Chronic pain in childhood and the medical encounter: Professional ventriloquism and hidden voices
Abstract
This article is a report on the experiences of three children with chronic pain and their families. The children and families experienced numerous encounters with health professionals during their "quest for a diagnosis"for chronic pain. In a high proportion of these encounters, the children/families felt they were judged, disbelieved, and labeled as difficult or dysfunctional, and this compounded the stresses they were already dealing with. The families described situations in which their accounts of pain were reinterpreted through a variety of professional lenses, and the children felt that their voices were muted or ignored. Professional ventriloquism is presented as a means of exploring the way in which the child's words are reinterpreted and mistranslated through professionals' own paradigms of understanding. Professionals need to stand back from what they believe to determine what the children themselves know about their pain.
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Children with chronic pain often experience negative, judgmental and stressful encounters with clinicians, related to clinicians' struggles to secure a diagnosis and confidently explain chronic pain.
“It has been previously highlighted how children with chronic pain often experience negative, judgmental and stressful encounters with clinicians, related to clinicians’ struggles to secure a diagnosis and confidently explain chronic pain; exposing a need to recruit clinicians, including physicians, to remedy this issue [7].”
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Considering medical assistance in dying for minors: the complexities of children’s voices
Singh, H. K., Macdonald, M. E., & Carnevale, F. A. (2020) · Journal of Medical Ethics · doi:10.1136/medethics-2019-105762 · Cited by 9 · see citing works
Pain-Related Injustice Appraisals in Youth with Sickle Cell Disease: A Preliminary Investigation
Miller, M. M., Rumble, D., Hirsh, A. T., Vervoort, T., Crosby, L. E., Madan‐Swain, A., Lebensburger, J. D., Hood, A., & Trost, Z. (2021) · Pain Medicine · doi:10.1093/pm/pnab001 · Cited by 8 · see citing works
“Diagnosis confirmation, particularly through objective tests, could legitimize an individual’s condition and may result in less disbelief or invalidation from close friends or family members [95, 96].”
BackgroundCoventry, J., Pacey, V., Smith, M., Williams, C., Ta, B. T., & Sturgiss, E. A. (2025) · Patient Education and Counseling · doi:10.1016/j.pec.2025.108634 · Cited by 7 · see citing works
Mandrell, B. N., Guo, Y., Li, Y., Hancock, D., Caples, M., Ashford, J. M., Merchant, T. E., Conklin, H. M., & Crabtree, V. M. (2024) · Children · doi:10.3390/children11101159 · Cited by 6 · see citing works
“Pediatric patients often under report symptoms and perceive symptoms as inherent in treatment [11,12].”
BackgroundHayhoe, B. W. J., Butler, C., Majeed, A., & Saxena, S. K. (2018) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dky223 · Cited by 6 · see citing works
Hilário, A. P. (2022) · Children & Society · doi:10.1111/chso.12542 · Cited by 5 · see citing works
Narrative Accounts of Youth and Their Mothers With Chronic Headache
Lund, T., Neville, A., Jordan, A. L., Carter, B., Sumpton, J. E., & Noel, M. E. (2024) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001238 · Cited by 5 · see citing works
“Carter 37 – 39 has championed the voices of children, traditionally excluded from dominant academic and clinical narratives.”
Remote Management of Pediatric Pain
Forgeron, P. A., & McGrath, P. J. (2008) · Humana Press eBooks · doi:10.1007/978-1-59745-476-6_5 · Cited by 5 · see citing works
“Parents and children viewed medical encounters as positive if the physician believed that the child was having pain, even if there was no diagnosis for the pain [ 7 ].”
BackgroundInfluentialPain and Complex Adaptive System Theory
Brown, C. A. (2012) · Springer eBooks · doi:10.1007/978-1-4614-4998-0_25 · Cited by 5 · see citing works
Hilário, A. P., & Augusto, F. R. (2019) · Societies · doi:10.3390/soc9040081 · Cited by 5 · see citing works
“The quest for a diagnosis and treatment tends to be characterized by frustration and despair, as most of the time healthcare professionals are unable to identify a physical cause and, thereby, tend to blame the child or the family for the condition [1,36].”
