Communication with children and young people in medicineNawras Al HalabiHayat AbdulhadiNawras@dr.comHayatAbdulhadi@dr.com

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Think like a wise man but communicate in the language of the peopleWilliam Butler YeatsIrish poet 1865 - 1939

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

Difficulties about communicating with a child patientUsing childrens own languageChild fear from strangerChilds previous experiencesChildish behavior or tantrumsExtra sympathy from the doctor

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Difficulties about communicating with a child patientSome medical procedures special difficultiesParents (overwhelmed fears, communication)Child isolationUnpredicted depravation

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How can we pass these difficulties?Adjust to child cognitive and physical levelAttention to not to talk down to children

__ ))))))7

NOTE:To change images on this slide, select a picture and delete it. Then click the Insert Picture iconin the placeholder to insert your own image.Try to get the childrens confidence before touchPassing communication with a child patient difficulties

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Ask about hobbies and interest before addressing medical problemsOpen Question

Passing communication with a child patient difficulties

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NOTE:To change images on this slide, select a picture and delete it. Then click the Insert Picture iconin the placeholder to insert your own image.

Dont allow the child to worryOr Make fake promises!Explain procedures before you doPassing communication with a child patient difficulties

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children are initially shy and some of them build up trust slowly

PreservePassing communication with a child patient difficulties

: !! ((( )))

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Consider using softer words (Childish language)Dont use complex language.

Instead of SayStethoscopeDoctors HeadphoneShoot an X-rayTake a picture

Passing communication with a child patient difficulties

Be aware of what you say, some words may have negative connotations.

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Use Tools, Play, Toys.Toys help to establish rapport with children and to explain medical procedures.

Passing communication with a child patient difficulties

Example (this teddy is kaza do you want to mama tedy bear)VIDEO

e.g Shall we have alook at teddys tummy and find out where it hurts?what would teddy need to make him feel better?13

Check understandingGive information in small chunks.Repeat and clarifyRegularly check understanding

Passing communication with a child patient difficulties

Be calm even if the child began to cryDont rely too much on bribery

Passing communication with a child patient difficulties

Ask the help of the parentsDont leave the child alone

Passing communication with a child patient difficulties

Ask if they want to be examined whilst sitting on mothers lap or on the examining table?? .

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Give realistic hopeDont lie

Passing communication with a child patient difficulties

AlwaysBe flexible to interact with children at their different stages of developmentPassing communication with a child patient difficulties

Developmental Stages: Birth to 6 monthsInfant is learning to regard the environment, especially faces.No stranger anxiety until late in this phase.Nonverbal communication:Facial expressionsTone of voiceTreat children as babies not patients (parents warm)Make faces and talk baby talk!

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

! Try to keep the child with a caregiverTry to talk to child

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Developmental Stages: 18 months 3 yearsMay 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.

---Will understand more words than they can say.--dont wait forever for cooperation with exam.----Toilet training often includes lessons about modesty and improper touching. Respect these lessons; uncover child selectively for exam.

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Developmental Stages: 3 years 6 yearsHere where communication starts!Curiosity, independency.Verbal enthusiasimBig mental development (understanding problems)misinterpret words (check understading)Give choices

(mental) Are starting to understand about being hurt or sick and that people will try to help themthe futureMagical thinkingWorry about being in trouble

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Developmental Stages: 6 years 12 yearsUse 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 modestFeel comfort with touchingDont embarrass them in front of peers.Dont tell them not to cry.

