1. Communicating with and Interviewing the Child and Family
Perry, Chapter 34, pp

2. 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

3. 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.

4. 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
Be culturally sensitive—p. 869, “Using an Interpreter.”

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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)

11. 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”

12. 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.

13. 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

14. 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