Why: | It is beneficial to the child to be involved in their medical consultation:
A child's involvement in their own health care has been shown to be beneficial with regard to the child's health outcomes. Children's active participation in their own care is practical as well as empowering. As children move towards the teenage years they can take on increasing responsibility for their own health in an age-appropriate way.
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| It is good practice to involve the child in their consultation:
Children over the age of 5 years old can be presumed competent to participate in health decisions. The General Medical Council, the Department of Health, and the British Medical Association advocate active child participation in decisions regarding their care.1–3 Children should be given appropriate information to aid shared decision-making and be asked for consent as appropriate.
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| Children are likely to be able to speak for themselves:
Primary school children are capable of complex tasks such as working computers, playing intricate games, and doing homework. A competent child may consult alone when it is necessary or if it is in their best interests.
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How: | Triadic consultations:
Consultations with children are almost always triadic: children are usually seen with an adult carer.4 The adult carer is likely to have brought the child to the doctor because they have a concern.5 An adult carer who has been able to voice their concerns early in a consultation is unlikely to interrupt doctor–child talk.5
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| Inviting the child to participate. Factors in the consultation observed to promote child involvement:5
Seating — triangular arrangement promotes triadic talk. A child obscured by an adult inhibits participation. Allowing the child or the adult carer to say why they have come. The child is not likely to speak unless invited to by one of the adults. Inviting the child to speak:
use the child's name; look at the child; ensure the parent/adult can see that the doctor/nurse is looking at the child; if the adult answers for the child, address a subsequent question to the child while looking at the child.
Give the child time to answer. Listen to the child.
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What next and when: |
Evidence suggests that children have little involvement in their consultations. They may join in social talk, greetings, giving the history, and cooperating with the examination but are unlikely to be involved in the planning and decision making parts of the consultation.4 Children have little quantitative say in the consultation. Paediatric consultation studies in UK showed the child talking took up 4.2–5.42% of the consultation.4 Parents/adults speaking for the child is the norm. All parties in the triad may be socialised to this position.4 Children may have concerns about their health, and not all are going to want to consult on their own behalf.5
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Patient information: | Department of Health. Consent— what you have a right to expect. A guide for children and young people. London: HMSO, 2001. |
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References/Web links: | There is a shortage of research evidence in this area:
General Medical Council. 0–18 years: guidance for all doctors. GMC publication, 2007 http://www.gmc-uk.org/children/index.asp Edge P. Consent, rights and choices in health care for children and young people. London: BMJ Books, 2000. Department of Health. National Service Framework for children, young people and maternity services. London: HMSO, 2004. Cahill P, Papageorgiou A. Triadic communication in the primary care paediatric consultation: a review of the literature. Br J Gen Pract 2007; 57: 904–911. Cahill P, Papageorgiou A. Video analysis of communication in paediatric consultations in primary care. Br J Gen Pract 2007; 57: 866–871.
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| More top tips can be found at: http://www.addenbrookes-pgmc.org.uk/handouts.asp?title=Primary%20Care
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Who are you: | Patricia Cahill, GP, Ipswich, Suffolk. Email: patriciacahill{at}doctors.org.uk
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Date: | June 2008 |