The spaces in between: silence as a witness to accompaniment in congenital heart disease.

Paediatric cardiology is often experienced as a noisy environment. Outpatient clinics, echocardiography laboratories, ICUs, catheterisation suites, and operating theatres are filled with alarms, conversations, machines, movement, and continual clinical activity. Beneath this activity, however, another dimension of CHD care exists: silence. These pauses are not simply absences within clinical work, but moments through which patients, families, nurses, physiologists, and clinicians encounter uncertainty, adaptation, fear, relief, and continuity across time. Across fetal diagnosis, infancy, childhood, adolescence, transition to adult services, and survivorship, silence emerges repeatedly within care. Some silences wound. Others sustain. At times, they create space for reflection and presence; at others, they may leave questions unspoken or emotions unsupported. Over years of care, individuals may be shaped by these experiences in ways rarely acknowledged within clinical medicine. This reflective perspective explores the role of silence, listening, and presence across the longitudinal experience of children and families living with CHD and those who care for them.