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ABSTRACT This paper uses a conversation analytic (CA) approach to study formal family consultations in Dutch neonatal intensive care. Clinical practice in intensive care is increasingly moving towards implementing models of shared decision making (SDM) that incorporate contingencies and identify pragmatic strategies (Walther et al, 2018; Weiss et al, 2019). In neonatal critical care, family-centred care (FCC) is gradually embraced as an important communicative framework for care practices (see Wreesmann et al., 2020). At the same time, studies report that a lack of practical guidance, implementation gaps and unmet communicative needs identified by parents, still remain (Lorié et al., 2021). So far, only a limited number of CA studies have conducted finegrained empirical analyses of formal family consultations in neonatal intensive care, as they occur in situ. The only study we know of, conducted in two neonatal care units in the UK, has examined the divergent ways in which treatment options are being presented to families (Shaw et al., 2016; Shaw et al., 2020). Depending on who initiated so-called ‘decision talk’, it was shown that doctors present treatment options differently (e.g. listing multiple options or recommending a single-option when initiated by parents or doctors, respectively). Our study offers a contribution to CA studies in neonatal critical care by reporting on 17 hours of audiotaped data of formal family consultations, involving different doctors talking to seven families in consecutive meetings. In all consultations, acute concerns about the baby's medical condition are presented to the families. We demonstrate how doctors present these concerns with elaborate informings that include largely implicit ways of addressing the possibilities and limitations of continuing life-sustaining treatment. We present a collection of 83 instances in which families, in response to these informings, pose alternative-offering questions (AOQs), formatted to include two 'model' answer options (Pomerantz, 1986). We present detailed evidence of what these questions index and how they are subsequently dealt with. Our findings illustrate the interactional difficulties physicians experience in responding to AOQs. We demonstrate three types of findings: (1) doctors do not deal with the candidate answer options embedded in the parent's questions in their subsequent turn, and produce claims to no knowledge or uncertainty; (2) doctors treat the AOQ as topicalising an 'untimely' subject (i.e. the child’s demise) which results in closing the topic rather than to elicit further topical talk on families’ underlying concerns, (3) physicians responses may address only one of the embedded options in the question, which we show to be the cause of further troubles in the ensuing talk. We conclude that the sequential placement of AOQs and how they are being treated, indexes the dilemma of how and when to adequately elicit families underlying concerns and worries. Our study highlights the interactional efforts parents have to undertake to voice their concerns as explicit, candidate options, in response to doctors' elaborate accounts. We also showed how appreciation of communication frameworks such as SDM or FCC need to be more firmly grounded in interactional analyses, and what such a fine-grained approach might offer.