"What happens at the Doctor's?": a Qualitative Study Exploring Social Representations and Experiential Knowledge of Medical Consultation in 5-6 Year-Olds

"What happens at the Doctor's?": a Qualitative Study Exploring Social Representations and Experiential Knowledge of Medical Consultation in 5-6 Year-Olds | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article "What happens at the Doctor's?": a Qualitative Study Exploring Social Representations and Experiential Knowledge of Medical Consultation in 5-6 Year-Olds Hugues Faucheu, Alyssa Gaillet-Lagrange, Philippe Jaury, Louis-Baptiste Jaunay This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8776881/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Medical consultations can be anxiety-provoking for young children, potentially affecting communication, examination, and adherence to care. While research has largely focused on procedural pain and fear of specific interventions, little is known about how preschool children conceptualize the medical consultation itself. Understanding children’s social representations and experiential knowledge may help clinicians adapt communication and improve care experiences. This study explored how children aged 5–6 conceptualize medical consultations. Methods An exploratory qualitative study was conducted in France using semi-structured individual and small-group interviews during school-based "Teddy Bear Hospital"-type school outings, where children play the role of the parent of their cuddly toy who is ill. Forty-nine children (5–6 years old) from seven nursery schools participated (39 interviews). Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis within an interpretivist framework. Results Four interrelated themes described children’s representations of medical consultations: (1) attitudes and behaviors toward doctors, (2) representations of illness, (3) understanding of medical examination and knowledge, and (4) representations of care and treatment. Illness was typically defined through single concrete symptoms and attributed to visible or imagined causes (falls, cold exposure, animals). Doctors were seen as identifying illness using instruments (e.g., stethoscope, thermometer, X-ray), and treatments were expected to be tangible and localized (bandages, injections, medication), sometimes with symbolic healing power. Children demonstrated coherent causal reasoning and actively engaged in caregiving behaviors toward their toys. Conclusion Children aged 5–6 already hold structured, experience-based models of illness, examination, and treatment. These representations shape expectations of care and may influence anxiety and cooperation during consultations. Recognizing and integrating children’s perspectives—particularly their focus on concrete signs, diagnostic tools, and tangible treatments—may support more effective communication and child-centred consultations. Preschool child Medical consultation Social representations Experiential knowledge Qualitative research Child perspective Figures Figure 1 Figure 2 Background Consulting a doctor for a young child is often a delicate process, with half of all parents reporting that their child aged 2 to 5 is afraid to go to the doctor [1]. This anxiety can make questioning and physical examination difficult [2]. Treatment and care can be challenging, including vaccination [3], nasal irrigation [4] and medication [5]. Failure to manage pain and associated anxiety leads to pain sensitization [6]. Because of anticipatory anxiety, some parents hesitate to consult a doctor even if their child is ill [1]. Care anxiety is transmitted from one generation to the next: the parent's attitude is crucial to the child's acceptance of care [7, 8]. Numerous studies have been carried out on the pain and associated anxiety of children in medical consultations. They concern all ages: infants [9–11], preschoolers [12], school-age children [13, 14], adolescents [14, 15]. However, these studies deal with procedural pain anxiety, particularly fear of injections [15–17]. In these studies, the assumption is that the child is in pain just like anyone else during a painful procedure, and that it is therefore normal for the child to be anxious. The proposed remedies are essentially symptomatic: they can be implemented by patients themselves [18], by parents [10] and by caregivers [9, 11, 19, 20]. Remedies can be psychological [15], using distraction [21], virtual reality [22], behavioral approaches [16], memory redirection [17], mechanical action [23], hypnosis [24] and analgesic drugs. In addition to these targeted approaches, it would be interesting to study the child's medical consultation from a global perspective. The study of social representations (SR) has made a major contribution to the advancement of social sciences in health [25]. In addition, in a context of health democracy where patients are placed at the heart of the healthcare system, the lived experience of their illness is seen as a source of knowledge and expertise [26, 27]. This is known as experiential knowledge (EK). Very few studies have explored how preschool children conceptualize the medical consultation as a social and symbolic event rather than a painful procedure. A study of SR and EK could clarify the point of view from which the child's anxiety arises and helps us to propose more global remediation. The 3–6 age group seems to be the most anxious [28] and the 5–6 age group is the age of the construction of contextual fears anchored in reality [29]. Thus, the aim of this study was to investigate the SR and EK of medical consultation in 5–6 year-old children. Methods Study design and setting This was an exploratory qualitative study using inductive thematic analysis [30], situated within an interpretivist framework, aiming to understand how children construct meaning around medical consultations through play and narrative. We conducted and reported our research following the COnsolidated criteria for REporting Qualitative checklist (see Supplementary File 1) [31]. The study assumes that children’s accounts reflect socially constructed meanings shaped by experience, observation, and interaction. The Teddy Bear Clinic setting was used as a symbolic and play-based environment facilitating expression. The Teddy bear clinic (TBC) is a tool that first appeared in Boston in the late 80s [32]. It's a role-playing game in which children accompany their sick teddies through various workshops on a care pathway led by healthcare students. Getting children to play is a method often used in sociology to gain access to their worldviews [33]. An initial observation of a TBC session (May 2022) was conducted to assess whether the setting allowed spontaneous child expression, symbolic play, and interaction with health-related objects. This confirmed that the TBC environment provided a familiar, low-anxiety, play-based context appropriate for eliciting children's representations. The use of puppets during interviews with children may help them to clarify and verbalize their affects [34]. We therefore preferred to have the child express himself through his cuddly toy, and the interviewer through a puppet representing a doctor (Fig. 1 ). [please insert Fig. 1 here] Data collection From March to May 2023, the first author (HF) observed and audio-recorded semi-structured interviews with kindergarten children in the context of TBC sessions. These sessions were organized by Ile-de-France health students in coordination with nursery schools. HF did not know the participants prior to the study. Data collection continued until theoretical sufficiency was reached, defined as the point at which enough data had been gathered to comprehensively describe and explain the pertinent topics and themes without significant gaps or logical inconsistencies. The interviews were conducted, transcribed, and anonymized by HF. The transcriptions were enhanced with notes on non-verbal communication, including gaze, facial expressions, gestures, and posture. Field notes on non-verbal behavior were written immediately after each interview to avoid disrupting interaction during the puppet-mediated interview. The audio recordings and notes were transcribed verbatim, with annotations concerning observation of the child's non-verbal language. 49 kindergarten children were interviewed, 29 girls and 20 boys from seven nursery schools located in five districts of Ile-de-France, aged 5 to 6. 