Children love to draw, and their work is a reflection of their inner world. Most kids don’t think about or censor their artwork. For the past 40 years, I’ve used children’s drawings as an important part of my pediatric practice. At each well-child visit beginning at 4 or 5 years old, our nurse asks the child to “draw a picture of your family doing something.” To simplify the process, each exam room is equipped with blank white paper on a clipboard with a black felt pen.

The family drawing helps me survey development at a given moment in time, and it may tip me off to potential problems. A single drawing is a snapshot of a child’s point of view — of her role in the family, her relationship to other family members, and her self-esteem. It also may show strengths in the child and the family that are important to recognize and validate. It can indicate cultural patterns that give me a better understanding of some behaviors or beliefs. I always ask the parents for their impression of the drawing, because our conversation can yield even more information that may not come up otherwise.

A big caveat here: We all want to find hidden meanings in drawings, but be cautious about overinterpreting. It’s not a good idea to read too much into your child’s sketches. Instead, use them as an opportunity to talk with your child about what he or she has drawn. Then ask questions about them to enhance communication between you. Do your best to avoid giving too many of your own impressions. I purposely keep the conversation very open-ended: “Tell me about your drawing. Who are the people in the picture? What are they doing?” For examples of what you might be looking for with your own children, check out my analysis of these kids’ drawings.

A Bunch of Balloons

This first picture is a great example of how artwork can be a springboard for conversation. It was drawn by a patient of mine when she was 11. She had lived alone with her mother since birth and she has no siblings. On the surface, her physical health, schoolwork, and social development were just fine. But she made friends slowly and she was unusually cautious about leaving her mother to go to friends’ houses. She preferred to have friends come to her house and play while her mother was nearby. I was concerned that their close bond got in the way of her learning how to separate from her mom, which is a necessary part of development.

I hadn’t been able to get this point across at previous office visits. But with this drawing, I had an opening. The way they were placed so closely together, and the fact that a short string connected the mother and daughter, stood out to me. When I asked Mom, “What do you think about this picture?” she initially talked proudly about her daughter’s drawing skills. But then she admitted that she could see what I’d been trying to say about their relationship. We were able to talk about it, and she left the office motivated to help her daughter (and herself ) discover ways to separate psychologically while maintaining their loving and close relationship.

The Stick-Figure Family

Drawing skills often begin to tell a story in kindergarten. Although kids at this age tend to use simple stick figures, you can sometimes pick things up from facial expressions, where family members are placed, and what they’re doing. This second picture, drawn by a 5-year-old girl, is an example of that. She drew her mother on the far left, followed by the family dog, her father, herself, and her 8-year-old brother. The girl drew herself as larger than her parents — this typically reflects good self-esteem. It’s worth noting that she placed herself between her father and brother: When children are between 4 and 6 years old, they develop a sense of their gender identity. As a part of this normal developmental process, young girls often get physically and emotionally closer to their father (boys this age tend to get closer to their mother), and the feelings are temporary.

Lots of Detail

The 7-year-old girl who drew the third picture is a triplet who was born prematurely. When I asked what the people in the picture are doing, she started on the left with her brother, who is on the high-functioning end of the autism spectrum. “He’s doing the laundry, Mommy is working on the computer, I am hanging up clothes, Daddy is washing the car, and my sister is washing the glasses.”

The fact that she has drawn numerous body parts and clothing on her parents suggests that she has mature visual and motor skills. By looking at everyone’s clothing, I see that she recognizes gender differences. The drawing also shows the children and parents as a cohesive unit; they seem to enjoy doing everyday tasks together. Notice how they’re each drawn in a distinctive way — the brother has a larger frame and a big head, and her sister has glasses, for instance. This tells me that she’s able to think of each family member as an individual.

A Hole In The Ground

The last image was drawn by a 7-year- old girl who’d recently gone with her parents and younger brother to her grandfather’s funeral. I was impressed with several aspects of her picture, including her ability to visually distinguish the adults from the kids and to draw faces that reveal sadness. She drew herself and her father in profile, which may indicate that she and her father have a strong bond. It was encouraging that she drew everyone close together, and touching; this shows she perceived her family as tight-knit in this sad moment in their lives.

The Soccer Match

This top drawing is terrific: It shows a family enjoying a sport together. When the 9-year-old boy who drew it was asked to describe the image, he answered, “We’re playing soccer. Dad said to pass, so I passed to him, and then he passed to Mom, and Mom passed to my little brother. And he scored!” The boy’s description of his picture reveals his active engagement with other members of his family. I notice that his mom is drawn as the biggest person in the family, and while that might not be significant, I could use the opportunity to say, “You drew your mom as the largest person in the picture. Is she the leader of the family team?”

A View from Above

The 7-year-old boy who drew this last picture says it’s “all of us playing Sorry.” I immediately noticed that he drew his family from the perspective of someone looking down at their game table. This suggests he’s got strong visual-spatial skills; children like this are often artistic and particularly good at puzzles and games. This family is engaged in playing together at home, which reveals a positive relationship among them. Since he drew his parents and younger sister around the sides and bottom of the board and himself at the very top, I might point to that and comment, “Great drawing — you sure are the strong one in the family,” and wait for his response. I’d start there because he depicts himself in a way that indicates a well-developed sense of identity.

Originally published in the October 2012 issue of Parents magazine.