Birth to 6 monthsInfant is learning to regard theenvironment, especially faces.No stranger anxiety until late in thisphase.Nonverbal communication is key Facial expressions Tone of voiceParents warm to medical personnelwho treat their children as babies,not patients. Make faces and talkbaby talk!
6 – 18 monthsStranger anxiety! Try to keepthe child with a caregiver.Communication is still mostlynonverbal but talk to the childanyway.Development in motor skills isoften faster than communicationskills.
6 – 18 monthsUse stimulating objects to catchattention for distraction orassessment.Use toe to head approach.
18 months – 3 yearsMore explorative but still shelterwith parents.Will understand more wordsthan they can say.Constantly moving.Play and curiosity are bigmotivators.
18 months – 3 yearsUse your tools and toys.Toe to head approach.Try not to hold them down butdon’t wait forever forcooperation with exam.Toilet training often includeslessons about modesty andimproper touching. Respectthese lessons; uncover childselectively for exam.
3 to 6 yearsUsually a great age to workwith.Learning to explore and beindependent. Very curious!Can be very talkative andverbally enthusiastic.Are starting to understand aboutbeing hurt or sick and thatpeople will try to help them.
3 to 6 yearsAre starting to understand theconcept of “the future”.May misinterpret words theyhear.Have “magical thinking”.Worry about being in trouble.Like to have choices.
3 to 6 years“This flashlight’s DEAD.”“I’m going to TAKE yourpulse.”“Don’t CUT OFF thecirculation with that strap.”“We’re going to have to TIEYOU DOWN on this board.”
3 to 6 years “I didn’t put my seatbelt on, so we got in a crash.” “Put a bandaid on it!” (and the boo- boo goes away…) “ I was bad in school so now I have to get a shot.”Please don’t ever threaten a child witha shot or a doctor’s visit if they’re not behaving right. This is sabotage!
3 to 6 years“Would you like your IV in this arm or that arm?” NOT “Where would you like your IV?”
6 – 12 yearsFear failure, inferiority. Want tobe treated as “big kids” but mayfeel “baby” insecurities.Want to be accepted and blendinBody-conscious and modestMay feel pain intenselyFeel comfort with touching
6 – 12 yearsQuestion the child directly andin simple but not babyish terms.Use common interests to buildtrust. Sports TV and movie charactersTreat them with respect.Offer limited choices.
6 – 12 yearsDon’t embarrass them in frontof peers.Don’t tell them not to cry!OK to touch in comfort.Respect their modesty.
6 – 12 years These are the “I have to pee!” years.Don’t fall for delaying tactics!
12 years and upIdentity and peer relationshipsare the key issues at this age.Body image and futuredeformities and dysfunctions arevery important.Reactions can be under- or over-exaggerated.Regressive behavior is common.
12 years and upRespect modesty and privacy.Avoid embarrassing the child.Direct yourself to the child asyou might to an adult, with anadjustment in language.Make eye contact but don’tforce it unless you need to makea point.
12 years and upTouch cautiously until you’re suretouch is welcome.Don’t lie. Don’t be condescending.Don’t try to “be one of the group”unless you are. These guys can spotfakes a mile away.
12 years and upIf drugs, pregnancy or othersensitive issues are involved,assure the child that your job isnot to judge or enforce the law(unless it is).Whenever possible, allow closefriends to maintain support rolesas socially-acceptable parentsurrogates.
CautionsDon’t ever intentionally lie to achild patient. If you’re caught, itblows the credibility of allmedical personnel.Always tell a child if somethingis going to hurt!Explain procedures in simpleterms but not until it’s time todo it. Anticipation is oftenworse than the procedure.
The hardest part of taking care ofkids is usually dealing with their parents and guardians.Whenever you’re caring for a child, you must consider the family members to be your patients too.
What parents like and want Treat children as people. Learn and use their preferred name. At least get the sex right! Keep children as physically and emotionally comfortable as possible. Basic and advanced pain management is important. Try to relieve fear and anxiety as early and as much as possible.
What parents like and want Treat every child as if they were the most special, beautiful, smartest child in the world. A compliment to a child is a complement to their parents. Listen to what the child has to say, even if it sounds like nonsense. Every child has something you should honestly be able to complement them on, even if it’s just that they have such good lungs for them to be able to scream so loudly…
Romig’s Rule of SmilingIf you can make the child smile first, the parents’ smiles will follow soon after. Corollary A smile is as calming for everyone on scene as a collective deep breath.
