{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:47:20Z","timestamp":1791218840987,"version":"4.1.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T00:00:00Z","timestamp":1713484800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T00:00:00Z","timestamp":1713484800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Although children wish to be included in their own healthcare, they recognize a gap between their right to be heard and their ability to become involved. Despite adaptation of medical consultation styles which suit a more patient-centered approach, data on the current state of child participation in clinical encounters are missing. We aimed to assess actual child participation in a Dutch pediatric clinic. Children aged 4\u201318\u00a0years visiting a pediatric outpatient clinic for consultation after general practitioner\u2019s referral were included. Sixteen consultations of six pediatricians were recorded and transcribed verbatim. Quantitative measurement included word count and speech turn; conversation analysis with qualitative appraisal provided data on participatory behavior. Quantitative child participation equaled parent participation in turns (28% vs 29%, respectively), but remained limited in words (relative contribution 11% for child, 23% for parent and 66% for pediatrician). Children spoke on average six words per speech turn. Child age correlated positively with participation in words (<jats:italic>p<\/jats:italic>\u2009=\u20090.022, <jats:italic>r<\/jats:italic>\u2009=\u20090.566) and turns (<jats:italic>p<\/jats:italic>\u2009=\u2009\u2009&lt;\u20090.001, <jats:italic>r<\/jats:italic>\u2009=\u20090.746). Children were mostly involved during social history taking, introduction, and physical examination but did not actively speak during the decision-making process. Children took an active role by instigating talks. Qualitative facilitators included appropriate language and verbal or non-verbal child allocated turns. Adults involved children by asking them questions and verifying their opinions or plans with the child. Teenagers participated most during the entire consultation, while younger children were more likely to lose their focus by the end of the conversation.<\/jats:p><jats:p><jats:italic>Conclusion<\/jats:italic>: Despite increased turn taking, children\u2019s verbal participation remains low in pediatric consultations. If pediatricians and parents maintain a triadic conversation style throughout every stage of the medical encounter, child participation may increase.\n<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is Known:<\/jats:bold><jats:italic>\u2022 Verbal child participation varies between 4 and 17%, measured in turns, words, speech time, or utterances.<\/jats:italic><jats:italic>\u2022 Child participation is limited to social talk, laughter, and providing medical information.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>What is New:<\/jats:bold><jats:italic>\u2022 Child speech turns equal parental speech turns (28%), but average relative word count remains low (11%).<\/jats:italic><jats:italic>\u2022 Three percent of the children\u2019s turns are defined a \u201ccontributing in decision making, giving their opinion or give consent,\u201d which equals three turns per consultation.<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s00431-024-05566-8","type":"journal-article","created":{"date-parts":[[2024,4,19]],"date-time":"2024-04-19T13:02:03Z","timestamp":1713531723000},"page":"3019-3028","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Child participation during outpatient consultations: a mixed methods study"],"prefix":"10.1007","volume":"183","author":[{"given":"Maud M.","family":"Koenis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heleen","family":"Vroman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L. P.","family":"Brand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiaan S.","family":"van Woerden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,19]]},"reference":[{"key":"5566_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2023.107749","volume":"113","author":"CS van Woerden","year":"2023","unstructured":"van Woerden CS, Vroman H, Brand PLP (2023) Child participation in triadic medical consultations: a scoping review and summary of promotive interventions. 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Discourse Stud 8:159\u2013190. https:\/\/doi.org\/10.1515\/text.1.1988.8.3.159","journal-title":"Discourse Stud"},{"key":"5566_CR5","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/S0738-3991(99)00075-0","volume":"40","author":"K Tates","year":"2000","unstructured":"Tates K, Meeuwesen L (2000) \u2018Let mum have her say\u2019: turntaking in doctor-parent-child communication. Patient Educ Couns 40:151\u2013162. https:\/\/doi.org\/10.1016\/S0738-3991(99)00075-0","journal-title":"Patient Educ Couns"},{"key":"5566_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2020.113291","volume":"266","author":"L Jenkins","year":"2020","unstructured":"Jenkins L, Hepburn A, MacDougall C (2020) How and why children instigate talk in pediatric allergy consultations: a conversation analytic account. 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Approval was granted by the Medical Ethics Committee of Isala hospital Zwolle (METC 220206, date 03-03-2022\/ No PAC-2022-019).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from all participants or their parents, as applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}