&NA;Medical procedures are a major source of social and communicative contact for children hospitalized for prolonged periods with a chronic illness. We investigated the structure and content of the language medical personnel used with their pediatric patients during medical procedures, using observational techniques in two hospital settings. Medical procedures were rarely characterized by appropriate verbal structuring. An unsupportive and unresponsive communicative environment may place such children at risk for delayed language development. Intervention strategies should address the hospital's discourse environment, involve relevant health care professionals and parents, and involve children as active participants in medical procedures.