Communication and support
Key points - chapter 3
- Listen to children and young people and consider their views when making decisions.
- Use communication methods that are appropriate to your patient group. Make reasonable adjustments to provide information that children, young people and their parents want or need to know, in a way they can understand.
- Tell children, young people and their parents when you have concerns about abuse or neglect, and how you will act on these concerns, unless doing this may put the child or young person, or anyone else, at risk of harm.
- Get advice if you are not sure what risks are associated with telling parents about your concerns and how best to manage such risks.
Meeting communication needs
Meeting the language and communication needs of children, young people and parents is important in any aspect of care, but it is especially important if you suspect abuse or neglect. If you know in advance that child protection concerns will be discussed during a consultation, you should make sure arrangements are in place to meet the language and communication needs of the child or young person and their parents. This might include, for example, using an independent advocate or interpreter. If you suspect abuse or neglect, you must not rely on children or other family members to interpret for the parents or depend on parents to interpret for the child or young person.
You should be able to use methods of communication that are appropriate to your patient group. For example, if you are communicating with very young children or people with learning disabilities, you should be prepared to use methods such as age-appropriate language, flash cards or signs to communicate effectively. Advice and support from organisations with specialist knowledge of specific disabilities can help you to meet the language or communication needs of children, young people or parents who have particular disabilities.
Communicating with children and young people
Children and young people are individuals with rights that you must respect. You must listen to children and young people and talk directly to them, taking into account their age and maturity. You must answer their questions honestly and make sure they know who they can go to for help or support (see Sources of independent advice and support for parents and families for examples of organisations that can give advice and support).
You must take children’s and young people’s views seriously and not dismiss their concerns, fears or views because of their age. Even if children are not mature enough to make decisions for themselves, their views and preferences are still important and you must take them into account when assessing their best interests. For more advice, see paragraphs 14 – 21 of 0–18 years: guidance for all doctors.8
Effective communication between doctors and children and young people is essential to the provision of good care. You should find out what children, young people and their parents want and need to know, what issues are important to them, and what opinions or fears they have about their health or treatment. In particular you should:
- involve children and young people in discussions about their care
- be honest and open with them and their parents, while respecting confidentiality
- listen to and respect their views about their health, and respond to their concerns and preferences
- explain things using language or other forms of communication they can understand
- consider how you and they use non-verbal communication, and the surroundings in which you meet them
- give them opportunities to ask questions, and answer these honestly and to the best of your ability
- do all you can to make open and truthful discussion possible, taking into account that this can be helped or hindered by the involvement of parents or other people
- give them the same time and respect that you would give to adult patients.
You should make it clear that you are available to see children and young people on their own if that is what they want. You should avoid giving the impression (whether directly, through reception staff or in any other way) that they cannot access services without a parent. You should think carefully about the effect the presence of a chaperone5 can have. Their presence can deter young people from being frank and from asking for help.
You should take children and young people’s views seriously and not dismiss or appear to dismiss their concerns or contributions. Disabled children and young people can feel particularly disadvantaged in this respect.
Children and young people usually want or need to know about their illnesses and what is likely to happen to them in the future. You should provide information that is easy to understand and appropriate to their age and maturity about:
- their conditions
- the purpose of investigations and treatments you propose and what that involves, including pain, anaesthetics and stays in hospital
- the chances of success and the risks of different treatment options, including not having treatment
- who will be mainly responsible for and involved in their care
- their right to change their minds or to ask for a second opinion.
You should not overburden children and young people or their parents, but give them information at an appropriate time and pace, and check their understanding of key points.
You should talk directly and listen to children and young people who are able to take part in discussions about their care. Young people who are able to understand what is being said and who can speak for themselves resent being spoken about when they are present. But younger children might not be able to understand what their illness or proposed treatment is likely to involve, even when explained in straightforward terms.
You should only keep the type of information described in paragraph 17 from children or young people if:
- it would cause them serious harm (and not just upset them or make them more likely to want to refuse treatment)
- they ask you to, because they would prefer someone else to make decisions for them.
You have the same duty of confidentiality to children and young people as you have to adults. But parents often want and need information about their children’s care so that they can make decisions or provide care and support. Children and young people are usually happy for information to be shared with their parents. This sharing of information is often in the best interests of children and young people, particularly if their health would benefit from special care or ongoing treatment, such as a special diet or regular medication. Parents are usually the best judges of their children’s best interests and should make important decisions up until children are able to make their own decisions. You should share relevant information with parents in accordance with the law and the guidance in paragraphs 27, 28 and 42 to 55.
In some cases, having a parent in the room during a consultation may discourage a child or young person from being open about what has happened to them, or about any concerns or fears they have. In these circumstances, you should consider speaking to the child or young person without the parent present, in a suitable environment and with appropriate support available to them – for example, by having another health professional, an experienced colleague or a support person present.
Communicating with parents
Good communication with parents is essential. Parents generally want what is best for their children and are experts in identifying when their child’s behaviour is not normal for them and may be due to ill health. You should acknowledge parents’ understanding of their children’s health, particularly where a child’s age or disability makes it difficult to communicate with them.
Most people do not intentionally harm children in their care. But a small number of parents abuse or neglect their children and are dishonest when telling you about events or their lifestyle. You must listen carefully to parents, children and young people, explore inconsistent accounts and keep an open mind about the cause of a child’s or young person’s injury or another sign that may suggest abuse or neglect.
You should normally discuss any concerns you have about a child’s or young person’s safety or welfare with their parents. You should only withhold information about your concerns, or about a decision to make a referral, if you believe that telling the parents may increase the risk of harm to the child or young person or anyone else. If this is difficult to judge, or you are not sure about the best way to approach the situation, you should ask for advice from a designated or named professional or a lead clinician or, if they are not available, an experienced colleague.
When discussing your concerns with parents, you should explain that doctors have a professional duty to raise their concerns if they think a child or young person is at risk of abuse or neglect. You should explain what actions you intend to take, including if you are contacting the local authority children’s services. You should give the parents this information when you first become concerned about a child’s or young person’s safety or welfare and throughout a family’s involvement in child protection procedures.
You must keep parents informed about what is happening, give them opportunities to ask questions and be willing to answer their questions openly and honestly. Being open and honest with families when concerns are raised about a child’s or young person’s safety or welfare, and avoiding judgemental comments or allocating blame, can encourage families to cooperate and help children and young people stay with their families in safety. You should give parents information about where they can get extra support and independent advice (see Sources of independent advice and support for parents and families for examples of organisations that can give advice and support).