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Alterations in Spanish Language Interpretation During Pediatric Critical Care Family Meetings. OBJECTIVES: To characterize alterations in Spanish language medical interpretation during pediatric critical care family meetings. DESIGN: Descriptive, observational study using verbatim transcripts of nine PICU family meetings conducted with in-person, hospital-employed interpreters. SETTING: A single, university-based, tertiary children's hospital. SUBJECTS: Medical staff, family members, ancillary staff, and interpreters. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Interpreted speech was compared with original clinician or family speech using the qualitative research methods of directed content analysis and thematic analysis. Alterations occurred in 56% of interpreted utterances and included additions, omissions, substitutions, editorializations, answering for the patient/clinician, confessions, and patient advocacy. Longer utterances were associated with more alterations. CONCLUSIONS: To minimize interpreter alterations during family meetings, physicians should speak in short utterances (fewer than 20 words) and ask interpreters to interrupt in order to facilitate accurate interpretation. Because alterations occur, physicians may also regularly attempt to assess the family's understanding.