Children Will Listen
Alan Jay Schwartz, MD, MSEd and John E Fiadjoe, MD
Opinion article
Grant AS. There’s One Lie I will Never Tell My Children. New York Times 2025; CLXXIV: Opinion Guest essay. https://www.nytimes.com/2025/02/17/opinion/theres-one-lie-i-will-never-tell-my-children.html
Our opinions and biases are molded by our experiences. Such was true when Allison Sweet Grant, a psychiatric nurse practitioner, and author for publications such as the New York Times and The Atlantic, recounted her experience as an 11-year-old being treated for leg length discrepancy. She pointedly wrote,
“… before the surgery, when I asked if it would hurt, the only thing I remember being told was “Don’t worry, we have ways to manage any unpleasantness.” The difference between what I was told and what I experienced shattered my faith in doctors and left me questioning whether I could trust adults at all.”1
There are monumental consequences to innocently and not intentionally deceiving children. Grant eloquently lays the issue before us.
“Many parents opt…to reassure their children. Since they can’t stop the needle from hurting, they believe the next best thing is to offer comfort. But when the pain does inevitably come, it’s accompanied by a heaping side of betrayal. Lies that mislead children about their experiences are not white lies. Though they may appear innocuous, they erode the fabric of the fundamental and necessary trust between parent and child. They create an emotional wound not easily healed. The pain of discovering you have been deceived by a trusted adult can cut deeper and last longer than the pain of an unavoidable medical intervention.”1
Grant’s attention to the issue of how we might communicate a two-way trusting interaction between children and adults has been studied. Grant guides us to view a study comparing children 3.8-5.9 years old during immunizations.2 A control group experienced no specific parental intervention compared to children approached with distraction or reassurance. The study Authors hypothesized and demonstrated in their analysis that children in the distraction group were the least distressed upon immunization, followed by the control group, and that children in the reassurance group were the most distressed.2. Strategies to enable children to cope with stressful and painful situations are available and will assist parents and healthcare practitioners to interact with children without needing to resort to “innocent” lies.3,4
The iconic Broadway composer and lyricist Stephen Sondheim got it right in his Broadway musical “Into the Woods”. His lyrics (https://www.allmusicals.com/lyrics/intothewoods/finalechildrenwilllisten.htm)
“Careful the things you say
Children will listen
Careful the things you do
Children will see and learn
Children may not obey, but children will listen
Children will look to you for which way to turn
To learn what to be
Careful before you say "Listen to me"
Children will listen”
remind us that children are always listening and learning from us. We therefore need to be mindful and careful about what we say and do.
How do you approach building a trusting relationship with adults as well as pediatric patients?
As you think about your adult strategies, take time to consider the nocebo effect.5 (See PAAD May 25, 2021 https://ronlitman.substack.com/p/tae-bo-placebo-and-nocebo ) In a study conducted at the Brigham and Women’s Hospital in parturients presenting for epidurals, the authors randomized two groups during lidocaine injection to what one may consider truth telling, “You are going to feel a big sting and burn in your back now, like a big bee sting; this is the worst part of the procedure.” vs neutral language, “We are going to inject the local anesthetic that will numb the area where we are going to do the epidural/spinal anesthesia and you will be comfortable during the procedure.” The numbing medicine in contrast to the bee sting group had significantly less pain as documented by a blinded observer.5 Consider using neutral language. Outright lying is not helpful.
Be careful not to consider your truth to be every patient’s truth.
For our pediatric patients, framing a mask induction as a nicely flavored mask with an interesting flavor rather than this smells bad, might positively impact the patient’s experience.
The language we use not only sets expectations but changes experience!
Share your strategies with Myron who will offer your successes to all of us in a Reader Response PAAD.
References
1. Grant AS. There’s One Lie I will Never Tell My Children. New York Times 2025; CLXXIV: Opinion Guest essay. https://www.nytimes.com/2025/02/17/opinion/theres-one-lie-i-will-never-tell-my-children.html
2. Manimala MR, Blount RL, Cohen LL. The Effects of Parental Reassurance Versus Distraction on Child Distress and Coping During Immunizations. Children’s Healthcare 2000; 29(3): 161-177 https://doi.org/10.1207/S15326888CHC2903_2
3. Wallwork SB, Noel M, Moseley GL. Communicating with children about ‘everyday’ pain and injury: A Delphi study. Eur J Pain. 2022; 26(9):1863–1872 DOI: 10.1002/ejp.2008
4. Cohen LL. Behavioral Approaches to Anxiety and Pain Management for Pediatric Venous Access. Pediatrics (2008) 122 (Supplement_3): S134–S139https://doi.org/10.1542/peds.2008-1055f
5. Varelmann D, Pancaro C, Cappiello EC, Camann WR. Nocebo-Induced Hyperalgesia During Local Anesthetic Injection. Anesth Analg 2010; 110(3): 868-870