Fundamental Principles of Effective Communication in Paediatric Practice: Building Trust with Children and Families

Introduction

Communication in healthcare has evolved from a traditionally paternalistic model toward a patient- and family-centered paradigm. In paediatrics, this transition is particularly significant, as care involves a triadic interaction between clinician, child, and caregiver. This interaction transforms communication into a complex clinical process requiring both technical expertise and interpersonal sensitivity.¹

Effective communication is strongly associated with improved health outcomes, increased treatment adherence, and reduced medical errors. Conversely, ineffective communication contributes significantly to adverse events and dissatisfaction within healthcare systems. In paediatric settings, these effects are amplified due to developmental variability and dependency on caregivers.

In Myanmar, sociocultural norms, hierarchical relationships, and resource constraints present additional barriers to effective communication. High patient volumes and time limitations often lead to abbreviated consultations, reducing opportunities for meaningful engagement². Therefore, communication must be conceptualized not as an adjunct skill but as a core clinical competency integral to safe and effective paediatric care.³

Concept of Trust in Paediatric Communication

Trust represents the foundation of all therapeutic relationships and is particularly critical in paediatric practice. It is defined as the willingness of individuals to accept vulnerability based on confidence in another’s competence and intentions.⁴

Trust as a Dynamic Process
Trust is not static; it develops over time through repeated interactions. Evidence from scoping reviews demonstrates that trust between healthcare providers, children, and caregivers is bidirectional and evolves through consistent, respectful communication. Establishing trust enhances cooperation, reduces anxiety, and improves clinical outcomes.^5,6
Cognitive and Affective Components
Trust comprises two key dimensions:
- Cognitive trust, based on perceived competence and reliability
- Affective trust, based on empathy, compassion, and emotional connection
In paediatrics, affective trust often precedes cognitive trust. Caregivers are more likely to accept medical advice when they perceive genuine concern and empathy from the clinician.⁶
Impact on Clinical Outcomes

Strong trust relationships facilitate open communication, enabling caregivers to share sensitive information and adhere to treatment plans. Conversely, lack of trust may result in resistance, non-compliance, and fragmented care. Trust has also been shown to influence children’s emotional responses to healthcare environments, affecting cooperation and recovery.

Neurobiological Basis of Communication

Communication influences not only psychological states but also physiological responses. Empathetic interactions can modulate neuroendocrine pathways, promoting oxytocin release and reducing stress responses. These effects are particularly relevant in paediatric patients, who are highly sensitive to environmental cues.

Effective communication reduces anxiety and fear, allowing children to engage more cooperatively in examinations and procedures. In contrast, negative interactions may trigger stress responses that impair comprehension and increase resistance to care. ⁵

The Triadic Model of Paediatric Communication

Paediatric communication is characterized by a triadic relationship involving clinician, caregiver, and child. Each participant plays a distinct role within this interaction.⁷

Triadic Communication Model in Paediatric Practice

1.The Clinician

The clinician acts as both a medical expert and an emotional regulator. Emotional intelligence is essential for recognizing and responding to the emotional states of both child and caregiver. Maintaining composure and empathy is critical in establishing a therapeutic environment.⁸

The Caregiver

Caregivers serve as the primary source of clinical history and decision-making authority. Effective communication requires acknowledging their expertise regarding the child while addressing their concerns and expectations.⁹.

3.The Child

Children should be actively involved in communication according to their developmental level. Exclusion of the child may lead to increased anxiety, reduced cooperation, and long-term mistrust of healthcare systems.

Research highlights that inadequate inclusion of children in communication can negatively impact their psychological well-being and engagement in care.⁹

Consequences of Poor Communication

Clinical Errors

Communication failures are a major contributor to medical errors. Studies indicate that ineffective communication is associated with a significant proportion of adverse events in healthcare. In paediatrics, weight-based dosing increases the risk of medication errors when instructions are not clearly communicated.¹⁰

Psychological Impact

Poor communication can lead to increased anxiety, fear, and traumatic experiences in children. These negative experiences may persist into adulthood, influencing future healthcare interactions.¹¹

Fragmentation of Care

Dissatisfaction with communication often leads to “doctor-shopping,” resulting in fragmented care and increased risk of inappropriate treatments.¹²

Developmentally Appropriate Communication

Communication strategies must be tailored to the child’s cognitive and emotional development.^13-15

Infants: Emphasis on caregiver reassurance and non-verbal communication
Young children: Use of simple language and reassurance to address misconceptions
School-aged children: Logical explanations to enhance understanding
Adolescents: Respect for autonomy and confidentiality

Effective communication supports children’s understanding of their condition and reduces anxiety.

Structured Communication Frameworks

NURSE Framework

The NURSE model provides a structured approach to empathy:

Naming emotions
Understanding concerns
Respecting experiences
Supporting patients
Exploring feelings

This framework enhances emotional connection and trust. ¹⁶

SPIKES Protocol

The SPIKES protocol offers a systematic approach to delivering difficult news. Evidence shows that structured communication training improves clinician confidence and communication skills. ¹⁷

Setting: Ensure privacy and comfort.