BackgroundBrady, G., Lowe, P., & Lauritzen, S. O. (2015) · doi:10.1002/9781119069522.ch1 · Cited by 5 · see citing works
Bruce, M. S. P., Surekha, A., Karnaboopathy, R., Balan, K. U. S., Chavada, V. K., Vedapriya, Boratne, A. V., Bobhate, P. S., & Raja, T. (2025) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1038_24 · Cited by 4 · see citing works
“[11] This study aims to address this gap in the literature by systematically investigating the reliability and validity of the VAS for measuring abdominal pain among school students.”
Joslin, R., Donovan‐Hall, M., Barker, M. E., Birnie, K. A., Melfi, E., & Roberts, L. C. (2025) · Health Expectations · doi:10.1111/hex.70347 · Cited by 4 · see citing works
Critchley, A., & Keddell, E. (2023) · Critical Social Policy · doi:10.1177/02610183231215231 · Cited by 4 · see citing works
“Carter de fi nes professional ventriloquism as ‘ a means by which professionals can almost bypass the child ’ s experience and articulate what they believe the child ’ s experience to be ’ (2002: 37).”
Group Membership and Social Identities in a Formative Intervention in a Mexican Hospital
Rivera, H. A. B., Alby, F., & Zucchermaglio, C. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.786054 · Cited by 3 · see citing works
“The researcher builds such a discursive structure by means of questions and proposals, using a sort of “ventriloquism” (Carter, 2002), to encourage participants to question themselves on certain issues.”
BackgroundBianchim, M. S., Caes, L., Forbat, L., Jordan, A. L., Noyes, J., Thomson, K., Turley, R. L., Uny, I., & France, E. F. (2024) · Health and Social Care Delivery Research · doi:10.3310/utpm7986 · Cited by 3 · see citing works
Cucchiaro, G. (2008) · Springer eBooks · doi:10.1007/978-0-387-78323-9_8 · Cited by 3 · see citing works
“Effective communication has been recently identified as the key element for a successful relationship between clinicians and patients [78].”
BackgroundBody mass in adolescents with chronic pain: observational study
Gauntlett‐Gilbert, J., Bhat, C. S., & Clinch, J. (2019) · Archives of Disease in Childhood · doi:10.1136/archdischild-2019-317843 · Cited by 3 · see citing works
The Lived Experience of Chronic Pain: Evidence of People's Voices
Brown, C. A. (2008) · Health care and disease management · doi:10.1002/9783527622665.ch1 · Cited by 3 · see citing works
Lermytte, E., Scavarda, A., Hilário, A. P., Gariglio, L., Mendonça, J., & Ceuterick, M. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.118045 · Cited by 2 · see citing works
Pain in cultural and communicative contexts
Clemente, I. (2013) · doi:10.1093/med/9780199642656.003.0011 · Cited by 2 · see citing works
Norton, J. G., Newton-John, T. R. O., Alcock, M., Moore, J., Southon, N., & Pate, J. W. (2025) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000001284 · Cited by 2 · see citing works
“Likewise, children and their families have reported consistently feeling disbelieved and dismissed by health professionals, 3,5,35,36 and subsequently present as wary and guarded during future health care interactions.”
Voicework and The Disarticulation of Young People’s Mental Health Needs
McVey, R. J. (2025) · Medicine Anthropology Theory · doi:10.17157/mat.12.2.9432 · Cited by 2 · see citing works
Wakefield, E. O., & Jerson, B. (2017) · Topics in Pain Management · doi:10.1097/01.tpm.0000515416.01386.7d · Cited by 2 · see citing works
Children’s experiences of hospitalisation
Coyne, I. (2007) · Nursing Children and Young People · doi:10.7748/paed.19.3.10.s16 · Cited by 2 · see citing works
The emergence of negotiated family care in intensive care : a grounded theory approach
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Bull, A. (2013) · Enlighten: Theses (The University of Glasgow) · Cited by 2 · see citing works
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Ford, K. (2010) · Figshare · doi:10.25959/23211734 · Cited by 3 · see citing works
Simmonds, M. K., Dick, B. D., Verrier, M. J., Reid, K. L., Jamieson-Lega, K., Balisky, K. J., Davey, A. E., & Freeman, K. M. (2022) · Children · doi:10.3390/children9091293 · Cited by 1 · see citing works
“It has been previously highlighted how children with chronic pain often experience negative, judgmental and stressful encounters with clinicians, related to clinicians’ struggles to secure a diagnosis and confidently explain chronic pain; exposing a need to recruit clinicians, including physicians, to remedy this issu…”
BackgroundMeys, A., & Jones, M. (2023) · New Zealand Journal of Physiotherapy · doi:10.15619/nzjp.v51i2.352 · Cited by 1 · see citing works
“A main stressor reported by these parents were the encounters with medical professionals, medical misinterpretations, and lack of diagnosis or treatment plans for their child’s pain (Carter, 2002).”
