Talking to Your Child, by Age

Part of Pediatric Trials: Talking with your child, and with your family.

About 4 minutes. Free, in your language, no account needed.

This is general education about clinical research — not medical advice, and not a way to join a study. Talk to your own doctor about your situation.

Assent depends on explanation, and explanation depends on age. This lesson offers general starting points.

You know your child. Where this lesson and your knowledge of your child disagree, your knowledge of your child wins.

Some things hold at every age

• Say true things. A child who discovers that something was untrue will trust the next explanation less, and there will be a next explanation.
• Do not promise it will not hurt unless you know it will not. "It might hurt for a moment, and I will be there" holds up. The other version does not.
• Small pieces, more than once. Children absorb information in fragments, over days.
• Let them ask the unwelcome question. Children often know more than adults think, and worry about things adults have not guessed.
• Say what will not change. Who will be there, that they are not in trouble, that they can say when something is wrong.

Toddlers and pre-school children

Their world is now, and it is concrete.

Talk about what they will feel, see and hear rather than why. "We will go to the hospital. A nurse will look at your arm. There will be cold cream first. I will hold your other hand."

Tell them shortly before, not days ahead. Play is useful — a doll, a toy stethoscope, a rehearsal. Expect the same question repeatedly, and answer it the same way each time.

Roughly five to eight

They can follow a simple reason, and they think in fairness and cause.

You can explain that doctors are trying to learn something that will help children, that nobody is sure yet, and that is why they are checking carefully.

Two things matter especially at this age. First, be clear that nothing that is happening is a punishment, and that they did nothing to cause their illness — children in this range often quietly believe otherwise. Second, tell them plainly that they may say if they do not want to do something, and that saying so will not make anyone angry.

Roughly nine to twelve

They can hold uncertainty, ask sharp questions, and will notice if an answer is evasive.

They can usually be told the actual purpose of the study, that nobody yet knows the answer, and that this is why it is being studied. They may want to know about the other children in it.

Privacy starts to matter here. They may prefer to ask a doctor something without a parent in the room, and that preference deserves respect.

Teenagers

An adolescent may be able to understand a study as well as an adult, and will usually resent being managed.

Some practical things:

• give them the actual information, not a filtered version
• let them speak to the team alone if they want to
• take their objections seriously and answer them rather than talking past them
• be honest that you hold the legal responsibility, while making clear their view genuinely matters
• respect that appearance, school, sport, friendships and independence are not trivial concerns

ICH E11 recognizes that adolescents are assuming responsibility for their own health, and notes that in some places a mature or emancipated minor may be able to give consent in their own right, defined by local law.

Children who communicate differently

Some children communicate in other ways, or at a different developmental stage from their age.

The principle is unchanged: they are told to the fullest extent possible, in a form they can use. That may mean pictures, symbols, a communication device, a familiar routine, or a person they trust doing the explaining.

Tell the team what works. They will not know unless you say.

In short

• Tell the truth, in small pieces, more than once, and do not promise something will not hurt.
• Younger children need concrete descriptions of what they will feel, close to the time.
• Children aged around five to eight need to hear that nothing is a punishment and that they may say no.
• Older children can hold uncertainty and may want to talk to the team without you.
• Teenagers should get real information and be allowed to speak for themselves, and children who communicate differently should be told in whatever form they can use.