Translation to the Clinical Setting

Understanding Cues in Order to Support Responsive Caregiving

• Whenever possible, follow the parent and child’s lead by reading and responding to their cues.
• Being aware of subtle disengagement cues in the patient, parents, and themselves can help the provider pace the visit better and respond more sensitively.
• An office visit will often trigger subtle disengagement cues, as the child tries to stay regulated despite feeling fearful about a new person being in the room, or while waiting for the exam, immunizations or during conversations about difficult topics.
• Parents will also often display subtle disengagement cues, especially when they feel worried about their child.
• For the provider, diagnostic uncertainty, time pressure, or anxiety about how the visit is going, can produce subtle displacement cues that the provider can recognize in themselves.
• When we enter an exam room, with a shy or worried child, slowing our pace down even for 30 seconds, can result in the child engaging with us and feeling capable and confident by the end of the visit. This helps parents feel capable and confident too and shows that we respect their child’s cues and that parents can too.
• Examples of sensitive responses to the presence of subtle disengagement cues in patients, their parents or ourselves might include:
  • moving further away from an anxious baby or toddler
  • skipping ahead to giving the vaccines right away
  • getting the exam over with first to help the child relax
  • going straight to advice giving with a very worried parent
  • providers taking a brief break out of the room to think or confer with a colleague and get re-regulated
• If it fits the interaction, notice the child’s cues with parents in the moment. We want to normalize that cues are signs of the child’s internal state and that it is NOT spoiling to follow the child’s cues.
  • “It looks like he’s really worried to be here and leaning into you for comfort…”
  • “I think he’s looking away because it’s too much right off the bat…”
  • “He seems a lot happier and is smiling now, after you were playing with him for a minute“
• If it fits the interaction, offer positive feedback that the emotion regulation provided by the parent helped the child calm down and do something new (engage with you and tolerate the visit!). These moments of success and mastery of a new situation build resilience and confidence for BOTH parents and children.
  • “He was really worried for me to check him, but he stayed close to you and your presence helped him get through the visit really well.”
  • “You quickly recognized she was getting scared and by coming closer and staying nearby, she seemed to feel better and was able to continue with the exam.”