour and speaking children in a median of 58.7 spates per hour. Observed practices of nonspeaking and speaking children included adult clinicians and family members doing something with a child without speaking, identifying the child as a recipient of some action, assessing the child, telling the child something, and physically tending to the child with verbal commentary. Clinicians and adult family members more often initiated spates of involvement (62.9%) than children themselves and were more responsive to spates initiated by nonspeaking children (89.6%) than speaking children (79.3%). Conclusions: This study demonstrates how children—including nonspeaking children—are regularly involved in clinical encounters. The study findings indicate a need to avoid exclusively focusing on verbal communication, to appreciate the diverse ways that children can be involved in clinical encounters about them.