39 interviews were conducted at the TBC site, some of which were group interviews, when children chose to speak together. There was no refusal to participate nor any dropouts. The total duration of the interviews was 4 h 14 min which corresponds to an average of 6 min 31 s per interview. The shortest interview lasted 2 min 25 s and the longest 11 min 56 s. Interview guide A semi-structured interview guide was developed by HP based on the study objectives and relevant literature (Table 1 ). The draft guide was reviewed by LBJ and pilot tested with children known to HF (outside the study sample) to ensure clarity of wording and appropriateness for age. The interview took place before and after all the TBC workshops. The pre-workshop interview explored prior representations of medical consultation. The post-workshop interview aimed to explore how children narrated the consultation experience after role-play and to identify newly mobilized knowledge. The study did not aim to measure learning effects but to capture the range of representations expressed across both temporal moments. Table 1 Interview guide Before the workshops After the workshops - Hello cuddly toy, what's your name? - How are you? - What are you going to the doctor for? - What are we going to do at the doctor's? - What's going to happen at the doctor's? - Hello again cuddly toy, so, what happened? - How are you now? - Now, do you know what happens at the doctor's? - What do we do at the doctor's? - What do we go to the doctor for? [please insert Table 1 here] Analysis Audio-recordings were transcribed verbatim. Data were analysed using inductive thematic analysis [30]. HF conducted initial open coding of all transcripts. Codes were compared across interviews and grouped into categories through constant comparison. AGP independently coded a subset of transcripts. Discrepancies were discussed until agreement was reached. Themes were developed by examining patterns of meaning across categories, with attention to both verbal content and observational notes. Analysis occurred alongside data collection. Data collection continued until theoretical sufficiency was reached, defined as the point at which enough data had been gathered to comprehensively describe and explain the pertinent topics and themes without significant gaps or logical inconsistencies. Reflexivity HF is a general practice trainee with a clinical interest in child consultations. HF had no prior relationship with participating children. His medical background may have influenced attention to health-related content. To reduce interpretative bias, transcripts were co-analysed with AGP, who has qualitative research experience. Ethical considerations The Ethics Committee of the French National College of Teaching General Practitioners gave its favorable opinion on 12/10/2022. Children’s parents gave their informed consent for their child's participation after considering the information provided to them about the study. Only children whose parents had provided written consent were approached. Teachers identified these children before the TBC session. Participation was voluntary and children could stop at any time. Results Analysis of observables and verbalizations Four primary themes emerged from the data regarding children's social representation and experiential knowledge during medical consultations: Attitudes and behaviors towards doctors; Illness; Medical science; and Care and treatment. The sub-themes have been organized in a conceptual map that summarizes the child's journey through the consultation (Fig. 2 ). [Please insert Fig. 2 here] Attitudes and behaviour during medical consultations Children frequently described attempts to present themselves as brave in the context of medical care, for example, "I took an injection and didn't even cry", "I'm not afraid" or "I'm not afraid of going to the doctor". At the same time, fear was also reported, particularly in relation to specific anticipated procedures such as injections or nasal irrigation that "tickles". Some children described avoidance behaviors, for example hiding when anticipating a procedure perceived as unpleasant "hides in my cuddly toy box". During the child's visit to the medical consultation workshop at the TBC, in hetero-assessment, there were no signs of anxiety: there was no anxiety-related crying or agitation. Representations of illness Children’s representations of illness were predominantly concrete and symptom-based. Children almost always know that they're going to the doctor "because I'm sick". Illness was often described through a single, concrete symptom such as "sore throat", "headache", "stomach ache". The illness is then merged with its isolated sign. Some children referred to named illnesses (e.g., "chicken pox", "flu", "COVID", "gastro") while others described more diffuse or global states such as : "aching all over", or "all the diseases in the world". Children frequently proposed causal explanations for illness that drew on daily and imagined experiences (e.g., falling, bumping into objects, being stung). Illness was sometimes linked to behaviors perceived as risky such as "I slipped on the ice, and my wood fell off [the cuddly toy is a reindeer]", "He rolled in the snow and now he's got a cold", "He wanted to swim even though he doesn't know how, so he went to the bottom of the sea and bumped his head", "walking alone in the forest and being bitten by a panther", "eating fruit and vegetables and having a stomachache". Descriptions of illness included both localized bodily sensations, particularly pain, in "the stomach", "the head", "the paw", "the ear", "the throat". This pain, when localized, is felt in "the skin". The signs of the illness are general could have functional consequences such as "she spends all her time in bed", "I can no longer fly", "he may die". Some children also mentioned constraints, such as changing sheets because "he vomits on my sheet". A few children described perceived benefits of illness, such as "eat in bed" or "draw all day". Understanding of medical examination and medical knowledge Children commonly described the doctor’s role as identifying illness through examination of body parts such as "the heart", "the ears", "the throat", "the back". They referred to anatomical and diagnostic knowledge: "the glottis" is at the back of the throat, you can touch to "see if my legs are alright" and you can hear the heart, which goes "pom pom pom" with "headphones". They referred to diagnostic instruments including the stethoscope, the "stick" to put "in the throat", the thermometer that you "put in the mouth and wait until it's red" and mentioned wanting to participate in the examination for example by using the otoscope. Imaging procedures, particularly X-rays, were frequently mentioned as a way to "see the bones" and find out if there is a "broken bone". Some children suggested X-rays even for non-traumatic complaints such as a "heartache". Participants also referred to medications and other therapeutic techniques like "skin adhesive", "pipettes" and medicines with complicated names like "palacetamol" for pain. Several children associated illnesses with "little microbes" that can be seen "at the back of the throat" or "in the ears". Sometimes, children’s associate illnesses with consistent symptoms: You "vomit" when you have "gastro". You "scratch" and have "pimples everywhere" when you have "chickenpox". Some children expressed uncertainty about how the disease will evolve, so the cure is incomplete and you "heal a little". Representations of care and treatment In most interviews, children proposed at least one form of treatment. Medication was frequently mentioned, along with dietary or hygiene measures such as "fruit and vegetables". Suggested treatments generally reflected elements of conventional medical care, although occasional non-medical remedies were also proposed, like a "caress". The children considered it important that the therapy be consistent with the illness. In the case of pain or a localized lesion, a tangible local therapy seems most effective. This can take the form of a "band-aid" for a "little ache", a "bandage" if it hurts "a lot", or a "shot". Band-aids could have a remote curative action against "stomach ache". Children frequently described concrete actions as effective remedies such as "a shower" or a "wet sheet on the forehead". For non-traumatic conditions, treatments were often described as addressing symptoms, whereas for injuries, repair of the underlying damage (e.g., fractures) was emphasized. Often, the child is cured by the treatment. Recovery was usually described as the expected outcome of treatment, though some children noted that improvement could take time or remain incomplete "time for it to work" and "time for it to repair itself". Many children spontaneously engaged in caregiving behaviours toward their cuddly toy during the session. Participants also referred to the roles of other health professionals, including the "pharmacy", the "radio center", the "physiotherapist". Discussion This study explored how children aged 5–6 conceptualize medical consultations and shows that young children already possess structured and experience-based models of illness, examination, and treatment. Far from being passive recipients of care, children described coherent causal explanations, expected diagnostic processes, and meaningful therapeutic actions. Their representations were grounded in concrete bodily experiences, everyday events, and symbolic reasoning emerging from play and observation. Children’s representations of illness and causality The findings reveal a significant diversity in SR among 5–6 year-olds, especially in relation to the origins of illness and treatment. The Laplantine framework