BackgroundInfluentialThe view from the bridge: bringing a third position to child health
Kraemer, S. (2017) · doi:10.1057/978-1-137-54747-7_5 · Cited by 1 · see citing works
Children’s Right to Health: Theory versus Practice
Simonelli, I. (2021) · Clinical Health Promotion - Research and Best Practice for patients staff and community · doi:10.29102/clinhp.21012 · Cited by 1 · see citing works
The 2010 Annual Conference of the Canadian Pain Society.
(2010) · PubMed Central · Cited by 1 · see citing works
Nursing Care and Management of Children's Perioperative Pain
Carter, B., & Jonas, D. (2009) · doi:10.1002/9781444314625.ch4 · Cited by 1 · see citing works
Logan, D. E. (2003) · Prevention & Treatment · doi:10.1037/1522-3736.6.1.66c · Cited by 1 · see citing works
OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
(2003) · Evidence-Based Nursing · doi:10.1136/ebn.6.1.e1 · Cited by 1 · see citing works
5 Management of Pediatric Pain
Forgeron, P. A., & McGrath, P. J. (2008)
The problem of pain : a heuristic and structural existential analysis of unexplained physical pain
Christophy, C. (2017) · Middlesex University Research Repository (Middlesex University Of London)
Self-Care in Young People With Diabetes: A Qualitative Exploration Using a Salutogenic Approach
Green, E. (2018) · UEL Research Repository (University of East London) · doi:10.15123/uel.8887x
Graham-Ray, L. (2020) · Staff Publications Online (The Tavistock and Portman)
Canadian Pain Society Conference May 12 – 15, 2010, Calgary, Alberta
(2010) · Pain Research and Management · doi:10.1155/2010/198368
An Update Proposal for Article 31 of the UN Convention
Simonelli, I. (2022) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-6684-5068-0.ch006
Children First, a Debate on the Restrictions to Tackle COVID-19
Verd, S. (2023) · Children · doi:10.3390/children10020211
“However, many children believe that they have been excluded from decisions affecting their bodies [25].”
Background
- Authors
- Carter, B.
- Affiliations
- University of Lancashire (GB)
- Corresponding author
- Carter, Bernie
- ORCID
- Carter, Bernie
- Venue
- Qualitative Health Research
- Publisher
- SAGE Publications
- Published
- 2002-01
- Volume
- 12
- Issue
- 1
- Pages
- 28-41
- ISSN
- 1049-7323 (ISSN-L)
- 1552-7557
- OpenAlex
- W2131865090
- Cited by
- 105
- References
- 48
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 7 · 2020: 3 · 2019: 5 · 2018: 2 · 2017: 5 · 2016: 2 · 2015: 5 · 2014: 3 · 2013: 4 · 2012: 3
- FWCI
- 2.40
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Qualitative Health Research (publishedVersion)
- PubMed (publishedVersion)
- CLOK (University of Central Lancashire) (submittedVersion)
- Edge Hill University Research Information Repository (Edge Hill University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Social Sciences › Sociology and Political Science › Children's Rights and Participation
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- pediatric chronic pain, healthcare encounters, patient voice, misdiagnosis, family experiences, patient-professional relationship
- MeSH terms
- Adolescent, Psychology, Adolescent, Attitude of Health Personnel, Child, Psychology, Child, Chronic Disease, Communication, Evaluation Studies as Topic, Female, Health Services Research, Humans, Judgment, Male, Medical History Taking, Pain, Physician-Patient Relations, Professional-Family Relations, United States
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