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James Asc gee (1909–55)


Seeing a child as a patient means you are dealing with at least one extra person in the room. Communication and rapport building need to be done with both the child and those who have brought the child (usually the parents). By engaging the child, you will usually win over the parent. Parents are often apprehensive about bringing their child to the doctor, concerned to the child might misbehave or do or say something to embarrass them. By displaying a natural interest in and ease with the child, a tolerance of child behaviour (or misbehaviour) and being generally ‘child friendly’, the consultation is more likely to be successful.


Engaging children can be done from the moment they are called from the waiting room. All of the usual rapport-building skills we use for adults (see CHAPTER 4) can be utilised with children. Respect, genuine interest in them, active listening and use of body language all matter with children, perhaps even more so than for adults as children naturally have less developed communication skills.


There is also a different style of communication required and this is age dependent. Infants will be dominated by emerging object permanence skills (e.g. playing peek-a-boo), attachment (they will constantly refer to their parent), separation and stranger anxiety. Toddler and preschooler communication is dominated by play, particularly ‘pretend’ or ‘imaginative’ play. Pretending to be a scary bear, to see animals in their ears when you examine them or to believe they are a different age from what they actually are will fire their imagination and make them curious in and more comfortable with you.


Primary school-aged children are old enough to have conversations about their pets, favourite toys, TV shows or movies (merchandised clothing they are wearing or accessories they are holding can give clues to these), their friends, teachers or school. Other rapport-building strategies include:


  • greeting children as well as parents

  • asking their name (even though you already know it) and/or what they like to be called

  • asking their age (even though you already know it)

  • if present, engaging the siblings too (e.g. asking a small child whether he or she is helping Mummy with the new baby)

  • talking at their level, not down to them (e.g. child sitting on parent’s knee, or the doctor squatting down or sitting on the floor)

  • having a vague idea of current children’s films, TV shows and their characters (e.g. Disney movies, Thomas the Tank Engine, The Wiggles)

  • having toys in the room, both displayed ...

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