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Anyone who has worked in providing psychological care to children and adolescents will be familiar with the dedication, concern, and thoughtfulness that almost every provider brings to that work. They may also be familiar with a terminological quirk that will be the focus of this essay. Providers often refer to their clients, internally but also in public remarks, as "kiddos." To most people, this is likely to seem like an amusing and even endearing use of language, but I think it is worthwhile to reflect on this language, its origin, and its possible justification.
The word "kiddo" is, of course, widespread. It was coined in the early 20th century and has significantly increased in usage in the last several decades. Parents use it to refer to their children, teachers to their students, and so forth. I don't intend to dwell on the rise of this term more broadly, only to reflect on its usage in specifically medical or caregiving contexts and on why we might think this usage problematic.
Begin with definitions. Dictionary definitions are not authoritative, but they can be useful data. The Collins Dictionary defines "kiddo" as a "vocative noun," one used when addressing "someone who is younger than you, as a sign of affection," and gives as an example: "I'll miss you, kiddo." The Oxford Learner's Dictionary gives a similar definition, saying it is "used when speaking to a friend or child," as in "Cheer up, kiddo—you'll be OK in a few days."
This usage, somewhat old-fashioned and with perhaps a touch of condescension, is not quite the usage that most providers are using. "Kiddo" in this sense is a word used only for the person one is directly addressing (that is what it means for it to be "vocative"). In contrast, providers typically use the term "kiddo" to describe clients in the third person, and generally not when they are in earshot. "Kiddo" in this usage is a way that adults have of talking about children when the children are not around. Children never describe other children as "kiddos."
This is telling. In clinical language, we tend to put a priority on using language to describe people that the people themselves would accept. When there is a divergence between the two, it is typically because providers adopt more clinical and descriptive language. For example, some people who use drugs in certain ways may describe themselves as "addicts," while providers might instead describe them as having a "substance use disorder."
This kind of linguistic divergence is not unproblematic, but it is at least familiar. "Kiddo" is the only case I can think of where providers regularly use an informal and slang-inflected term to describe clients, in a way that clients would not choose for themselves.
Is this really such a big deal? After all, clinical usage is continuous with ordinary usage and, as I have said, the use of "kiddo" by adults to describe children is widespread. This sort of language rarely makes it into official documentation, and, as we have emphasized, it tends not to be used around children themselves. What harm is there in this usage?
I do not know if this usage is actually harmful but it does, at least, call for more critical reflection. One of the lessons of work in mental health advocacy in recent decades has been to emphasize the autonomy of clients and the need for approaching them with appropriate respect—not least, in using appropriate language in describing them, ideally language that they would not object to if they overheard it.
This sort of consideration, I think, is no less true for children. Children do lack certain legal privileges, but they are nonetheless autonomous clients like any other, and the language that we use about them should ideally reflect that. It can be difficult to keep this point in front of mind, since children themselves so often need assistance and guidance, but this makes it all the more important to acknowledge it when we can.
There is no great harm in using "kiddo," but there may be some value in deliberately refraining from it. One way of acknowledging client autonomy is to be more precise and deferential in the language that we use. And one way to do this is to refer to children in our clinical care not as "kiddos" but as children, young people, or simply as clients.
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