A. Pediatric clinicians acknowledge the significance of nurturing an independent and trusting relationship with the child. As a child’s primary care provider, the pediatric clinician has the unique opportunity to develop such a bond over time. Even short encounters with children can benefit from the skills required to sustain a longitudinal relationship.

B. The child must be recognized and valued as an equal partner and active participant in his care. This enhances his self-esteem as he learns about and develops responsibility for his own health. The child must view his pediatric clinician as a source not only of treatment but also of guidance and support. He should recognize the pediatric clinician as his physician, not his parent’s. These experiences mold the child’s view of himself and may contribute to his response to health and illness in adulthood.

C. The establishment of a therapeutic alliance with the child allows the pediatric clinician to ascertain important information about the child and his environment such as the child’s strengths, stressors, developmental status, and place in the family and community. Children may also reveal information that the parent is unaware of or may have omitted. At the same time, the pediatric clinician is able to assess language, speech, and auditory functioning.

D. The pediatric clinician models for parents the art of listening to and respecting the views of their child from as early as infancy. The pediatric clinician’s response to the child’s feelings or misbehavior may illustrate to the parent appropriate management techniques (e.g., reflection, limit setting).

A. The reception area. A child-friendly environment conveys to the child that this place is for children. If possible, provide separate areas for children of different ages with age-appropriate décor and materials. Toys, a fish tank, books, a drawing board, room to crawl and walk, child-sized furniture, children’s drawings, and children’s pictures all impart a welcoming environment. Paper and crayons allow the child to draw pictures that may be used to facilitate conversation or to illustrate the child’s perception of himself, his family, or his situation. Consider not having a television in the waiting room as this does not support the message that families should be selective in television viewing and does not encourage parents to interact with their children. A literacy-rich waiting room is a more positive slant on how children and adults can interact around a book.

B. The examination/interview room. Toys, books, drawing materials, child-sized furniture, and child-friendly décor are useful in making the child feel at ease. A quiet, appealing, and private environment encourages the child to interact with the pediatric clinician. There should be no barriers (such as a large desk) between the pediatric clinician and the child, and the pediatric clinician should place herself at the child’s eye level.

C. The greeting. When appropriate, speak to the child first. This promotes the message that the child is the patient. Approach the child in a calm and friendly manner and ask him what he would like to be called. Commenting on a toy or a book that he has brought or the clothes he is wearing can be a pleasant icebreaker. If you use a computer-based electronic medical record, acknowledge to the child that sometimes you will need to type during the visit.

A. Open-ended questions. Start with open-ended questions to allow the child to express his thoughts and concerns for the visit. Further questions may elicit the child’s personal and culturally influenced perception of his situation, helping his pediatric clinician understand his frame of reference. Closed-ended questions may follow open-ended questions to generate additional specific information. Members of some cultures will not respond to or be comfortable with an open-ended question if they are expecting the physician to act in a more directive manner.

B. Pauses and silence. Allowing the child time to organize his thoughts or regain composure and then to express his feelings without pressure shows him respect and concern.

C. Reflection (repetition). If the child makes a puzzling or significant comment, repeat the key words or phrases back in a neutral or questioning tone to encourage him to clarify or elaborate further.

D. Empathy. Acknowledge and respond to the child’s feelings to convey warmth and sympathy. Listen for the message behind his words.

E. Active listening. Provide undivided attention and facilitate the conversation through open-ended questions, silences, and repetition to communicate to the child respect and concern. Both body language (leaning forward, eye contact) and verbal expressions (e.g., “tellmemore”) can convey support and interest, allowing the child to feel comfortable in expressing his feelings and thoughts and thus to participate in the visit more fully.

F. Tracking. Allow the child to set the interview’s style, pace, and language.

G. Summarizing. After explaining the assessment and plan to the child, review the major points. Avoid using medical jargon. Asking the child to summarize what has been said will ensure that the information has been understood. It is helpful to make the recommendations practical and concrete.