Paediatric consultation with child, young person and family — branching viva

Opening

A paediatric consultation is a triad — clinician, child and family — and the child is a person and an informant, not a prop. I structure every encounter with Calgary-Cambridge, adapted to developmental stage, and I hear the child's voice alongside the parental account before I close. [1] [2]

Branch A — the 3-year-old

The parent is the primary historian. I observe the child through play and on the parent's lap, assess alertness and work of breathing, and manage stranger anxiety with a toy and short, concrete reassurance. I build rapport before any examination, then sequence from least to most invasive, leaving ears and throat until last so the child learns to trust me through the easy parts first. [1]

Branch B — the 14-year-old

I frame confidentiality and its limits up front, then offer the young person time alone. In private I run a HEEADSSS psychosocial screen — home, education, eating, activities, drugs, sexuality, suicide and depression, safety — which surfaces risks no parent-present history reveals. I respect emerging autonomy and capacity, and a participatory style raises engagement and visit satisfaction. [3] [1]

Branch C — the complex-chronic 8-year-old

The child is both patient and experienced self-advocate. I elicit her own words about symptoms and goals, gather the parental ideas, concerns and expectations, and coordinate across the multiple teams already involved. I name a key contact, write a plain-language plan, and avoid dumping new targets on a family already carrying a heavy service load. [2]

Difficult conversations

For breaking bad news I use SPIKES — setting, perception, invitation, knowledge, emotions, strategy and summary — adapted to the child's developmental level. I tell the truth in words the child can hold and keep the dialogue open, rather than delivering a single devastating sentence or agreeing to deception. [4]

Closure

Whatever the age, I close with teach-back, an explicit and documented safety-net — what to watch for, when, and where to return — and a named follow-up. A well-structured consultation is a safety intervention, not a soft skill: it improves disclosure, adherence and recall, and reduces complaint. [1] [2]