Transcript PEDIATRIC COMMUNICATION

Communicating with and
Interviewing the Child and
Family
Perry, Chapter 34, pp. 866-881
Communicating with Children
 Make communication developmentally
appropriate
 Rely on nonverbal behavior more than verbal
 Get on child’s eye level but avoid staring at child
 Approach child gently/quietly. Give them time to
warm up to you. Use transition objects or play
techniques.
 Always be truthful
 Give child choices as appropriate
Communicating cont’d
 Avoid analogies and metaphors
 Give instructions clearly
 Give instructions in positive manner
 Avoid long sentences, medical jargon,
colloquialisms; think about “scary words” See
handout on choosing language.
 Allow younger children to be close to parent
 Give older child opportunity to talk without
parents present
Communicating cont’d
 Allow children to express feelings and fears
 Offer praise, encouragement, and rewards
 See Guidelines p. 870 and 872
 Use a variety of communication
techniques—see Box 34-4 pp. 873-4
 Be culturally sensitive—p. 869, “Using an
Interpreter.”
Developmentally Appropriate
Communication--Infants
 Non-verbal
 Crying as communication
 Pick up adults non-verbal behaviors
 If under 6 months, will usually respond to
anyone.
 If over 6 months, stranger anxiety exists
Early Childhood (Toddler &
Preschool)
 Focus on CHILD in your communication
 Need “warm-up” time. May be uncooperative
 Use words child will recognize; use short,
familiar, and concrete terms
 Be consistent: don’t smile when doing painful
things
 Allow child to handle most equipment
 Keep fearful equipment out of sight until it is
needed.
School Age
 High level of curiosity; likes to help
 Give explanations and reasons
 Explain how things work; allow handling of
most equipment
 Allow to express feelings
 Respect privacy
 Generally behave well and communicate
effectively
Adolescent
 Be honest with them
 Aware of privacy needs
 Think about developmental regression
 Importance of peers
 Listen to them and respect their views
 Avoid judging or criticizing; tolerate
differences
 Pick your battles
 Avoid the third degree
Play
 Children’s “work”
 Child’s “developmental workshop”
 As therapeutic intervention
 As stress reliever for child/family
 As pain reliever/distracter
 As barometer of illness
Therapeutic Art
 One of the most valuable forms of communication
 Can tell about child’s situation both from seeing
what he draws and what he says about it.
Remember to take into account other information
about family.
 Important points: first figure, size of figures,
order, position, exclusion, accentuated parts,
absence of parts, size and place of drawing, stroke
type, erasures, cross-hatching (p. 874)
Communicating with Parents
 Most information comes from them
 If parent sees a problem, pay attention
 Listen actively; listen for information
directed “over the child’s head.”
 Try to be a facilitator in arriving at a
solution to the problem rather than always
giving your ideas
 Remember to use open-ended questions that
start with “what” “how” “tell me about”
The Health History
 Pediatric health history has similar and different
components from adult history (Box 34-5, p. 875)
 If pain is part of chief complaint, see p. 876,
“Analyzing the Symptom: Pain.” Note that a lot
of the assessment is nonverbal and the pain scale
is different than adults
 Review of systems is somewhat different than
adults (Guidelines, p. 882) especially in areas that
require evaluation of behavior (eyes or ears for
instance) and in sexual development.
Complete Family Assessment
 Family composition
 Home environment
 Occupation and education of members
 Cultural and religious elements
 Family interactions including who makes
decisions, how members communicate, how
they solve problems, disciplinary methods,
and support for each other
Family Assessments cont’d
 Are not necessary in all circumstances, but
may be indicated for:
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–
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Comprehensive checkups
Developmental delays
Child abuse/behavioral or emotional problems
Children with stressful events and major life
changes
– New home care patients