"Keeping the Door Open": The Lived Experiences of Developmental Pediatricians in Caring for Families.

Objective: Within an evolving and increasingly complex pediatric context, little is known about how developmental pediatricians experience their interactions with families within nuanced clinical practices that demand flexibility and a tolerance for ambiguity. To address this gap, this study explored the perspectives and experiences of developmental pediatricians regarding their communications and interactions with children and families.

Method: A qualitative exploratory design informed by phenomenology was used. Individual semi-structured interviews were conducted with 12 developmental pediatricians across Canada. Issues involving children's agency and their right to participate in shared decision-making were examined.

Results: Developmental pediatrics emerged as an inherently relational practice that involves building strong long-term relationships with caregivers through a strength-based, humble, and self-reflexive approach. "Keeping the door open" and "planting the seed" arose as metaphorical representations of developmental pediatricians' commitment to ensuring caregivers feel supported and understood. Moreover, challenges associated with involving children in decision-making processes, as well as managing caregivers' understandings and desires for their child's diagnosis were evident.

Conclusion: The findings generated by this study elucidate the clinical approaches and communication styles of developmental pediatricians. Despite participants' strong family-centered approach to care, future clinical considerations should accentuate the promotion of children's autonomy and rights in developmental pediatrics.