Managing parental expectations: A necessary skill for paediatric orthopaedic surgeons

The mother of the 2- year-old looked sceptic as the surgeon tried explaining that surgical correction of the congenital vertical talus her son suffered from, had been successful. She could appreciate the alignment of ‘the ankle bone’ and ‘the heel bone’ on the X-rays had been brought to normal but was still concerned about the appearance of the foot. "Why is the heel still twisted ?", she said referring to the minimal residual eversion of the hind foot. While the surgeon felt he had a good outcome, the parents had expected a ‘fully normal’ foot at the end of the surgery. Clearly a case of conflicting expectations.

Managing parental expectations is crucial in the success of paediatric orthopaedic care. Parents often come with heightened anxieties and hopes for their child’s recovery, influenced by emotional, cultural, and social factors. It is imperative for paediatric orthopaedic surgeons to address these concerns early in the doctor-patient interaction. Regular follow-ups and progress updates reassure families and are crucial to adjust expectations.

Effective communication is the cornerstone of managing expectations. Clinicians must provide clear, jargon-free explanations of diagnoses, treatment options and potential outcomes, while also acknowledging uncertainties such as growth-related challenges or variable recovery timelines. Brochures or online content explaining complex procedures can enhance understanding and retention of information.

Shared decision-making fosters trust and empowers parents, ensuring they are active participants in their child’s care. By involving them in discussions about treatment plans and potential risks, clinicians can reduce misunderstandings and align expectations with realistic outcomes. Empathy is equally essential; listening to parents’ fears and validating their emotions builds rapport and eases emotional distress.

Almost all paediatric orthopaedic surgeons can recall being at wrong end of mal-aligned expectations. Managing ‘difficult’ caregivers is also a historically under discussed topic during training. A delicate balance of empathy, clear communication and realistic goal setting is required to bridge the gap of expectations.