As an FY1 you will likely manage paediatric patients during their admission, often in other specialties like general surgery. Difficult communication scenarios can occur & being prepared and responding to them well can instil confidence in our patients & their parents as well as help us feel more confident in approaching them. Do look at communicating with relatives & dealing with a complaint also.

Communication
In paediatrics, perhaps even more so than most other specialties, good communication is key! Parents are often very anxious (quite understandably so) and it is important to fully explain what is going on and what the plan is. A few extra points to consider:

• Work: Parents often have other children at home and have to take time off work to stay in the hospital with them. It is important to give a time-frame of when they might be discharged. However, it should be STRESSED that this is an estimate and things can change.
• Support on discharge: Parents like to know there is support available on discharge, in case something happens/something goes wrong. This may simply be GP support, but it is important to communicate that the GP receives a copy of the discharge letter so will know exactly what has happened.
• Medications: The nurses are very good at explaining how to take medications and the frequency etc. However, it is good practice to check the parents are happy.

Consent
Like adults, children aged 16-17 years are expected to have the capacity to consent unless there are reasons to suspect otherwise (in exceptional cases only, this can be overruled).

Use the following sites for official advice:

• https://www.nhs.uk/conditions/consent-to-treatment/children/
• https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/0-18-years

In summary, children under 16 years can consent to their own treatment if they are Gillick competent. This is judged on the same principles as for adults:

• Are they able to understand the information?
• Can they retain the information?
• Can they reason with the information (weigh up the pros and cons)?
• Can they communicate this to you?

According to the Gillick case: If a child has the capacity to consent, the parents cannot veto the decision. Otherwise, someone with Parental Responsibility can consent on their behalf. Most commonly:

• Mother or Father.
• Legally appointed guardian.
• A residence order concerning the child.
• A local authority with designated care for the child.
• Or a local authority with an emergency protection order.

Healthcare professionals only need one person with parental responsibility to consent for any given procedure. The Fraser guidelines relate specifically to providing contraception (and abortions) for children.

A final note…
Most importantly, enjoy communicating with paediatric patients as no matter what specialty you go into, you will usually see or work with children. It can be very rewarding & very fun so do make the most of it!

Dr A Przystupa (FY3 Paediatrics: DGH in the East of England)