of social representation disease [35] was applied after inductive theme development as an interpretive lens. According to this model, children identified traumatic illnesses as ontological, with a specific cause and identified organic lesion, as exogenous, due to an external aggression, as subtractive, associated with a loss of function, and finally as malefic, experienced in a negative way. This corresponds to the dominant representation of contemporary Western medicine. As for non-traumatic illnesses, the position is more nuanced: certain illnesses have been identified as relational when the child has "pain everywhere" or "sick eyes", as endogenous because spontaneous, as additive because one "catches a cold" and even as beneficial because one can "eat in bed" and "draw all day". The origins of these illnesses vary widely and are comparable to those of adults. Following Laplantine's therapeutic models, the children proposed a wide variety of therapies: allopathic with drugs or not with caresses, additive with food and subtractive with showers, sedative with analgesics and excitatory with injections, and exorcistic with surgery and adorcistic with physiotherapy. Here again, we find a wide variety of therapies proposed by children, in a framework comparable to that of adults. Children sometimes associate the natural evolution of a scratch with the action of a band-aid. In such cases, he considers that the band-aid has a curative and analgesic action of its own. He suggests a band-aid for localized symptoms such as abdominal pain or headaches. Understanding of medical examination and knowledge Children portrayed the medical consultation as a structured investigative process. Doctors were described as identifying illness through examination of specific body parts and the use of diagnostic instruments such as stethoscopes, thermometers, and X-rays. These tools were not only recognized but attributed epistemic value: they allowed doctors to “see” or “hear” what is wrong. Treatments were primarily described as concrete, localized actions—bandages, injections, medication, showers, or cooling cloths. Even when the underlying mechanism was not understood, tangible interventions were perceived as having intrinsic curative power. Symbolic and affective dimensions also emerged, such as caregiving gestures or comforting actions. These findings highlight that, for young children, treatment effectiveness is closely linked to visible or sensory features. This reflects an early understanding of medicine as a knowledge-based practice mediated by technology. With regard to all the aspects raised by children aged 8 to 11 [36, 37], our study showed that children aged 5 to 6 were ready to grasp these issues at their own level. These findings suggest that children as young as 5–6 years may be able to engage in discussions about illness and care when communication is adapted to their level of understanding. The consultation as a social and symbolic event The Teddy Bear Hospital setting revealed children’s strong engagement in caregiving roles and their sense of responsibility for their toy’s health. This suggests that medical consultations are not only clinical encounters but also social and symbolic events in which children position themselves as actors. Play appeared to facilitate expression and reflection, supporting previous work indicating that symbolic mediation can help children articulate experiences that may be difficult to verbalize directly [33, 34]. The difference in attitude between the child playing with his cuddly toy and the child in a real consultation situation can be explained by the fact that: it's the cuddly toy that endures the consultation, not the child it's a game the child is not ill nor uncomfortable the group effect children feel responsible for the health of their cuddly toy. Using a cuddly toy during the consultation, or even organizing a consultation of the cuddly toy, could help the child to open up. Clinical implications (Tables 2 and 3 ) Table 2 Communication strategies derived from findings. For doctors 1) Address the child at every stage of the consultation. Children often expressed trust in doctors. Children are happy to communicate and have lots to say. 2) Encourage play . Children can bring a cuddly toy, and the doctor can use a puppet to play the doctor's role. 3) Remind the child why he's here. It may be helpful to express the goal in positive terms: taking care of his health together. 4) Discuss the origin of the illness. Children have a structured and coherent discourse to explain the origin of illnesses. 5) Discuss signs of illness. Children can describe their symptoms, and can sometimes link them to a disease, or even associate them into a coherent syndrome. Discussing these directly with the child naturally justifies a physical examination to explore these signs. 5) Involve the child in the physical examination and diagnosis. Children are attracted to the doctor's instruments, proud to know their complicated names, and often want to play with them themselves. 6) Rely on the child's beliefs. Children’s existing beliefs about treatment can be acknowledged and explored during explanations. 7) Accepting pain. Children know that an injection can hurt. It is possible to work on the child's acceptance of this fact. 8) Preventive actions. All the above elements contribute to making children more responsible for their own health. 9) Offer a dedicated prevention consultation with the child's cuddly toy. On the model of the TBC medical consultation, it could be appropriate to receive the children in consultation for a role-play with their cuddly toy, who are ill and need to be vaccinated. Table 3 Communication strategies derived from findings. For parents 1) Before the consultation: raise awareness of the need to go to the doctor. Children describe doctors as people who treat illnesses. A first step can be to make him aware that he's ill, by asking questions like: How are you? Is it normal if your stomach hurts? Do you usually feel pain like this? Then, to make him aware of the importance of going to see the doctor, we could ask him questions like: What can we do so that you can play as usual? How do we know what medicine to give you? Where do you go to get medicine? 2) During the consultation: help your child detail his symptoms. Children may have difficulty verbalizing their symptoms during the consultation. In this case, we can help him by contextualizing the questions so that his story is anchored in his own experience. 3) After the consultation, you can discuss the effect of treatment and the natural course of the disease. These findings suggest possible avenues for communication strategies to help children establish a constructive relationship with their health from an early age, in order to prepare them to take responsibility for their health and obtain their free and informed consent. [please insert Table 2 here] [please insert Table 3 here] Study limitations This study has several limitations. First, interviews were conducted with young children, whose verbal abilities and attention span may limit the depth and precision of their responses. Although age-appropriate techniques were used, some answers remained brief or concrete. Group interviews may also have shaped responses through peer influence or social desirability. Second, the study relied on a relatively small and context-specific sample drawn from participating schools, which may limit transferability to other sociocultural or health-care settings. Third, the data were collected in a simulated educational setting (the Teddy Bear Clinic) rather than during real medical consultations. Children’s accounts may therefore reflect expectations associated with play-based role-play rather than experiences of actual clinical encounters. Moreover, the presence of health-care students during the session may have influenced children’s representations and language, particularly in the post-intervention interviews, where some statements could reflect newly acquired vocabulary rather than pre-existing understanding. However, this play-based approach has helped to get children talking who may otherwise tend to be reticent when visiting the doctor. Conclusion This study shows that many children aged 5–6 express structured ideas about illness, examination and treatment when given an opportunity to speak through play. Children can engage in discussions about illness and care, especially in a playful atmosphere, using their cuddly toy. Their explanations try to be logical and coherent. Children expect to be examined and are interested in examination techniques. They understand the doctor's diagnostic approach and appreciate the explanations given. As for treatment, even though it usually involves medication, it also favors tangible therapies such as band-aids and bandages, which often have a specific, in-depth curative effect. The therapies offered are rich and varied and are comparable to those used for adults. These findings suggest that clinicians can discuss with children the origins and symptoms of their illness, the diagnostic