Connecting Cultures would like to thank Alvaro Vergara Mery, PhD CMI, and Juan F Gutiérrez Sanín, MD MPH, for contribuiting this article!

Interpreting pediatric encounters can be particularly challenging. Not only there are a number of situations that can get in the way of establishing and maintaining an effective flow of information. It is also very common to encounter a situation where there is a bilingual child accompanied by an LEP parent or relative.

The purpose of this paper is to leave you with an overview of how pediatric encounters differ from adult ones, as well as a concrete set of strategies you can use in order to minimize the potential for errors and the stress associated with the encounter, while maximizing your accuracy.

Children and Communication

One very important thing to keep in mind is that children are not small adults. They think and process information differently. They have different priorities, and their outlook is a lot shorter, since they have not yet developed the ability of long-term planning. They tend to think in more concrete terms. Metaphors and figures of speech don’t make much sense.

Children are particularly sensitive to emotionally charged interactions and stress seriously affects their memory and attention. Also, whereas children as young as 3 years old have shown to be able to participate in interpreted encounters, having access to non-verbal communication from the source speaker is crucial to elicit their participation (Nielsen, 2013). This makes phone interpreting for children particularly challenging. Also places a greater demand on the interpreter for maintaining eye contact with the child, in order to meet their needs for attention and validation.

Children have shorter attention spans than adults, and they tend to be more easily distracted (Cowan, Elliot et al, 2006). It is very important to use strategies to attract and maintain the child’s attention during the encounter. These strategies are essentially non-verbal (Nielsen, 2013).

Eliciting Participation

Hospitals and clinics are stressful places. This is why pediatricians and child care professionals use special techniques to ease children into a dialogue. A brief summary of these include:

Lower the pitch of your voice to convey calm
Don’t patronize or use “kiddy” language
Speak slower than normal, but not louder
Use short sentences, and pause often (more so than with adults)
It is especially important to avoid very high register or technical terms
Ask the provider to introduce new concepts by relating or comparing them with familiar ones
Do not force the pace of the dialogue
Always ask for the parents’ permission to touch or interact with the child
Always have a pre-session with the provider, child and parent(s) to clarify what you are going to do, and what is expected of them.

Keeping the Session on Track

There are a number of things you can do to keep communication running smoothly in any interpreted encounter. There are many factors that can make communication with a child very difficult. Some examples include:

Stress
Brain Injury
Developmental delay
Mistrust
Very young children

The steps that you can take to overcome these difficulties are no different than the standard clarification procedure you would use with an adult. Only, you need to adapt these strategies to a child’s expectations and needs.

You can do this in seven simple steps:

If you don’t understand what the child is saying, simply say so in a friendly way
Watch for non-verbal signs of misunderstanding
Calmly pause and ask for clarification
Recruit the parent or guardian to help you clarify
Check for understanding using the teach-me-back method

Building Trust and Maximizing Accuracy

Use an informal tone and style. If the target language has an informal pronoun for the second person (such as tu in Spanish), use this pronoun rather than the formal one.

You may have to use reported speech (3rd person) on occasion, for the child to understand who is speaking.

Stick to consecutive interpreting. Simultaneous makes comprehension more difficult, and creates a more stressful environment, especially when remote interpreting.

It is very important to attune to the child’s emotions. Make conscious effort to attune to them, and position yourself accordingly. Always exhibit a calm, compassionate demeanor.

Never, Ever Use Children as Interpreters

This is very tempting especially when you have a parent who speaks a language of lesser diffusion (LLD) and you are trying to relay-interpret. However, using the child is a particularly bad idea. Here are some reasons why:

Research shows that about 70% of the information doctors need comes from the medical interview (Rich, 1985; Young, 1986).
Adults who interpret with no formal training make an average of 31 mistakes per encounter. Of these, 77% are dangerous for the patient (Flores et al, 2003, 2006, 2012).
Children who are in control of communication tend to use this as leverage against their parents, thus changing the power dynamics in the family.
Children are very likely to invent or change a word they don’t know in order to avoid feeling embarrassed, and less likely to realize the potential consequences of doing so.
The legal liability associated with errors made by a child under your supervision is yours, not theirs.

When you feel compelled to use a child’s help for communicating with their parent, this is a sure sign that your own communication with that parent is inadequate. This is a good reason to either withdraw from the encounter, or to recruit a professional relay interpreter who can help you effectively.

Remember as an interpreter you are also a stakeholder in improving quality and access to care for LEP members of your community. When you can safely do so, make an effort to educate the providers you know about the dangers of using children as interpreters.

ABOUT THE AUTHORS:
Alvaro Vergara Mery, PhD CMI, is a Senior Medical Interpreter at University Medical Center of Southern Nevada in Las Vegas. He is in charge of interpreter education and training, language proficiency, cultural competency, translation, and curriculum design. Alvaro received a bachelor’s from Universidad de La Serena, Chile, a Master’s in Education and Spanish from Minnesota State University at Mankato, and a Doctorate in Spanish from Arizona State University. He has held faculty appointments at colleges and universities around the country.

Juan Felipe Gutiérrez Sanín, MD MPH, is the President of the National Institute for Coordinated Healthcare. He is a trained physician and public health professional. His extensive professional career has consisted of developing, implementing, and managing health and diversity programs aimed at reducing disparities, and improving access and quality of health services for low income and under-served communities, particularly limited English proficient (LEP) groups. A nationally recognized public speaker and trainer on the aforementioned topics, Juan is also a recognized researcher and curriculum developer. He has served as adjunct faculty member at Western Kentucky University. He is fully bilingual in English and Spanish. Juan has been a liaison between multiple federal and state agencies, and local communities. A founding member of the board of directors of the South Eastern Medical Interpreters' Association, he currently serves as Washington State's Vice-Chair for the International Medical Interpreters' Association. Juan holds a Medical Degree from Colombia and two master’s degrees in Public Health, and Occupational Safety and Health Administration. Juan plays classical and electric guitar. He loves to ski, whitewater kayak, and mountain bike.

Will you be attending CHIA's 14th Education Conference on March 21-22, 2014? Be sure to attend Alvaro and Juan's workshop Interpreting for Children and Parents and discover even more about interpreting successfully in these challenging encounters