In the pediatrics clerkship, represented by the jigsaw puzzle in this image, I was particularly struck by the differences in attempts at communicating with pediatric patients as opposed to adult patients. Communication is represented by the can-and-string “phone,” a playful means of communicating that is both favored by children and for all its simplicity is design, difficult to execute.

The equation of father + mother = ? baby refers to the fact that the behaviors of children are not independent of their caretakers’ behaviors. In any pediatric interview, the dynamic of present or absent family members must be acknowledged and accounted for to ensure effective communication.

The US and Mexican flags indicate that language barriers can exist between children and doctors, as well as parents and doctors. In some cases, interpreters enter the interview dynamic.

The syringe is easy to interpret. Since the bulk of their early visits with health care providers result in the unpleasant stimulus of receiving a vaccination, children reasonably develop trepidation of doctors. As a result, an interviewer must learn age-specific techniques to place the child at ease before attempting to obtain information.

The two drawings show that children do not see the world the way that adults do and they do not communicate about it with the same skills that adults do. This requires the interviewer to learn developmentally appropriate methods of communicating with a child. It also requires some art in understanding what the child is trying to communicate.

Lastly, the hands represent that children are built differently than adults. Consequently, physical exam techniques used for examining adults do not always work on a child’s body. Furthermore, findings on physical exams may have different interpretations in children than in adults.