مهارات التواصل مع الأطفال والمرضى الصغار في الطّبّ كلية الطب البشري في الجامعة السورية الخاصة Please LIKE my page! http://facebook.com/NawrasAlHalabi 2014 Faculty of medicine of Syrian Private University.

1. Communication with children and
young people in medicine
Nawras Al Halabi
Hayat Abdulhadi
Nawras@dr.com
HayatAbdulhadi@dr.com

3. Think like a wise man but
communicate in the
language of the people
WILLIAM BUTLER YEATS
IRISH POET 1865 - 1939
“
”

4. Communication with young is special
Children and young people medical
communication has unique aspects
that differ in structure, format, and
content from adult patient medical
communication.

5. Difficulties about communicating with a child
patient
• Using children’s own language
• Child fear from stranger
• Child’s previous experiences
• Childish behavior or tantrums
• Extra sympathy from the doctor

6. Difficulties about communicating with a child
patient
• Some medical procedures special difficulties
• Parents (overwhelmed fears, communication)
• Child isolation
• Unpredicted depravation

7. How can we pass these difficulties?
 Adjust to child cognitive and
physical level
 Attention to not to talk
down to children

8.  Try to get the children’s
confidence before touch
Passing communication with a child patient difficulties

9.  Ask about hobbies
and interest before
addressing medical
problems
Open Question
Passing communication with a child patient difficulties

10.  Don’t allow the child to worry
Or Make fake promises!
 Explain procedures
before you do
Passingcommunicationwithachildpatientdifficulties

11. • children are initially
shy and some of them
build up trust slowly
 Preserve
Passing communication with a child patient difficulties

12.  Consider using softer words (Childish
language)
 Don’t use complex language.
Instead of Say
Stethoscope Doctor’s Headphone
Shoot an X-ray Take a picture
‫معدة‬ ‫بطون‬
‫بول‬ ‫بيبي‬
Passing communication with a child patient difficulties

13.  Use Tools, Play, Toys.
Toys help to establish rapport with
children and to explain medical
procedures.
Passing communication with a child patient difficulties

14.  Check understanding
 Give information in small chunks.
 Repeat and clarify
 Regularly check understanding
Passing communication with a child patient difficulties

15.  Be calm even if the child
began to cry
 Don’t rely too much on
bribery
Passing communication with a child patient difficulties

16.  Ask the help of the parents
 Don’t leave the child alone
Passing communication with a child patient difficulties

17. Give realistic hope
Don’t lie
Passing communication with a child patient difficulties

18. Always
Be flexible to interact with
children at their different
stages of development
Passing communication with a child patient difficulties

19. Developmental Stages: Birth to 6 months
• Infant is learning to regard the environment, especially faces.
• No stranger anxiety until late in this phase.
• Nonverbal communication:
• Facial expressions
• Tone of voice
• Treat children as babies not patients (parents warm)
• Make faces and talk baby talk!

20. Developmental Stages: 6 – 18 months
• Stranger anxiety.
• Most communication is non-verbal.
• Development in motor skills is often faster than
communication skills.
• Use tools (Stimulation, catch attention, Distraction)

21. Developmental Stages: 18 months – 3 years
• May isolate, but ask to be with parents.
• More verbal.
• Constantly moving.
• Use tools, Play, curiosity as motivators.
• Same level approach.
• Training involves touch.
• Respect child privacy and exam selectivity.

22. Developmental Stages: 3 years – 6 years
Here where communication starts!
Curiosity, independency.
Verbal enthusiasim
Big mental development (understanding problems)
misinterpret words (check understading)
Give choices

23. Developmental Stages: 6 years – 12 years
• Use common interests to build trust (ask about hobbies)
• Fear failure, inferiority.
• Want to be treated as “big kids” but may feel “baby”
insecurities. (Do not talk very childish)
• Body-conscious and modest
• Feel comfort with touching
• Don’t embarrass them in front of peers.
• Don’t tell them not to cry.

24. Developmental Stages: Special Attention
 Differentiate between
normal development
and a developmental
delay

25. Physical environment
Children are definitely influenced by the
smells, sounds, and surroundings of
their medical visit.

26. Physical environment: waiting room
 Colored walls
 Play material
 Furniture “Child-oriented”

27. Physical environment: waiting room
 The “No Shot Zone” sign at the
entrance to the clinic gets lots of
“thumbs-up” approval from the
kids and puts them at ease.
John M. Purvis, MD

28. Physical environment: consulting room
 Child – oriented
 Privacy
 Toys: “the toys give abridging
language for the child and health
professional”

29. Physical environment: Doctors’ appearance
 Wear fun badges on their lapels
 Carry a small clothes toy
 Child oriented clothes
 On visit: wear casual clothes (if possible)

30. Physical environment: Doctors’ appearance
Use Child oriented medical tools:
 multi – colored stethoscopes
 Beautifully colored MRI

31. Physical environment: Doctors’ appearance
Use Child oriented medical tools:
 multi – colored stethoscopes
 Beautifully colored CT