process, the disease itself and treatments. Children aged 5 to 6 can be explicitly involved in their own care. This could help to reduce their anxiety, better assess their symptoms, involve them in physical examinations, encourage compliance with treatment and facilitate long-term health follow-up. Abbreviations SR Social Representations EK Experiential knowledge TBC Teddy Bear Clinic Declarations Ethics approval and consent to participate The Ethics Committee of the “Collège National des Généralistes Enseignants” (CNGE) gave its favorable opinion on 12/10/2022. Clinical trial number: not applicable Consent for publication Children’s parents gave their informed consent for their child's participation after considering the information provided to them about the study. Availability of data and materials Due to the sensitive nature of qualitative data involving minors, transcripts are not publicly available but may be requested. Competing interests None of the authors have a conflict of interest to disclose. Funding None Authors’ contributions Hugues Faucheu: Conceptualization, Investigation, Writing - original draft, Methodology, Formal analysis. Alyssa Gaillet-Lagrange:Formal analysis. Philippe Jaury: Writing - review & editing. Louis-Baptiste Jaunay: Conceptualization, Methodology, Validation, Writing - review & editing, Formal analysis, Supervision. Acknowledgments None References Clark SJ, Freed GL. C.S. Mott Children’s Hospital National Poll on Children’s Health. 2018. Jan MMS. Neurological examination of difficult and poorly cooperative children. J Child Neurol. 2007;22:1209–13. https://doi.org/10.1177/0883073807306262. McLenon J, Rogers MAM. The fear of needles: A systematic review and meta-analysis. 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Garber SW, Spizman RF, Garber MD. Monsters Under the Bed and Other Childhood Fears: Helping Your Child Overcome Anxieties, Fears, and Phobias. Random House Publishing Group; 1993. Vears DF, Gillam L. Inductive content analysis: A guide for beginning qualitative researchers. FoHPE. 2022;23:111–27. https://doi.org/10.11157/fohpe.v23i1.544. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57. https://doi.org/10.1093/intqhc/mzm042. Creedon CM. Teddy bear clinic. Todays OR Nurse. 1989;11:31–3. Camus J, Geay B, Pagis J. Serious Sociological Games in the ELFE Cohort Study: Using Children’s Play to Gain Perspective on their Visions of the World. Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique. 2020;146:99–123. https://doi.org/10.1177/0759106320908231. Epstein I, Stevens B, McKeever P, Baruchel S, Jones H. Using puppetry to elicit children’s talk for research. Nurs Inq. 2008;15:49–56. https://doi.org/10.1111/j.1440-1800.2008.00395.x. Laplantine F. Anthropologie de la maladie : étude ethnologique des systèmes de représentations étiologiques et thérapeutiques dans la France contemporaine. Payot; 1986. Le Berre S. La consultation de médecine générale vue par l’enfant. 2013. Robert de Rancher C. “Qui c’est pour toi ton docteur ?” : la relation enfant-médecin perceptions et attentes des 10-11 ans. Université Claude Bernard Lyon; 2013. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1COREQchecklist.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 24 Apr, 2026 Reviews received at journal 21 Apr, 2026 Reviews received at journal 18 Apr, 2026 Reviewers agreed at journal 28 Mar, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers agreed at journal 25 Mar, 2026 Reviewers invited by journal 24 Mar, 2026 Editor invited by journal 09 Mar, 2026 Editor assigned by journal 09 Feb, 2026 Submission checks completed at journal 09 Feb, 2026 First submitted to journal 03 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8776881","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":612044511,"identity":"2e124e7b-a50f-407f-bfaf-ad261340190c","order_by":0,"name":"Hugues Faucheu","email":"","orcid":"","institution":"Paris Cité University","correspondingAuthor":false,"prefix":"","firstName":"Hugues","middleName":"","lastName":"Faucheu","suffix":""},{"id":612044513,"identity":"111fdf39-d690-4ab2-a1c6-fbd305571398","order_by":1,"name":"Alyssa Gaillet-Lagrange","email":"","orcid":"","institution":"Sorbonne University","correspondingAuthor":false,"prefix":"","firstName":"Alyssa","middleName":"","lastName":"Gaillet-Lagrange","suffix":""},{"id":612044514,"identity":"a3761e78-815d-485a-819e-4879ef75ec14","order_by":2,"name":"Philippe Jaury","email":"","orcid":"","institution":"Paris Cité University","correspondingAuthor":false,"prefix":"","firstName":"Philippe","middleName":"","lastName":"Jaury","suffix":""},{"id":612044515,"identity":"c36a90b4-2828-44bb-8ef0-eeb727cf72ec","order_by":3,"name":"Louis-Baptiste Jaunay","email":"data:image/png;base64,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","orcid":"","institution":"Paris Cité University","correspondingAuthor":true,"prefix":"","firstName":"Louis-Baptiste","middleName":"","lastName":"Jaunay","suffix":""}],"badges":[],"createdAt":"2026-02-03 14:09:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8776881/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8776881/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105565951,"identity":"7d040bd3-10b4-491c-a39c-75caaa2ce4e8","added_by":"auto","created_at":"2026-03-27 12:54:52","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":172462,"visible":true,"origin":"","legend":"\u003cp\u003eIllustration of interview setup: The child expresses himself through his cuddly toy, and the interviewer through a puppet representing a doctor\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8776881/v1/8b9c62c7bc05443b3da12580.jpeg"},{"id":105497586,"identity":"e9baae9f-e86a-432c-9b2a-92ec64dad59b","added_by":"auto","created_at":"2026-03-26 16:46:27","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":328829,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual map of children’s representations of the consultation process\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8776881/v1/7b873747f7d3b63d3fb369b2.png"},{"id":105569267,"identity":"1e078235-822e-4961-89b8-14f4dc06b2ac","added_by":"auto","created_at":"2026-03-27 13:12:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1692785,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8776881/v1/72f076c5-cb10-4324-90df-d5dc9c5aea65.pdf"},{"id":105497589,"identity":"bd83934b-549d-472d-81f8-f51de92466ba","added_by":"auto","created_at":"2026-03-26 16:46:27","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":27299,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1COREQchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-8776881/v1/e2716f1a721391d34fe52605.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\"What happens at the Doctor's?\": a Qualitative Study Exploring Social Representations and Experiential Knowledge of Medical Consultation in 5-6 Year-Olds","fulltext":[{"header":"Background","content":"\u003cp\u003e Consulting a doctor for a young child is often a delicate process, with half of all parents reporting that their child aged 2 to 5 is afraid to go to the doctor [1]. This anxiety can make questioning and physical examination difficult [2]. Treatment and care can be challenging, including vaccination [3], nasal irrigation [4] and medication [5]. Failure to manage pain and associated anxiety leads to pain sensitization [6]. Because of anticipatory anxiety, some parents hesitate to consult a doctor even if their child is ill [1]. Care anxiety is transmitted from one generation to the next: the parent's attitude is crucial to the child's acceptance of care [7, 8].\u003c/p\u003e \u003cp\u003eNumerous studies have been carried out on the pain and associated anxiety of children in medical consultations. They concern all ages: infants [9\u0026ndash;11], preschoolers [12], school-age children [13, 14], adolescents [14, 15]. However, these studies deal with procedural pain anxiety, particularly fear of injections [15\u0026ndash;17]. In these studies, the assumption is that the child is in pain just like anyone else during a painful procedure, and that it is therefore normal for the child to be anxious. The proposed remedies are essentially symptomatic: they can be implemented by patients themselves [18], by parents [10] and by caregivers [9, 11, 19, 20]. Remedies can be psychological [15], using distraction [21], virtual reality [22], behavioral approaches [16], memory redirection [17], mechanical action [23], hypnosis [24] and analgesic drugs. In addition to these targeted approaches, it would be interesting to study the child's medical consultation from a global perspective.\u003c/p\u003e \u003cp\u003eThe study of social representations (SR) has made a major contribution to the advancement of social sciences in health [25]. In addition, in a context of health democracy where patients are placed at the heart of the healthcare system, the lived experience of their illness is seen as a source of knowledge and expertise [26, 27]. This is known as experiential knowledge (EK). Very few studies have explored how preschool children conceptualize the medical consultation as a social and symbolic event rather than a painful procedure. A study of SR and EK could clarify the point of view from which the child's anxiety arises and helps us to propose more global remediation.