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Aims Within Paediatrics, the complexity of communication over a range of developmental stages in childhood and caregivers means clear communication is key to safe clinical care and reducing adverse events. A Danish study 1 of root-cause analysis (RCA) of adverse healthcare events identified communication errors in >50% of cases.Simulation is an evidence-based tool to optimise communication and confidence in multi-disciplinary team (MDT) leadership. However, assessment of communication in the workplace and simulations are largely focused on verbal communication.60-70% of communication is non-verbal though visual cues from lip-reading and facial-expressions for both hearing and Deaf people. 2 The advent of facemasks across the NHS has highlighted the impact of losing half the communication modality. A 'Silent Sims' programme was developed for Paediatric A&E MDT focused on non-verbal communication aiming to establish: 1. 'Innate skills' to facilitate non-verbal communication 2. Identifying strategies to facilitate challenging communication 3. An inclusive Paediatric ED (PED) department. Methods A monthly Simulation programme was well-established within PED. A new programme alternating between verbal and non-verbal 15 minutes Sims was developed to encompass clinical staff rotations to ensure ongoing learning over 6-months.Following Sim pre-briefing, participants were informed just before commencement, 'this is a silent sim' to enable them to devise real-time communication strategies. Scenarios included Pneumothorax, Sepsis, DKA with Deaf carer (verbal Sim) and Ventilation issues.There were 15 minutes team-debriefs and feedback. Immediately after each session, a survey was circulated to rate learning and experience using 10-point Likeart-Scales alongside free-texts. Results There were 18 participants with an average 6 participants per Simulation. Likert-scores were consistently high regardless of the scenarios involved. (table 1)Qualitative feedback was overwhelmingly positive with 100% of participants requesting regular 'silent sims'. Common themes were identified (figure 1) and disseminated to all staff via infographic newsletter. Conclusion 'Silent sims' were initially expected be challenging and potentially not work in practice. However, the clinical teams rose to the challenge, following expected clinical algorithms with safe outcomes. Participants reported intrigue at natural use of innate non-verbal and manual communication through pointing, miming, waving to get attention etc.