Objective One function of expressing emotion is to receive support. The aim of this study was to assess how children with heart disease express negative emotions during routine consultations, and examine the interaction between children’s expressions and adults’ responses. Methods Seventy children, aged 7–13 years, completed measures of anxiety and were videotaped during cardiology visits. Adult–child interactions were analyzed using the Verona Definitions of Emotional Sequences. Results Children expressed negative emotion, mainly in subtle ways; however, adults rarely recognized and responded to these expressions. The frequency of children’s expressions and adults’ responses were related to the child’s age, level of anxiety, and verbal participation. Conclusion Children do not openly express negative emotions frequently during routine cardiac consultations; they are more likely to provide subtle cues of negative emotion. When expression of negative emotions does occur, adults may consider using the opportunity to explore the child’s emotional experiences.