Training of Lecturers

Parents’ role in the Pediatrician-Child-Parent Communication Triangle. Toddlers/ Children/ Adolescents

Parents’ role in the doctor—child communication varies according to the child’s age. Up to the age of 6-7 the parent is the person who can communicate better and functions as a main translator of the child’s symptoms, questions and wishes in general. Around the age of 6-7 children can provide a better description of their symptoms than their parents (Tates & Meeuwesen 2001). In the age group of 6-12-year-old children, parents’ role consists mainly of encouraging the child to communicate directly with the doctor, telling the symptoms in his own words, providing help when needed. For pediatricians, parents’ stories about the child’s hobbies and interests are an excellent information source in building trust and finding out how to build a common ground with little patients. Teenagers’ and young adults’ medical visits are mostly characterized by a more passive parent or a parent isn’t present at the medical encounter at all.

In 2000, Tates and Meeuwesen published a study about Dutch children’s participation in medical encounters after examining videotaped observations of 106 medical interviews taken over a period of almost 20 years. Results showed that the child’s control in the medical consultation is rather limited, though, over the years, they participate more actively. Another important finding of the study was “the difference in the way GP and parent accommodate their turntaking patterns to the child; parental control appears to be constant over the years, and is not related to the age of the child, whereas the GP is considering the child’s age” (Tates & Meeuwesen 2000).

The same researchers found that most of the studies have ignored the implications of a child's presence in medical encounters (Tates & Meeuwesen 2001). Instead of focusing on the doctor-child-parent interaction studies on doctor-patient communication examine predominantly the dyadic interactions between adults. Many previous researches that claim to focus on the interaction in the doctor-parent-child triad used methodologies based on dyads. As the interactional dynamics of a triad differ fundamentally from those of a dyad Tates and Meeuwesen proposed to conduct more triadic analyses.

A triadic analysis was carried out by Tates et. al (2002) with the purpose of developing a typology for doctor-parent-child relationships and providing empirical validation for the typology proposed. In total, three different groups have been found by the research team: 1) both adults supportive (was found mainly in interactions with older children) 2) both adults non-supportive (the younger the child the more GP and parent were non-supportive) 3) GP supportive and parent non-supportive (this pattern was also age-related and occurred more frequently in older children). Based on the analyzed videotapes recorded in pediatrician offices the researchers concluded that” ninety percent of the consultations conclude in a non-participatory manner, partly due to the decrease in the GP’s supportive behavior. The finding that GPs are less child-oriented towards the end of the consultation is in accordance with previous studies which state that physicians seldom discuss treatment decisions with children. (…) the parental need to express their concern and to be involved in treatment decisions (…) may explain the shifts in GP’s supportive behavior towards the child (…) The GP hardly ever resumed his or her supportive behavior towards the child after the dyadic discussion with the parent” (Tates et al. 2002). In total, 58 GPs participated in the study, the majority, 91%, being male.

Therefore, a doctor’s main responsibility in the parent-child-doctor communication is 1) to evaluate if the child is ready to participate actively or not in that specific situation (for example, a child with a child with an open, outgoing personality can be different when ill); is there any constant factor that prevents the child from communicating openly (shyness); is the child old/cognitively developed enough to tell his own symptoms 2) to ensure the possibility for the child to tell the symptoms, express his emotions and ask questions, maintain the child’s active role in the conversation and reduce parent involvement/engagement when necessary).

Online Resources

• Tates K., Meeuwesen L. (2001) Doctor-parent-child communication. A (re)view of the literature. Social Science and Medicine, 52, 839-851.Studies on doctor–patient communication focus predominantly on dyadic interactions between adults. The aim of this review study is to evaluate the state of the art of research into doctor–parent–child communication, and to explore the specific role of the child.
• Tates et al. (2002) Doctor-parent-child relationships: a “pas-de-trois”. Patient Education and Counseling, 48, 5-14The child’s opportunities to participate are rather limited and parental speaking for the child is, in a way, institutionally co-constructed. This study aimed at further characterizing the relationships within this triad by developing a typology of doctor–parent–child interactions, which classified adult behavior in terms of supporting versus non-supporting child participation.
• Tates K., Meeuwesen L. (2000) “Let Mum have their say”: Turntaking in doctor-parent-child communication. Patient Education and Counseling, 40, 151-162Legislation in the Netherlands requires that children should play a part in decision making regarding their own health care. In order to get a grip on aspects of asymmetry and control in doctor–parent–child communication, the present study explores the turntaking patterns in this triad at the general practitioner’s surgery, and makes a comparison over the years.