Building a child’s trust before a medical procedure: a linguistic case study

When a pediatrician establishes a trusting relationship with a child patient, the chances of a positive outcome for the procedure multiplies. A calm child who maintains a sense of agency and participates fully in the communicative exchange is more receptive to the clinician’s requests and reports weaker sensations of pain. Research has shown how this experience stays with the child, shaping how they approach and manage their health care as adults so the implications of these interactions on clinical practice are manifold. Our study addresses this aspect of health care by teasing apart layers of a 32-minute video-taped exchange between a pediatrician (co-author) and a child she is preparing for a risky ophthalmic procedure. Non-pharmacological methods are key to managing his anxiety and experience of pain because the associated risks increase significantly under deep sedation. When advising about the appropriate language to use with child-patients, most literature focuses vocabulary: use positive words; avoid negative ones. With this study, we demonstrate that although this is so, there is a wide range of techniques exploited by the doctor, operating at higher tiers of communication than the word. We unpack these components in an accessible way, illustrating how they work, and how seemingly disconnected strategies group naturally under easily understood general principles. The pay-off is that fewer overarching principles are easier to grasp and deploy. We hope this snapshot of how linguists and medics can together disclose the most successful facets of a doctor-patient encounter leads to further clinically-helpful collaborations.