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There is consensus that enabling patient self-care and expertise leads to better management of chronic illness. Clinicians are being encouraged to manage clinical encounters in ways that promote these outcomes rather than perpetuate hierarchical relationships. This article describes one part of a larger study of 55 outpatient consultations conducted within 14 months of the diagnosis of Type 1 diabetes mellitus in young children. Participants were parents and the specialist doctors, nurses, dieticians and social workers who oversee the child's secondary care. Consultations were audio-recorded and transcribed. Our analysis draws on aspects of conversation analysis (CA) to investigate how parents' talk enacts a growing confidence in the management of their child's disease in the face of questioning from professionals. Analysis reveals how this talk distinguishes a duality of focus that combines the normal watchfulness exhibited by all parents as they protect their children, with an additional intense, parallel watchfulness for signs of potentially serious manifestations of diabetes. We term this phenomenon parallel vigilance and illustrate its development using five representative extracts from consultations. The concept of parallel vigilance extends the chronic illness literature and informs our understanding of a process that contributes to parents' developing expertise and provides new and important insights into the way in which parents conceptualize and implement their evolving role in the care of their child. Moreover, parallel vigilance serves as an enabler of parental contributions to the specialist consultation.

OBJECTIVES: This article examines how health professionals guide parental acquisition of knowledge and development of expertise following diagnosis of Type 1 diabetes in a young child. METHODS: Fifty-five consultations from two outpatient paediatric diabetes clinics, one in the UK and one in the US, were audio recorded, transcribed and analysed; eight exemplar extracts are presented here. Participants were parents, whose child younger than 6 years of age had been diagnosed with diabetes within the previous 14 months, and health professionals, who were experienced doctors, nurses, dieticians and social workers. RESULTS: Over the first year following diagnosis, experienced health professionals use four strategies to enable parental self-management of their child's diabetes. Clinicians begin by setting expectations to define the shared responsibilities for the management of the child's disease. Next, they introduce two concepts, trial and error, to help parents respond to variations in blood glucose values and pattern recognition, to help parents refine therapy. As parents gain confidence, clinicians encourage independent pro-active management. Together, these four strategies form a framework to enable development of parental expertise. CONCLUSIONS: This framework addresses the needs of parents and guides their socialization as they assume the role of an expert health care provider for their child. If incorporated into clinical guidelines and health professional training programmes, the framework could facilitate improved self-management of diabetes and perhaps of other chronic diseases.