Perception: Ask what they already know.

Invitation: Ask how much detail they want.

Knowledge: Give information in small chunks.

Empathy and strategy: Questions and answers should be empathetic and crystal clear.

Communication Tools in Practice

Studies demonstrate that combining verbal and written communication improves comprehension and adherence. Repetition and reinforcement are particularly effective in paediatric settings.

Conflict Management in Paediatric Practice

Conflicts often arise from fear, uncertainty, and unmet expectations. Effective management requires:

Maintaining emotional control
Recognizing underlying concerns
Using active listening
Promoting shared goals

Active listening techniques, such as verbal affirmations and non-verbal cues, enhance engagement and de-escalate tension.

Adversity Quotient and Resilience

The Adversity Quotient (AQ) reflects an individual’s capacity to respond to challenges (18). In paediatric practice, high AQ enables clinicians to maintain effective communication despite stress and workload pressures.

The CORE model (Control, Ownership, Reach, Endurance) provides a framework for managing adversity. Clinicians with higher AQ demonstrate improved adaptability, reduced burnout, and better patient interactions. ¹⁹

Cultural Considerations in Myanmar

Sociocultural Barriers

Cultural norms may discourage questioning authority, limiting open communication. Clinicians must actively encourage dialogue and normalize uncertainty.

Health Literacy

Variability in health literacy necessitates clear and simplified communication. The teach-back method is an effective strategy for confirming understanding and improving adherence ²⁰.

Education and Training

Communication skills should be formally incorporated into medical education. Evidence supports the use of simulation, role-play, and feedback to enhance communication competence.

Training programs focusing on structured frameworks and emotional intelligence improve both clinician performance and patient outcomes.

Conclusion

Communication is a fundamental component of paediatric practice, directly influencing clinical outcomes, patient safety, and caregiver satisfaction. By integrating evidence-based communication strategies, developmental understanding, cultural sensitivity, and resilience frameworks, clinicians can optimize paediatric care.

References

Silverman J, Kurtz S, Draper J. Skills for communicating with patients. 3rd ed. London: Radcliffe Publishing; 2013.
Ahmed MM, Oweidat M, Okesanya OJ, Alaswad M, Abdelbar SMM, Gill P, Alsabri M. (2025). Barriers to Pediatric Emergency Care in Low-Resource Settings: A Narrative Review. Sage Open Pediatr.
Street RL. (2003)Communication in medical encounters: An ecological perspective. London: Routledge.
Hall MA, Dugan E, Zheng B, Mishra AK. (2001). Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q;79(4):613-39
Carter CS. (2014). Oxytocin pathways and the evolution of human behavior. Annu Rev Psychol;65:17-39.
Thom DH, Hall MA, Pawlson LG. (2004) Measuring patients’ trust in physicians when assessing quality of care. Health Aff (Millwood) 23(4):124-32.
Tates K, Meeuwesen L. (2001) Doctor-parent-child communication. A (re)view of the literature. Soc Sci Med ;52(6):839-51.
Goleman D. (2005).Emotional intelligence. 10th anniversary ed. New York: Bantam.
Jenkins, L., Ekberg, S., & Wang, N. C. (2024). Communication in Pediatric Healthcare: A State-of-the-Art Literature Review of Conversation-Analytic Research. Research on Language and Social Interaction, 57(1), 91–108.
Joint Commission. Sentinel event data 2022 annual review. Oakbrook Terrace, IL: Joint Commission; 2022.
Sisk BA, Zavadil JA, Blazin LJ, Baker JN, Mack JW, DuBois JM. (2021).Assume It Will Break: Parental Perspectives on Negative Communication Experiences in Pediatric Oncology. JCO Oncol Pract.17(6): e859-e871.
Hagihara, A., Tarumi, K., Odamaki, M. and Nobutomo, K. (2005). A signal detection approach to patient–doctor communication and doctor-shopping behaviour among Japanese patients. Journal of Evaluation in Clinical Practice, 11: 556-567.
Piaget J. (1926).The language and thought of the child. London: Routledge & Kegan Paul.
Peter Dryden, Sarah Greenshields. (2020) Communication with children and young people. British Journal of Nursing.
Sanci LA, Sawyer SM, Weller PJ, et al. (2005) Confidentiality in health care for adolescents. Med J Aust.183(6):298-301.
Pollak KI, Arnold RM, Alexander SC, et al. (2011).Helping residents respond to patient’s emotional cues: the NURSE curriculum. Clin Pediatr (Phila);50(12):1087-92.
Baile WF, Buckman R, Lenz R, et al. (2000). SPIKES—A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist.5(4):302-11.
Stoltz PG. (1997) Adversity quotient: Turning obstacles into opportunities. New York: Wiley.
Lalrohlui H, Jyoti Sharma, Mohammad Sidiq and Aksh Chahal. (2025) Role of Resilience Factors Affecting Work Performance. Journal of Clinical and Diagnostic Research.
Schillinger D, Piette J, Grumbach K, Wang F, Wilson C, Daher C, Leong-Grotz K, Castro C, Bindman AB. (2003) Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med.13;163(1):83-90.