Listening and talking to patients. V: Communicating with children.

Ours is a period when the spread of communication has become almost explosive-"pulling the communication cord" is not what it was. I find it surprising that paediatricians have not been in the forefront medically. We might have been expected to be, if only because we explore tentatively the learning difficulties of children and witness the near miraculous speed with which normal and most abnormal children overcome them. The difficulties have been daunting but there is plenty of evidence that the communication problems of children are being penetrated both in theory and in daily practice. Communication should not be thought of only in terms of the child who can obviously hear and speak. The unborn baby is certainly sharing communication of a sort when he moves or kicks violently in response to an external stimulus. The newborn infant can hardly wait to communicate if given a chance; we have only to observe mother-child eye fixation, the child's response to the mother's cuddling and cooing, the mother's reactions to her baby's smile to recognise that a two-way form of communication is in action. Handicapped children pose further problems. At the other extreme of childhood we can detect an opposite trend, a decrease in communication. This is not uncommon even in the normal adolescent. The adolescent iron curtain comes down. Communication with adults slows down and may stop altogether. These troubled adolescents for a time become isolated from adults and dominated by their peers.