Table 2 Indications and contextual factors of the puppet interview

(Developmental) age, cognitive development

4–11 years

Language

Requirements are comparatively low; whether they are met can be evaluated through play

Contextual factors

commotion at the adjacent bed at the hospital

tiredness due to therapy

side effects of the illness or treatment (e.g. pain, fever, nausea)

important medical examinations are scheduled, or the child and parents are upset or anxious by inconclusive findings or pending test results

Such situations do not necessarily contradict the use of the puppet interview. Sometimes, especially in acute crisis, the puppet interview offers a welcome diversion from the daily routine of the clinic and treatment, or the next treatment steps can be discussed in a playful way. Many children engage in conversation with the puppet even despite severe nausea or vomiting in order to talk about this. This shows that the puppet interview can also be useful in acute treatment phases

Motivational factors and concentration

concentration for the entire duration of the puppet interview (especially younger children)

wariness of the (unfamiliar) interviewer

If the child is unfocussed, the puppets can negotiate “rules” for the puppet interview. Breaks should be incorporated during which the child can play with the puppets of tell them what they have experienced in the previous days. A first appointment can be used to build a relationship with the child (e.g. by drawing or playing) before conducting the interview