32. Physical environment: Even the whole place!
Child oriented healthcare centers

33. Gathering information about the patient
 Infants have their own personality and preferences
 interact with:
 eye contact
 speak in calm
 gentle manner
 make the encounter feel (basic communication)
 Children like to feel in control
 Involve child and parents in decision making

34. Addressing the child’s feelings
• Because of fear, loss, disability the
children may regress their behavior to
that of a much younger child
• Reassure children that they are not
responsible for the illness
This is normal

35. Addressing the child’s feelings
Compliment and encourage children:
encourage after each medical procedure
encourage the child even when the procedures are over
(by have photo albums of procedures)

36. Addressing the child’s feelings
Child is communicating but hasn’t verbalized clearly
what your face and body say are every bit as important as what
your mouth says
So
Age Verbal Non-
Verbal

37. Separation , isolation and chronic illness
we can help them by:
• Adjust them to the strange environment by:
1. adapting to their usual routines
2. encouraging them to bring in favorite object
• Try to inform children of staffing changes

38. Separation , isolation and chronic illness
• The child should be helped to feel in control of the
environment
• This can be achieved as follows:
• provide several activities, and let child choose from
these
• Mark and celebrate events
• If possible, provide a telephone

39. Separation , isolation and chronic illness
Encourage:
• frequent visit
• the parents child to put up photographs and pictures
• the child to make a chart and mark off the days until discharge

40. Separation , isolation and chronic illness
• Spend time with the child, even when there are
no medical procedures to carry out and wear
casual clothes (when possible)
• Always Give realistic hope!

41. Dealing with adolescents
The development of children
ages 12 through 18 years old
is expected to include
predictable physical and
mental milestones.

42. Dealing with adolescents
 Identity and peer relationships are the key issues at this age
 Adolescents need boundaries ( more than children do) they may test them
to the limits: Ex:
Arriving late at the consultation
Do not comply with the treatment
 Doctor must be delicate, boundaries needs to be flexible

43. Dealing with adolescents
• Try to adjust them to the changes
• Respect modesty and privacy
• Avoid embarrassing them
• Direct yourself to them as you might to an adult
• Make eye contact but don’t force it unless you need to make a point.

44. Dealing with adolescents
• Touch cautiously until you’re sure touch is welcome
• Don’t lie, Don’t be condescending.
• If drugs, pregnancy or other sensitive issues are involved, assure
the child that your job is not to judge or enforce the law.
• taking care not lecture them
• They need to feel omnipotence

45. Breaking bad news
• What is “bad news” in medicine?
“Information that produces a negative alteration to a person’s expectation
about their present and future could be deemed “Bad News”

46. Breaking bad news
• Your "Bad News" may not be my "Bad News“
• "Bad News" doesn’t have to be fatal
• "Bad News" doesn’t have to seem so bad to the medical practitioner

47. Breaking bad news
• Traumatic Death
• Death after chronic illness
• Diagnosis of cancer
• Leukemia
• Diagnosis of chronic disease
• Diabetes
• Asthma
• Diagnosis of permanent disability
• Birth defect
What is “bad news” in medicine?

48. Delivering Bad News
There is in a simple mnemonic of ABCDE:
 Advance Preparation
 Build a therapeutic environment / relationship
 Communicate well
 Deal with patient & family reactions
 Encourage and validate emotions

49. What to do?
Introduce yourself, Look to comfort and privacy
Determine what the parents already know
Try to learn what the child knows about illness
Discuss with parents whether to tell the child, who should tell, and what to tell
(respect parents’ values)
Give information in presence of the parent
Be direct and honest

50. What to do?
Identify parents and siblings concerns
Adopt to child’s developmental stage
Identify the child’s main concern
Play, tools, drawing express illness or disability
Summarize and check understanding
Give realistic hope

51. How to do it ?
 Be sensitive, and consider appropriate touching
 Maintain eye contact
 Give information in small chunks, Repeat and clarify
 Regularly check understanding
 Be calm about any reactions

52. What not to do ?
 Hurry
 Condense information.
 Use complex or medical language
 Lie or be economical with the truth
 Be blunt.
 Guess the prognosis

53. Conclusion (1)
• The doctor is the advocate for the child, not for the parents or the hospital.
• Relate to the child according to their developmental. Involve the child in the
treatment and explain each stage of the medical process.

54. Conclusion (2)
• Think of the child as an individual who can provide important information on
the diagnosis and treatment.
• Break the bad news in the best way.
• Work together with the family and, whenever necessary, with other medical
or non-medical professionals (child psychotherapists, psychiatrists, family
therapist).

55. Good communication example

56. “
”
ُ‫ال‬َ‫ْم‬‫ل‬‫ا‬ُ‫ة‬َ‫ين‬ِ‫ز‬ َ‫ن‬‫و‬ُ‫ن‬َ‫ْب‬‫ل‬‫ا‬َ‫و‬ْ‫ن‬ُّ‫الد‬ ِ‫اة‬َ‫ي‬َْ‫ْل‬‫ا‬‫ا‬َ‫ي‬
ۖ
‫العظيم‬ ‫هللا‬ ‫صدق‬