Background: Article 12 of the UN Convention on the Rights of the Child (1989) guarantees every child’s voice, but this must go beyond just hearing what a child says. All too often clinical communication relies on spoken language, excluding pre-verbal, non-speaking, non-English-speaking and silenced children. This project aimed to address these inequities by exploring applying established practices in speech and language of alternative communication methods to paediatrics

Methods: A systematic literature review identified more than 20,000 papers on the benefits of alternative communication but only 4 on its practical application in paediatric clinical conversations.  A communication toolkit ‘My Voice Matters’ was co-designed with 126 London schools and safeguarding teams from 26 NHS trusts to promote accessible, child-centred participation in child protection assessments.  Communication stations with co-designed tailored tools for clinical conversations were introduced across a children’s hospital including emergency department, inpatient wards and 2 community child health clinics

Results: Existing evidence and pilot data demonstrate visual communication tools empower children to share experiences and understand clinicians’ perspectives. In the first three months, My Voice Matters enabled eight children to disclose previously unreported abuse and nearly doubled documentation of the child’s voice. In hospital settings, children reporting not being heard fell from 9% to 0%, while staff use of alternative communication rose from 17% to 96%.

Conclusions: Child-centred communication tools make children’s rights a clinical reality; improving safeguarding, equity and care quality. Having tailored communication aids readily available should be a universal standard in paediatric settings.

Dr Claire Stewart is a paediatric registrar at the Evelina London Children’s Hospital and is the National Trainee Representative for the British Association of Community Child Health (BACCH).  She has won multiple national and international awards for leading transformative quality improvement initiatives that have changed standards. She has 16 peer-reviewed publications and has spoken in over 40 national and international conferences.  Recognising that a difficult situation or subject matter can create a communication need in any child, her latest work improving how the ‘Voice of the Child’ is heard is driving improvements in care and safeguarding practices across the UK.