\u003c/p\u003e \u003cp\u003eThe 3\u0026ndash;6 age group seems to be the most anxious [28] and the 5\u0026ndash;6 age group is the age of the construction of contextual fears anchored in reality [29]. Thus, the aim of this study was to investigate the SR and EK of medical consultation in 5\u0026ndash;6 year-old children.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eThis was an exploratory qualitative study using inductive thematic analysis [30], situated within an interpretivist framework, aiming to understand how children construct meaning around medical consultations through play and narrative. We conducted and reported our research following the COnsolidated criteria for REporting Qualitative checklist (see Supplementary File 1) [31].\u003c/p\u003e \u003cp\u003eThe study assumes that children\u0026rsquo;s accounts reflect socially constructed meanings shaped by experience, observation, and interaction. The Teddy Bear Clinic setting was used as a symbolic and play-based environment facilitating expression. The Teddy bear clinic (TBC) is a tool that first appeared in Boston in the late 80s [32]. It's a role-playing game in which children accompany their sick teddies through various workshops on a care pathway led by healthcare students. Getting children to play is a method often used in sociology to gain access to their worldviews [33].\u003c/p\u003e \u003cp\u003eAn initial observation of a TBC session (May 2022) was conducted to assess whether the setting allowed spontaneous child expression, symbolic play, and interaction with health-related objects. This confirmed that the TBC environment provided a familiar, low-anxiety, play-based context appropriate for eliciting children's representations. The use of puppets during interviews with children may help them to clarify and verbalize their affects [34]. We therefore preferred to have the child express himself through his cuddly toy, and the interviewer through a puppet representing a doctor (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e[please insert Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eFrom March to May 2023, the first author (HF) observed and audio-recorded semi-structured interviews with kindergarten children in the context of TBC sessions. These sessions were organized by Ile-de-France health students in coordination with nursery schools. HF did not know the participants prior to the study. Data collection continued until theoretical sufficiency was reached, defined as the point at which enough data had been gathered to comprehensively describe and explain the pertinent topics and themes without significant gaps or logical inconsistencies.\u003c/p\u003e \u003cp\u003eThe interviews were conducted, transcribed, and anonymized by HF. The transcriptions were enhanced with notes on non-verbal communication, including gaze, facial expressions, gestures, and posture. Field notes on non-verbal behavior were written immediately after each interview to avoid disrupting interaction during the puppet-mediated interview. The audio recordings and notes were transcribed verbatim, with annotations concerning observation of the child's non-verbal language.\u003c/p\u003e \u003cp\u003e49 kindergarten children were interviewed, 29 girls and 20 boys from seven nursery schools located in five districts of Ile-de-France, aged 5 to 6. 39 interviews were conducted at the TBC site, some of which were group interviews, when children chose to speak together. There was no refusal to participate nor any dropouts. The total duration of the interviews was 4 h 14 min which corresponds to an average of 6 min 31 s per interview. The shortest interview lasted 2 min 25 s and the longest 11 min 56 s.\u003c/p\u003e\n\u003ch3\u003eInterview guide\u003c/h3\u003e\n\u003cp\u003eA semi-structured interview guide was developed by HP based on the study objectives and relevant literature (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The draft guide was reviewed by LBJ and pilot tested with children known to HF (outside the study sample) to ensure clarity of wording and appropriateness for age. The interview took place before and after all the TBC workshops. The pre-workshop interview explored prior representations of medical consultation. The post-workshop interview aimed to explore how children narrated the consultation experience after role-play and to identify newly mobilized knowledge. The study did not aim to measure learning effects but to capture the range of representations expressed across both temporal moments.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterview guide\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore the workshops\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter the workshops\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e- Hello cuddly toy, what's your name?\u003c/p\u003e \u003cp\u003e- How are you?\u003c/p\u003e \u003cp\u003e- What are you going to the doctor for?\u003c/p\u003e \u003cp\u003e- What are we going to do at the doctor's?\u003c/p\u003e \u003cp\u003e- What's going to happen at the doctor's?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e- Hello again cuddly toy, so, what happened?\u003c/p\u003e \u003cp\u003e- How are you now?\u003c/p\u003e \u003cp\u003e- Now, do you know what happens at the doctor's?\u003c/p\u003e \u003cp\u003e- What do we do at the doctor's?\u003c/p\u003e \u003cp\u003e- What do we go to the doctor for?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[please insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e here]\u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eAudio-recordings were transcribed verbatim. Data were analysed using inductive thematic analysis [30]. HF conducted initial open coding of all transcripts. Codes were compared across interviews and grouped into categories through constant comparison. AGP independently coded a subset of transcripts. Discrepancies were discussed until agreement was reached. Themes were developed by examining patterns of meaning across categories, with attention to both verbal content and observational notes. Analysis occurred alongside data collection. Data collection continued until theoretical sufficiency was reached, defined as the point at which enough data had been gathered to comprehensively describe and explain the pertinent topics and themes without significant gaps or logical inconsistencies.\u003c/p\u003e\n\u003ch3\u003eReflexivity\u003c/h3\u003e\n\u003cp\u003eHF is a general practice trainee with a clinical interest in child consultations. HF had no prior relationship with participating children. His medical background may have influenced attention to health-related content. To reduce interpretative bias, transcripts were co-analysed with AGP, who has qualitative research experience.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The Ethics Committee of the French National College of Teaching General Practitioners gave its favorable opinion on 12/10/2022. Children\u0026rsquo;s parents gave their informed consent for their child's participation after considering the information provided to them about the study. Only children whose parents had provided written consent were approached. Teachers identified these children before the TBC session. Participation was voluntary and children could stop at any time.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eAnalysis of observables and verbalizations\u003c/h2\u003e \u003cp\u003eFour primary themes emerged from the data regarding children's social representation and experiential knowledge during medical consultations: Attitudes and behaviors towards doctors; Illness; Medical science; and Care and treatment. The sub-themes have been organized in a conceptual map that summarizes the child's journey through the consultation (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e[Please insert Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e here]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eAttitudes and behaviour during medical consultations\u003c/h2\u003e \u003cp\u003eChildren frequently described attempts to present themselves as brave in the context of medical care, for example, \"I took an injection and didn't even cry\", \"I'm not afraid\" or \"I'm not afraid of going to the doctor\". At the same time, fear was also reported, particularly in relation to specific anticipated procedures such as injections or nasal irrigation that \"tickles\". Some children described avoidance behaviors, for example hiding when anticipating a procedure perceived as unpleasant \"hides in my cuddly toy box\".