communication and health assessment of the child and family

Mosby items and derived items © 2005, 2001 by Mosby Inc.

Mosby items and derived items © 2005, 2001 by Mosby Inc.

Communication and

Health Assessment of the Child and FamilyChapter 6

Mosby items and derived items © 2005, 2001 by Mosby Inc.Mosby items and derived items © 2005, 2001 by Mosby Inc.

Principles of Communication• 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


Involve Child in Communication


Principles of Communication (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


Principles of Communication cont’d• Allow children to express feelings and

fears

• Offer praise, encouragement, and rewards

• Use a variety of communication techniques—see pp. 115-116.

• Be culturally sensitive—see p. 109


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


Developmentally Appropriate Communication• Early childhood

– Focus on CHILD in your communication– Need “warm-up” time. May be uncooperative– Use words he 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.


Developmentally Appropriate Communication (cont’d)• School-age years

– 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


Developmentally Appropriate Communication (cont’d)• 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


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. 116)


Communicating with Parents


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 (p. 117 and 119)• If pain is part of chief complaint, see p. 116• Complete family assessments are indicated in the

following instances:– Comprehensive checkups– Developmental delays– Child abuse/behavioral or emotional probs– Children with stressful events and major life

changes– New home care patients


The Health History (cont’d)• Family Assessments gather information about:

– 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


The Health History (cont’d)• Nutritional Assessment

– Especially important for patients with evidence of nutritional problems (p. 128-129)

– Dietary recalls are frequently unreliable – Most common is 24h but is only useful if day is

typical; 3 day diaries are more helpful– May also use specific history questions as

seen on p. 126 or a food frequency record on p. 127.

– Other methods for assessing nutritional status include anthropometrics and labs

communication and health assessment of the child and family

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