Nonverbal communications What your face and body say are every bit as important as what your mouth says.
Nonverbal communications Get to the child’s eye level. Try not to make the child look at you at an awkward angle. Make eye contact but don’t hold it in a challenging manner. Use your eyebrows to exaggerate your expressions, especially for babies through elementary-age kids.
Nonverbal communications Use a soft voice with a moderate pace and interrupt only when necessary. Use noises like “um-hmm” and “I see” to encourage children to talk. For preverbal children, use a happy voice and bring the tone up at the ends of sentences (inviting a response from the patient).
Nonverbal communications Infants less than about 6 months can be touched anywhere first, but go to the most painful place last. For children with stranger anxiety, offer your hand or a tool for them to touch and explore first. Go for their heads and trunks and any painful parts last.
Nonverbal communications Touch school-agers in a playful fashion. “High five” is often a good way to start. Tickling is good in young school-agers but don’t do it until you’ve gotten your assessment. Once a school-ager trusts your touch, try to maintain some contact while getting info from the parent.
Nonverbal communications Touch teens only as needed for your exam, unless further touch is clearly welcome. Try to always have a witness when with a teen, especially a teen of the opposite sex, in case one of your gestures is misinterpreted. Watch your facial expressions with teens! If you look like you don’t believe them, you lose them.
FlashlightTest range of motion of joints,mobility, and grip strength.Check pulmonary function (“blowout the candle!”)Look in mom’s throat or show thechild your own.Look for Mickey Mouse,SpongeBob, etc. under clothes.Make an “ET finger”
Pager/Cell phoneCheck range of motion, etc…Get a page or call from Mickey,SpongeBob, etc.Play with the tones and/orvibration featureTry to keep it from beingthrown across the room…Please do not answer pages orphone calls while with a patient unless it’s urgent!
Dr. Lou’s Bag of TricksAny toy or interesting tool can beused to check the motor exam andmental status of a child.If you don’t have a toy and want tocheck neck flexion (nontraumatic),ask the child to show you his/herbelly button. They almost alwayslook down as they pull up theirshirt.If they don’t look down, askdubiously if they’re sure that’s theirbelly button.
Dr. Lou’s Bag of TricksDemo what you want to do on momor dad.If you want a young school-ager todo something, bet them that theycan’t do it as well as you can.To improve deep breathing forauscultation, ask the child to act likeshe’s blowing up a balloon orblowing out a candle, but quietly.
Dr. Lou’s Bag of TricksTo check pulmonary function ona school-age or older child, havethem see how far they canslowly count out loud on asingle breath. Normally, theyshould get at least into the teens.Repeat to assess effectiveness oftreatment.
Dr. Lou’s Bag of TricksTell a preschool child thatyou’re going to give their arm ahug when you take their bloodpressure.Have a child tilt their head backif checking their throat. You geta better view.
Dr. Lou’s Bag of TricksTo help palpate a ticklishabdomen, put the child’s handunder yours and palpate withtheir hand.To get your tool or toy back,distract the child with somethingelse while you or the parentretrieves it. Get it out of sightimmediately!
Dr. Lou’s Sure-Fire Laugh LinesWhen a child’s done a good job atdeep breathing for you… “Wow, you’re a really good breather! I’ll bet you do it all the time, don’t you?”
Dr. Lou’s Sure-Fire Laugh Lines“Does your … hurt?”Mention normal painful body partsand then start throwing in others …Hair, eyelashes, fingernails,toenails, freckles?
Dr. Lou’s Sure-Fire Laugh Lines To a school-aged child:“My goodness, you’re so cute! Howmany girl(boy)friends do you have?” OR“Are you married? Have any kids?”
Dr. Lou’s Sure-Fire Laugh Lines If no girlfriend, whisper loudly, “You’re supposed to say your mother’s your girlfriend!” ORIf horrified by the thought of a girlfriend, “That’s OK. Girls are yucky anyway.” Both are guaranteed to make the parents laugh!
SummaryGetting along well with yourchild patients often enhancesyour communication with theirparents.Developmental stages influenceyour communication approachbut you should always talk toyour child patient, regardless ofage.
SummaryTell the parents what they wantto hear about their child. Thentell them about the medical stuff.Smiles are powerfulcommunication tools.Sometimes it’s not what you saybut how you say it, with yourbody as well as your words.
SummaryNever lie.Shamelessly use any tools andtricks you have to enhancecommunications and build trust.This can only make your jobeasier.Make ‘em laugh!