Communicating psychosocial problems in German well-child visits. What facilitates, what impedes pediatric exploration? A qualitative study

•We conducted a conversation analysis of video recorded well-child visits in Germany.•Psychosocial topics play a marginal role in German well-child visits.•Pediatricians mostly pursue a reserved conversational style.•Psychosocial exploration is eased when parents are open and stressors baby-related.•Pediatricians would benefit from communication skills training.

ObjectiveTo examine whether, and if so, how psychosocial topics are discussed between parents and pediatricians.MethodsThirty well-child visits at eight pediatricians’ practices in southwest Germany were video recorded. Conversations were analyzed.ResultsAlthough psychosocial topics were frequently touched upon, they were rarely thoroughly explored. Pediatricians pursued a rather reserved conversation style. Especially when parents withdraw and psychosocial stressors are less baby-related, pediatricians hardly explore the psychosocial situation.ConclusionIn summary, the pediatrician's conversation style, the nature of the stressors and the parents’ openness are paramount in determining the depth of psychosocial exploration.Practice implicationsIn order to ensure a good and fair quality of care to all parents, pediatricians should be provided with tailored communicative skills training allowing them to create a climate in which parents may open up and build trust toward their pediatrician.