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 Ex: “little stick in the arm” “cough your head off” Scary: Cut, Sticks, Tubes, etc.

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 Types of cries: Caregiver’s understanding

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. Don’t call kids/ babies “IT”. Examples

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 Honesty will help gain their trust Privacy is from their viewpoint Illness>>act much younger; with pain>>act much younger I want Mommy, etc. Peers: whole group in hospital room Socialize with other hospitalized teens//determine appropriateness

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 It is WHAT THEY DO It is HOW they learn and mature Example of tea party to increase po intake Too sick to play>>getting better>>start to play again

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: Comprehensive checkups Developmental delays Child abuse/behavioral or emotional problems Children with stressful events and major life changes New home care patients