\u003c/p\u003e \u003cp\u003eDuring the child's visit to the medical consultation workshop at the TBC, in hetero-assessment, there were no signs of anxiety: there was no anxiety-related crying or agitation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRepresentations of illness\u003c/h2\u003e \u003cp\u003eChildren\u0026rsquo;s representations of illness were predominantly concrete and symptom-based. Children almost always know that they're going to the doctor \"because I'm sick\". Illness was often described through a single, concrete symptom such as \"sore throat\", \"headache\", \"stomach ache\". The illness is then merged with its isolated sign. Some children referred to named illnesses (e.g., \"chicken pox\", \"flu\", \"COVID\", \"gastro\") while others described more diffuse or global states such as : \"aching all over\", or \"all the diseases in the world\".\u003c/p\u003e \u003cp\u003eChildren frequently proposed causal explanations for illness that drew on daily and imagined experiences (e.g., falling, bumping into objects, being stung). Illness was sometimes linked to behaviors perceived as risky such as \"I slipped on the ice, and my wood fell off [the cuddly toy is a reindeer]\", \"He rolled in the snow and now he's got a cold\", \"He wanted to swim even though he doesn't know how, so he went to the bottom of the sea and bumped his head\", \"walking alone in the forest and being bitten by a panther\", \"eating fruit and vegetables and having a stomachache\".\u003c/p\u003e \u003cp\u003eDescriptions of illness included both localized bodily sensations, particularly pain, in \"the stomach\", \"the head\", \"the paw\", \"the ear\", \"the throat\". This pain, when localized, is felt in \"the skin\". The signs of the illness are general could have functional consequences such as \"she spends all her time in bed\", \"I can no longer fly\", \"he may die\". Some children also mentioned constraints, such as changing sheets because \"he vomits on my sheet\". A few children described perceived benefits of illness, such as \"eat in bed\" or \"draw all day\".\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eUnderstanding of medical examination and medical knowledge\u003c/h2\u003e \u003cp\u003eChildren commonly described the doctor\u0026rsquo;s role as identifying illness through examination of body parts such as \"the heart\", \"the ears\", \"the throat\", \"the back\". They referred to anatomical and diagnostic knowledge: \"the glottis\" is at the back of the throat, you can touch to \"see if my legs are alright\" and you can hear the heart, which goes \"pom pom pom\" with \"headphones\".\u003c/p\u003e \u003cp\u003e They referred to diagnostic instruments including the stethoscope, the \"stick\" to put \"in the throat\", the thermometer that you \"put in the mouth and wait until it's red\" and mentioned wanting to participate in the examination for example by using the otoscope. Imaging procedures, particularly X-rays, were frequently mentioned as a way to \"see the bones\" and find out if there is a \"broken bone\". Some children suggested X-rays even for non-traumatic complaints such as a \"heartache\".\u003c/p\u003e \u003cp\u003e Participants also referred to medications and other therapeutic techniques like \"skin adhesive\", \"pipettes\" and medicines with complicated names like \"palacetamol\" for pain.\u003c/p\u003e \u003cp\u003eSeveral children associated illnesses with \"little microbes\" that can be seen \"at the back of the throat\" or \"in the ears\". Sometimes, children\u0026rsquo;s associate illnesses with consistent symptoms: You \"vomit\" when you have \"gastro\". You \"scratch\" and have \"pimples everywhere\" when you have \"chickenpox\". Some children expressed uncertainty about how the disease will evolve, so the cure is incomplete and you \"heal a little\".\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRepresentations of care and treatment\u003c/h2\u003e \u003cp\u003eIn most interviews, children proposed at least one form of treatment. Medication was frequently mentioned, along with dietary or hygiene measures such as \"fruit and vegetables\".\u003c/p\u003e \u003cp\u003eSuggested treatments generally reflected elements of conventional medical care, although occasional non-medical remedies were also proposed, like a \"caress\".\u003c/p\u003e \u003cp\u003eThe children considered it important that the therapy be consistent with the illness. In the case of pain or a localized lesion, a tangible local therapy seems most effective. This can take the form of a \"band-aid\" for a \"little ache\", a \"bandage\" if it hurts \"a lot\", or a \"shot\". Band-aids could have a remote curative action against \"stomach ache\". Children frequently described concrete actions as effective remedies such as \"a shower\" or a \"wet sheet on the forehead\".\u003c/p\u003e \u003cp\u003eFor non-traumatic conditions, treatments were often described as addressing symptoms, whereas for injuries, repair of the underlying damage (e.g., fractures) was emphasized.\u003c/p\u003e \u003cp\u003eOften, the child is cured by the treatment. Recovery was usually described as the expected outcome of treatment, though some children noted that improvement could take time or remain incomplete \"time for it to work\" and \"time for it to repair itself\".\u003c/p\u003e \u003cp\u003eMany children spontaneously engaged in caregiving behaviours toward their cuddly toy during the session. Participants also referred to the roles of other health professionals, including the \"pharmacy\", the \"radio center\", the \"physiotherapist\".\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored how children aged 5\u0026ndash;6 conceptualize medical consultations and shows that young children already possess structured and experience-based models of illness, examination, and treatment. Far from being passive recipients of care, children described coherent causal explanations, expected diagnostic processes, and meaningful therapeutic actions. Their representations were grounded in concrete bodily experiences, everyday events, and symbolic reasoning emerging from play and observation.\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eChildren\u0026rsquo;s representations of illness and causality\u003c/h2\u003e \u003cp\u003eThe findings reveal a significant diversity in SR among 5\u0026ndash;6 year-olds, especially in relation to the origins of illness and treatment.\u003c/p\u003e \u003cp\u003eThe Laplantine framework of social representation disease [35] was applied after inductive theme development as an interpretive lens. According to this model, children identified traumatic illnesses as ontological, with a specific cause and identified organic lesion, as exogenous, due to an external aggression, as subtractive, associated with a loss of function, and finally as malefic, experienced in a negative way. This corresponds to the dominant representation of contemporary Western medicine. As for non-traumatic illnesses, the position is more nuanced: certain illnesses have been identified as relational when the child has \"pain everywhere\" or \"sick eyes\", as endogenous because spontaneous, as additive because one \"catches a cold\" and even as beneficial because one can \"eat in bed\" and \"draw all day\". The origins of these illnesses vary widely and are comparable to those of adults.\u003c/p\u003e \u003cp\u003eFollowing Laplantine's therapeutic models, the children proposed a wide variety of therapies: allopathic with drugs or not with caresses, additive with food and subtractive with showers, sedative with analgesics and excitatory with injections, and exorcistic with surgery and adorcistic with physiotherapy. Here again, we find a wide variety of therapies proposed by children, in a framework comparable to that of adults.\u003c/p\u003e \u003cp\u003eChildren sometimes associate the natural evolution of a scratch with the action of a band-aid. In such cases, he considers that the band-aid has a curative and analgesic action of its own. He suggests a band-aid for localized symptoms such as abdominal pain or headaches.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eUnderstanding of medical examination and knowledge\u003c/h2\u003e \u003cp\u003eChildren portrayed the medical consultation as a structured investigative process. Doctors were described as identifying illness through examination of specific body parts and the use of diagnostic instruments such as stethoscopes, thermometers, and X-rays. These tools were not only recognized but attributed epistemic value: they allowed doctors to \u0026ldquo;see\u0026rdquo; or \u0026ldquo;hear\u0026rdquo; what is wrong. Treatments were primarily described as concrete, localized actions\u0026mdash;bandages, injections, medication, showers, or cooling cloths. Even when the underlying mechanism was not understood, tangible interventions were perceived as having intrinsic curative power. Symbolic and affective dimensions also emerged, such as caregiving gestures or comforting actions. These findings highlight that, for young children, treatment effectiveness is closely linked to visible or sensory features.\u003c/p\u003e \u003cp\u003eThis reflects an early understanding of medicine as a knowledge-based practice mediated by technology. With regard to all the aspects raised by children aged 8 to 11 [36, 37], our study showed that children aged 5 to 6 were ready to grasp these issues at their own level. These findings suggest that children as young as 5\u0026ndash;6 years may be able to engage in discussions about illness and care when communication is adapted to their level of understanding.