Migrant children's epistemic authority in paediatric consultations.

Abstract

Giving patients a voice in medical consultations and encouraging patient-centered communication are essential to improving the effectiveness and appropriateness of medical treatments. However, this is often difficult to achieve when patients are children, as paediatricians prefer to interact with parents and need parental consent. Drawing on a corpus of 12 authentic interactions recorded in an Italian diabetes outpatient clinic, this paper investigates the ways in which migrant children exercise agency and how this can be supported by paediatric diabetologists and sometimes by their parents. Adopting a discourse analysis approach, the paper identifies two ways in which children assert their agency by displaying epistemic authority, namely (1) by taking initiatives to trigger talk, and (2) by accepting the floor from other participants. Children's initiatives are produced that provide information, ask questions and sometimes contradict adults' utterances. Paediatricians usually support children's exercise of agency in such cases. Children's agency can also be promoted when children do not take the floor spontaneously but are encouraged to speak by pediatricians, who invite them to elaborate on their answers by using minimal positive feedback, by asking questions and by formulating and encouraging children's answers. The findings also show how parents' competition to take or hold the floor can hamper children's agency.