Synopsis
Communicate directly, honestly and developmentally with children and young people while supporting families, meeting language and accessibility needs, preserving confidentiality and turning difficult conversations into a clear shared plan.
- Address the child first by name, explain your role and ask how they prefer to communicate; parents add essential knowledge but do not replace the child's voice.
- Observe before touching: play, gaze, gesture, posture, interaction and response to the caregiver reveal both developmental level and distress.
- Use short concrete sentences, one idea at a time, and check meaning; vocabulary must match developmental understanding rather than chronological age alone.
- Tell the truth about sensations and uncertainty: ‘a sharp scratch for a few seconds’ is safer than ‘this will not hurt’.
- Offer bounded choices such as which arm or whether to sit on a caregiver's lap; never offer a choice that cannot be honoured.
- Use play, demonstration, dolls, drawings, pictures, easy-read material, sign, augmentative communication or the child's own communication passport when helpful.
- For spoken-language barriers, use a trained professional interpreter and speak directly to the child or parent, pausing for complete interpretation.
- Identify, record, flag, meet and review disability-related information and communication needs in line with the NHS Accessible Information Standard.
- Use chunk-and-check and teach-back: ask the family to explain the plan in their own words rather than asking only ‘Do you understand?’
- Give adolescents routine private time, explain confidentiality and its serious-harm limits before sensitive questions, and agree what may be shared.
- Separate emotion from information: acknowledge fear or anger first, then clarify the shared goal, uncertainties, options and next review point.
- End every encounter with the diagnosis or uncertainty, actions, medicine details, red-flag safety-netting, contact route and who is responsible for follow-up.
Key red flags
A child who becomes silent, unusually compliant, fearful of an accompanying adult or unable to speak privately may be signalling coercion, abuse or exploitation.
Using a child, sibling or untrained relative to interpret clinical detail risks omission, distortion, breached confidentiality and unsafe consent.
Saying a painful procedure ‘will not hurt’ breaks trust; prepare honestly and provide analgesia, comfort and choices that are genuinely available.
A family repeating an inaccurate plan after apparently agreeing indicates a communication failure, not non-compliance; stop and use teach-back.
Withholding serious uncertainty or deterioration from a child who can understand it can intensify fear and exclude them from decisions about their own care.
Investigation priorities
Identify language, hearing, vision, literacy, neurodevelopmental, cognitive and preferred-format needs before complex discussion.
Choose vocabulary, question style and tools the child can understand and use.
Management branches
A child attends with a parent or caregiver for assessment or review.
- Introduce everyone, establish roles and ask the child how they prefer to communicate.
- Observe and hear the child's account first where possible, then add caregiver history and reconcile differences.
- Explain the plan in manageable chunks, use teach-back and provide accessible safety-netting and follow-up ownership.