I recently had the chance to shadow New York pediatrician Dr. Barney Softness as he cared for young patients and talked with parents. I asked Dr. Softness (yes, that’s his real name) to share his thoughts about the mistakes parents make when they visit. — Tara Parker-Pope

By Barney Softness, M.D.

Recently, a mother and her nervous toddler were waiting for me in my office. To reassure the child, the mother promised her there wouldn’t be any needles used during the visit. “Right, Dr. Barney? No needles?”

At that point, I hadn’t even examined the child. I didn’t know what was wrong with her and had no way of knowing if she might need a blood test. “That all depends on what is wrong with her,” I told the mother, who quickly scowled her disapproval, and the child erupted in protests.

Parents are an essential part of their children’s health care. Even though pediatricians are trained to treat children, we rely on parents’ instincts about their child’s health and their ability to comfort a child during an exam. Knowing what to say and what not to say can make the experience better for everyone, especially the child.

Yet well-meaning parents, who are really trying to make things as comfortable as possible for their child, can sometimes end up doing the exact opposite. Here are some examples.

Don’t make promises you may not be able to keep. While parents will want to reassure a child who is afraid of needles, it is far worse to make a promise the doctor cannot keep. Then you have lost trust. I may look at the child’s record and discover she is due for a vaccination. A promise of no needles would mean coming back another time — and the anticipation of coming back for a shot prolongs the agony. Focus on the positives when you are trying to reassure your child about a doctor visit — a favorite toy in the waiting room, the stickers we give at the end of the visit, or the trip to the playground after the appointment.

Don’t try to trick kids. Sometimes parents tell a child he is coming along just to accompany his brother to the doctor, and then surprise him with an exam as well. Even if it’s a harmless ear check, it may not seem so to the child, and he won’t fall for that one again. And he won’t trust you — or me — next time.

We’re not the bad guys. You’d be surprised how often I hear the phrase: “Here comes the mean doctor (or nurse).” We do sometimes have to do things that are painful or uncomfortable, but it does not do the child any good to portray us as mean or evil. It makes our job more difficult, and it makes the child think you’re not doing a very good job protecting her if you’re allowing us to do the dirty work. You know it hurts, but we are helping your child, and that is the message you should try to convey.

Don’t sugarcoat too much. You may think that a doctor’s stethoscope on your chest is not much of an issue. But if a toddler is screaming about it, it is to him. Telling him that this doesn’t hurt, or is even fun, doesn’t legitimize his feelings. And further, if he’s just learning the language, the next time you tell him you’re going to the playground to have some fun, he may get the wrong idea.

Don’t tell me your diagnosis. Often parents come in to rule out a single ailment — such as Lyme disease or diabetes. Or they tell me they think their child has another sinus infection or strep throat. They mean well and usually are worried because someone — or often a Web site — told them their child’s symptoms match a particular problem. But, an accurate description of symptoms is much more valuable. As doctors, we don’t presume a sore throat is always strep or frequent urination is always diabetes. It could be any number of things. However, if you have a specific reason to suspect a particular condition (for example, her brother has Lyme disease), it may help in the analysis.

There’s no such thing as a quickie. Squeezing two kids into one appointment isn’t good for your kids, and it’s not fair to the other children in the waiting room. Too often parents will bring a sibling along and ask me to “just check his chest real quick.” But even when the quick exam is normal, it often leads to follow-up questions about what else could be wrong. Each child deserves my full attention.

Let your kids take part in sensitive conversations. There are obviously certain discussions that need to be conducted out of earshot of the child — divorce, unemployment or the parent’s health come immediately to mind. But many times parents don’t want to embarrass their children by discussing other sensitive subjects in front of them, like bedwetting, constipation, weight or poor school performance. Sometimes an entire visit is merely a pretense for the real concern, which the parent finally brings up after a child has left the room. But your child already knows the problem!

Having a parent transmit my advice to the child doesn’t work nearly as well as when the child is involved in the original discussion. If the discussion is handled in a professional matter-of-fact manner, you can almost hear the sigh of relief. (Even if the child makes no eye contact during the conversation, they are definitely listening.) It is never as embarrassing as parents expect it to be.

Dr. Softness is a general pediatrician in Manhattan as well as a pediatric endocrinologist and diabetes specialist. He is on the faculty of Columbia University’s College of Physicians and Surgeons. Tara Parker-Pope is on vacation.