Communication, Trust, and Transparency in Paediatric Medico-Legal Assessments: Insights from Dr Anna Manolopoulos

Children aren't small adults. They process pain differently, recall events differently, communicate differently - and they will see right through you if you're not being straight with them.

In this episode of Medico Legal Mastery, host Jess Marshall sat down with Dr Anna

Manolopoulos, a Melbourne-based orthopaedic surgeon with a subspecialty in paediatric orthopaedics, to pull apart exactly what makes assessing a child so technically and ethically demanding - and what experienced practitioners do differently.

Children aren't mini adults. Treat them accordingly.

Children aren't small adults: adapting the assessment approach

The first thing Dr Manolopoulos makes clear: the default adult assessment framework doesn't simply scale down. Younger children - particularly those under six - can tell you about right now, but they often can't reliably speak to what happened before. That changes everything about how you structure the interview.

Her approach mirrors something you'd do with an interpreter in the room. She introduces herself directly to the child, shakes their hand, and makes it explicit that they are the focus - not the parent or guardian sitting beside them. And then she asks the child first, even if silence is the answer.

Why does this matter? Because children are, in Dr Manolopoulos's words, exceptional at detecting inauthenticity. If they sense you're being evasive or talking around them, you've lost the room. And unlike adults, they can't be easily recovered.

“Children are very good at monitoring whether the adult talking to them is telling the truth. They've got a good radar for that. If they think you're lying or trying to hide something from them - you've lost them.”

If under-sixes need warmth and patience, teenagers need something else entirely: honesty delivered without condescension. Dr Manolopoulos is refreshingly direct about this. She doesn't pretend the assessment is going to be interesting. She doesn't try to be their friend.

Instead, she names it plainly.

“I need to have this information. This is why you're here. We have to talk to each other. It's not fun. It's not pleasant. Some of this is going to be really boring for you - and I'm really sorry - but I've still got to talk to you about it.”

That kind of candour cuts through the folded arms faster than anything else. A bit of self-deprecation helps too. She references sending a teenager for physiotherapy for a dislocated kneecap:

"You tell them at the beginning: I'm sending you for physiotherapy. I'm really sorry. It's going to be boring. You still have to do it. That gets them to laugh - and then realise: yeah, she's not joking. I do have to do this."

Building trust through honesty and transparency

Dr Manolopoulos reviews the file before every assessment - and she arrives with questions already formed. Discrepancies between what's documented and what's presented in the room aren't uncommon. Her approach: show people what you've found, without accusation.

She'll put the documents on the table and explain:

"I'm not making this up. It's written down. And once it's written down, it's very hard to undocumented things - so I need really good information from you to tell me what the real story is."

“Documentation is a funny thing. If you write something in someone's medical history, it can be repeated at infinitum - and it can be an error that gets perpetuated throughout the notes. So now that I've found it, let's fix it.”

It's a generous framing that gets results. Parents often don't realise the full scope of what's been submitted. When they see it laid out, clarity usually follows.

Assessing function in children and adolescents

Ask a child how long they can sit or walk, and you'll likely get a blank stare or a shrug. Adult functional surveys don't translate. Instead, Dr Manolopoulos reframes the questions entirely around the child's actual world: Can you run around the playground? Can you get on the monkey bars? Can you do sport?

For domestic function - a staple of adult assessments - she has to get creative: "Can you keep your room tidy? Can you help with the dishes?" Usually gets a laugh from both parent and child, and a unanimous no. But it tells her something.

“You've got to get out of the mindset that a child is going to give you tolerances - because they don't have the perspective to do that. If this is just how they've been for a long time, this is 'me.' There's nothing wrong with me. This is how I function.”

Recognising external influences on a child's presentation

One of the more nuanced skills in paediatric IME work is recognising when a child's vocabulary sounds too adult. If a seven-year-old is describing their anxiety about the injury in terms a 40-year-old would reach for, that's worth pausing on.

Dr Manolopoulos is careful about how she frames this. She won't use the word "coaching" in her report - you can't prove it, and it's a loaded term. But she will document exactly what the child said, and then frame her interpretation: "This language is not what you would expect a child of this age to say. I think there's probably been some discussion at home where the child has been listening."

“Parents don't often coach their children. They really don't. But they often talk in front of their children about their own anxieties - and kids will absorb that. They might be repeating what they've been hearing.”

Ethics, chaperoning and managing frustrated claimants

Paediatric IME work introduces ethical obligations that simply don't arise in adult assessments. Chaperoning is critical. Dr Manolopoulos keeps her examination room adjacent to her desk with the door open, exposes only what's necessary, and ensures a guardian or support person is always present - except in cases where an older child explicitly requests otherwise, and where that request is carefully documented. Around ages 14–16, that can become genuinely complex. The law isn't prescriptive, and navigating it requires real care and transparency with everyone in the room.

A question from colleague Dr Pam Boekel raised something that doesn't get discussed enough: how do you respond when a claimant is visibly frustrated with the bureaucracy they've been put through to get to your door?

Dr Manolopoulos doesn't deflect. She agrees with them.

“I tell them: I don't like the system either. I think it's designed badly. I understand that you've been sent here with very little information to see the big boogeyman - who's the IME - to have an assessment. Once they realise I'm just another person trying to figure out what's going on, they tend to relax.”

She also makes a point of explaining what the process actually is: why they're there, how long it will take, and - crucially - that they're entitled to see her report unedited. That transparency, she finds, changes the temperature of the whole assessment.

Listen to the full interview with Dr. Anna Manolopoulos here, or find Medico-Legal Mastery wherever you get your podcasts.