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eThe consultation as a social and symbolic event\u003c/h2\u003e \u003cp\u003eThe Teddy Bear Hospital setting revealed children\u0026rsquo;s strong engagement in caregiving roles and their sense of responsibility for their toy\u0026rsquo;s health. This suggests that medical consultations are not only clinical encounters but also social and symbolic events in which children position themselves as actors. Play appeared to facilitate expression and reflection, supporting previous work indicating that symbolic mediation can help children articulate experiences that may be difficult to verbalize directly [33, 34].\u003c/p\u003e \u003cp\u003eThe difference in attitude between the child playing with his cuddly toy and the child in a real consultation situation can be explained by the fact that:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eit's the cuddly toy that endures the consultation, not the child\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eit's a game\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ethe child is not ill nor uncomfortable\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ethe group effect\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003echildren feel responsible for the health of their cuddly toy.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eUsing a cuddly toy during the consultation, or even organizing a consultation of the cuddly toy, could help the child to open up.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eClinical implications (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommunication strategies derived from findings. For doctors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1) Address the child at every stage of the consultation. Children often expressed trust in doctors. Children are happy to communicate and have lots to say.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2) Encourage play\u003c/b\u003e. Children can bring a cuddly toy, and the doctor can use a puppet to play the doctor's role.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3) Remind the child why he's here.\u003c/b\u003e It may be helpful to express the goal in positive terms: taking care of his health together.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e4) Discuss the origin of the illness.\u003c/b\u003e Children have a structured and coherent discourse to explain the origin of illnesses.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5) Discuss signs of illness.\u003c/b\u003e Children can describe their symptoms, and can sometimes link them to a disease, or even associate them into a coherent syndrome. Discussing these directly with the child naturally justifies a physical examination to explore these signs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e5) Involve the child in the physical examination and diagnosis.\u003c/b\u003e Children are attracted to the doctor's instruments, proud to know their complicated names, and often want to play with them themselves.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6) Rely on the child's beliefs.\u003c/b\u003e Children\u0026rsquo;s existing beliefs about treatment can be acknowledged and explored during explanations.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e7) Accepting pain.\u003c/b\u003e Children know that an injection can hurt. It is possible to work on the child's acceptance of this fact.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e8) Preventive actions.\u003c/b\u003e All the above elements contribute to making children more responsible for their own health.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e9) Offer a dedicated prevention consultation with the child's cuddly toy.\u003c/b\u003e On the model of the TBC medical consultation, it could be appropriate to receive the children in consultation for a role-play with their cuddly toy, who are ill and need to be vaccinated.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommunication strategies derived from findings. For parents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"1\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1) Before the consultation: raise awareness of the need to go to the doctor. Children describe doctors as people who treat illnesses. A first step can be to make him aware that he's ill, by asking questions like: How are you? Is it normal if your stomach hurts? Do you usually feel pain like this? Then, to make him aware of the importance of going to see the doctor, we could ask him questions like: What can we do so that you can play as usual? How do we know what medicine to give you? Where do you go to get medicine?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e2) During the consultation: help your child detail his symptoms.\u003c/b\u003e Children may have difficulty verbalizing their symptoms during the consultation. In this case, we can help him by contextualizing the questions so that his story is anchored in his own experience.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e3) After the consultation, you can discuss the effect of treatment and the natural course of the disease.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e These findings suggest possible avenues for communication strategies to help children establish a constructive relationship with their health from an early age, in order to prepare them to take responsibility for their health and obtain their free and informed consent.\u003c/p\u003e \u003cp\u003e[please insert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e here]\u003c/p\u003e \u003cp\u003e[please insert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e here]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations. First, interviews were conducted with young children, whose verbal abilities and attention span may limit the depth and precision of their responses. Although age-appropriate techniques were used, some answers remained brief or concrete. Group interviews may also have shaped responses through peer influence or social desirability.\u003c/p\u003e \u003cp\u003eSecond, the study relied on a relatively small and context-specific sample drawn from participating schools, which may limit transferability to other sociocultural or health-care settings.\u003c/p\u003e \u003cp\u003eThird, the data were collected in a simulated educational setting (the Teddy Bear Clinic) rather than during real medical consultations. Children\u0026rsquo;s accounts may therefore reflect expectations associated with play-based role-play rather than experiences of actual clinical encounters. Moreover, the presence of health-care students during the session may have influenced children\u0026rsquo;s representations and language, particularly in the post-intervention interviews, where some statements could reflect newly acquired vocabulary rather than pre-existing understanding. However, this play-based approach has helped to get children talking who may otherwise tend to be reticent when visiting the doctor.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study shows that many children aged 5\u0026ndash;6 express structured ideas about illness, examination and treatment when given an opportunity to speak through play.\u003c/p\u003e \u003cp\u003eChildren can engage in discussions about illness and care, especially in a playful atmosphere, using their cuddly toy. Their explanations try to be logical and coherent.\u003c/p\u003e \u003cp\u003eChildren expect to be examined and are interested in examination techniques. They understand the doctor's diagnostic approach and appreciate the explanations given.\u003c/p\u003e \u003cp\u003eAs for treatment, even though it usually involves medication, it also favors tangible therapies such as band-aids and bandages, which often have a specific, in-depth curative effect. The therapies offered are rich and varied and are comparable to those used for adults.\u003c/p\u003e \u003cp\u003eThese findings suggest that clinicians can discuss with children the origins and symptoms of their illness, the diagnostic process, the disease itself and treatments.\u003c/p\u003e \u003cp\u003e Children aged 5 to 6 can be explicitly involved in their own care. This could help to reduce their anxiety, better assess their symptoms, involve them in physical examinations, encourage compliance with treatment and facilitate long-term health follow-up.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSocial Representations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExperiential knowledge\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTBC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTeddy Bear Clinic\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of the “Collège National des Généralistes Enseignants” (CNGE) gave its favorable opinion on 12/10/2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChildren’s parents gave their informed consent for their child's participation after considering the information provided to them about the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the sensitive nature of qualitative data involving minors, transcripts are not publicly available but may be requested.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone of the authors have a conflict of interest to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHugues Faucheu: Conceptualization, Investigation, Writing - original draft, Methodology, Formal analysis. Alyssa Gaillet-Lagrange:Formal analysis. Philippe Jaury: Writing - review \u0026amp; editing. Louis-Baptiste Jaunay: Conceptualization, Methodology, Validation, Writing - review \u0026amp; editing, Formal analysis, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eClark SJ, Freed GL. C.S. Mott Children\u0026rsquo;s Hospital National Poll on Children\u0026rsquo;s Health. 2018.\u003c/li\u003e\n\u003cli\u003eJan MMS. Neurological examination of difficult and poorly cooperative children. J Child Neurol. 2007;22:1209\u0026ndash;13. https://doi.org/10.1177/0883073807306262.\u003c/li\u003e\n\u003cli\u003eMcLenon J, Rogers MAM. The fear of needles: A systematic review and meta-analysis. J Adv Nurs. 2019;75:30\u0026ndash;42. https://doi.org/10.1111/jan.13818.\u003c/li\u003e\n\u003cli\u003eJeffe JS, Bhushan B, Schroeder JW. 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Brief Clinical Report: A Systematic Review and Meta-analysis of Pain Memory-reframing Interventions for Children\u0026rsquo;s Needle Procedures. Pain Pract. 2018;18:123\u0026ndash;9. https://doi.org/10.1111/papr.12572.\u003c/li\u003e\n\u003cli\u003eDelvecchio E, Salcuni S, Lis A, Germani A, Di Riso D. Hospitalized Children: Anxiety, Coping Strategies, and Pretend Play. Front Public Health. 2019;7:250. https://doi.org/10.3389/fpubh.2019.00250.\u003c/li\u003e\n\u003cli\u003eDion P, Vermeersch T. Prise en charge de l\u0026rsquo;anxi\u0026eacute;t\u0026eacute; li\u0026eacute;e \u0026agrave; la consultation chez les enfants de 9 \u0026agrave; 36 mois : \u0026eacute;tude du v\u0026eacute;cu et des pratiques aupr\u0026egrave;s des m\u0026eacute;decins g\u0026eacute;n\u0026eacute;ralistes. Th\u0026egrave;se d\u0026rsquo;exercice. Universit\u0026eacute; de Reims Champagne-Ardenne; 2019.\u003c/li\u003e\n\u003cli\u003ePinot-Lancesseur P. Pratiques des m\u0026eacute;decins g\u0026eacute;n\u0026eacute;ralistes bas-normands en r\u0026eacute;ponse aux comportements d\u0026rsquo;opposition des nourrissons \u0026acirc;g\u0026eacute;s de 9 \u0026agrave; 24 mois. Universit\u0026eacute; de Caen Normandie, UFR de m\u0026eacute;decine; 2016.\u003c/li\u003e\n\u003cli\u003eAli S, Ma K, Dow N, Vandermeer B, Scott S, Beran T, et al. A randomized trial of iPad distraction to reduce children\u0026rsquo;s pain and distress during intravenous cannulation in the paediatric emergency department. Paediatr Child Health. 2021;26:287\u0026ndash;93. https://doi.org/10.1093/pch/pxaa089.\u003c/li\u003e\n\u003cli\u003eGer\u0026ccedil;eker G\u0026Ouml;, Bektaş M, Aydınok Y, \u0026Ouml;ren H, Ellidokuz H, Olgun N. The effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in pediatric hematology-oncology patients: Randomized controlled trial. Eur J Oncol Nurs. 2021;50:101886. https://doi.org/10.1016/j.ejon.2020.101886.\u003c/li\u003e\n\u003cli\u003eBallard A, Khadra C, Adler S, D Trottier E, Bailey B, Poonai N, et al. External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol. BMJ Open. 2019;9:e023214. https://doi.org/10.1136/bmjopen-2018-023214.\u003c/li\u003e\n\u003cli\u003eGeagea D, Tyack Z, Kimble R, Polito V, Ayoub B, Terhune DB, et al. Clinical Hypnosis for Procedural Pain and Distress in Children: A Scoping Review. Pain Med. 2023;24:661\u0026ndash;702. https://doi.org/10.1093/pm/pnac186.\u003c/li\u003e\n\u003cli\u003eJoffe H. Social Representations and Health Psychology. Social Science Information. 2002;41:559\u0026ndash;80. https://doi.org/10.1177/0539018402041004004.\u003c/li\u003e\n\u003cli\u003eBorkman T. Experiential Knowledge: A New Concept for the Analysis of Self-Help Groups. 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Anthropologie de la maladie : \u0026eacute;tude ethnologique des syst\u0026egrave;mes de repr\u0026eacute;sentations \u0026eacute;tiologiques et th\u0026eacute;rapeutiques dans la France contemporaine. Payot; 1986.\u003c/li\u003e\n\u003cli\u003eLe Berre S. La consultation de m\u0026eacute;decine g\u0026eacute;n\u0026eacute;rale vue par l\u0026rsquo;enfant. 2013.\u003c/li\u003e\n\u003cli\u003eRobert de Rancher C. \u0026ldquo;Qui c\u0026rsquo;est pour toi ton docteur ?\u0026rdquo; : la relation enfant-m\u0026eacute;decin perceptions et attentes des 10-11 ans. Universit\u0026eacute; Claude Bernard Lyon; 2013.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Preschool child, Medical consultation, Social representations, Experiential knowledge, Qualitative research, Child perspective","lastPublishedDoi":"10.21203/rs.3.rs-8776881/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8776881/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMedical consultations can be anxiety-provoking for young children, potentially affecting communication, examination, and adherence to care. While research has largely focused on procedural pain and fear of specific interventions, little is known about how preschool children conceptualize the medical consultation itself. Understanding children’s social representations and experiential knowledge may help clinicians adapt communication and improve care experiences. This study explored how children aged 5–6 conceptualize medical consultations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn exploratory qualitative study was conducted in France using semi-structured individual and small-group interviews during school-based \"Teddy Bear Hospital\"-type school outings, where children play the role of the parent of their cuddly toy who is ill. Forty-nine children (5–6 years old) from seven nursery schools participated (39 interviews). Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis within an interpretivist framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFour interrelated themes described children’s representations of medical consultations: (1) attitudes and behaviors toward doctors, (2) representations of illness, (3) understanding of medical examination and knowledge, and (4) representations of care and treatment. Illness was typically defined through single concrete symptoms and attributed to visible or imagined causes (falls, cold exposure, animals). Doctors were seen as identifying illness using instruments (e.g., stethoscope, thermometer, X-ray), and treatments were expected to be tangible and localized (bandages, injections, medication), sometimes with symbolic healing power. Children demonstrated coherent causal reasoning and actively engaged in caregiving behaviors toward their toys.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChildren aged 5–6 already hold structured, experience-based models of illness, examination, and treatment. These representations shape expectations of care and may influence anxiety and cooperation during consultations. Recognizing and integrating children’s perspectives—particularly their focus on concrete signs, diagnostic tools, and tangible treatments—may support more effective communication and child-centred consultations.\u003c/p\u003e","manuscriptTitle":"\"What happens at the Doctor's?\": a Qualitative Study Exploring Social Representations and Experiential Knowledge of Medical Consultation in 5-6 Year-Olds","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-26 16:46:16","doi":"10.21203/rs.3.rs-8776881/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-24T06:09:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T21:59:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-18T16:50:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65093775908600918799597488778951461549","date":"2026-03-28T07:59:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100709926081927317117425336668607124892","date":"2026-03-26T16:43:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"259286830108084674973312045589108967510","date":"2026-03-25T13:11:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"62319804212292393974432650468520063575","date":"2026-03-25T06:11:39+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-24T17:26:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-09T07:09:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-10T02:16:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-10T02:16:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-02-03T13:34:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4198d26b-19d2-4611-8f28-71d4f4e6653d","owner":[],"postedDate":"March 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T17:53:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-26 16:46:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8776881","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8776881","identity":"rs-8776881","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}