Want to be accepted and blend in.Use common interests to build trust.SportsTV and movie characters

(May feel pain intensely)

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Developmental Stages: Special AttentionDifferentiate between normal development and a developmental delay

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

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Physical environment: waiting roomColored walls

Play material

Furniture Child-oriented

Small tables+ chairs that is in scale with there sizeSafetyEasily reachedDoors(in a way do not interrupt big guys)26

Physical environment: waiting roomThe 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

Physical environment: consulting roomChild orientedPrivacyToys: the toys give abridging language for the child and health professional

Remember the children need privacy just as much as adults ((draw the curtains or shut the door))28

Physical environment: Doctors appearanceWear fun badges on their lapels

Carry a small clothes toy

Child oriented clothes

On visit: wear casual clothes (if possible)

In order to create a more relaxed and friendly impression

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Physical environment: Doctors appearanceUse Child oriented medical tools:multi colored stethoscopesBeautifully colored MRI

Physical environment: Doctors appearanceUse Child oriented medical tools:multi colored stethoscopesBeautifully colored CT

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

Gathering information about the patientInfants have their own personality and preferencesinteract with:eye contactspeak in calmgentle mannermake the encounter feel (basic communication)Children like to feel in controlInvolve child and parents in decision making

2- inviting the child and parents to participate in decision-making3- lets see, what do you think we should do to get rid of this??

speak to the child development stage (do not be over)

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Addressing the childs feelingsBecause 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 illnessThis is normal

Addressing the childs feelingsCompliment and encourage children:encourage after each medical procedureencourage the child even when the procedures are over (by have photo albums of procedures)

2- encourage after each medical procedure - encourage the child even when the procedures are over (( by have photo albums of procedures)) .

Also may benefit other children who have the same problem

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Addressing the childs feelingsChild is communicating but hasnt verbalized clearly

what your face and body say are every bit as important as what your mouth says

SoAge

VerbalNon- Verbal

Separation , isolation and chronic illnesswe can help them by:Adjust them to the strange environment by:adapting to their usual routinesencouraging them to bring in favorite object

Try to inform children of staffing changes

Sometimes we have to isolate the child from friends and familiar environment

+ + + ( ) ....

*

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Separation , isolation and chronic illnessThe child should be helped to feel in control of the environmentThis can be achieved as follows:provide several activities, and let child choose from theseMark and celebrate eventsIf possible, provide a telephone

Separation , isolation and chronic illnessEncourage:frequent visitthe parents child to put up photographs and picturesthe child to make a chart and mark off the days until discharge

Separation , isolation and chronic illnessSpend time with the child, even when there are no medical procedures to carry out and wear casual clothes (when possible)

Always Give realistic hope!

Give realistic hope.

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

Dealing with adolescentsIdentity 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 consultationDo not comply with the treatment

Doctor must be delicate, boundaries needs to be flexible

Your role is to explain the dangers and possible consequences of their actions, particularly when parents or teachers have failed to do so.

Need to be flexible

you have to show that you are on their side

(aknoledge their desire to be independent (emphasis the importance of their attending appointments))

Omnipotence ( )Your role is to explain

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Dealing with adolescentsTry to adjust them to the changesRespect modesty and privacyAvoid embarrassing themDirect yourself to them as you might to an adultMake eye contact but dont force it unless you need to make a point.

Your role is to explain the dangers and possible consequences of their actions, particularly when parents or teachers have failed to do so.

Need to be flexible

you have to show that you are on their side

(aknoledge their desire to be independent (emphasis the importance of their attending appointments))

Omnipotence ( )Your role is to explain

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Dealing with adolescentsTouch cautiously until youre sure touch is welcome Dont lie, Dont 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 themThey need to feel omnipotence

Your role is to explain the dangers and possible consequences of their actions, particularly when parents or teachers have failed to do so.

Need to be flexible

you have to show that you are on their side

(acknowledge their desire to be independent (emphasis the importance of their attending appointments))

Omnipotence ( ) (decision making)Your role is to explain

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Breaking bad newsWhat is bad news in medicine?Information that produces a negative alteration to a persons expectation about their present and future could be deemed Bad News

Breaking bad newsYour "Bad News" may not be my "Bad News

"Bad News" doesnt have to be fatal

"Bad News" doesnt have to seem so bad to the medical practitioner

Breaking bad newsTraumatic DeathDeath after chronic illnessDiagnosis of cancerLeukemia

Diagnosis of chronic diseaseDiabetesAsthmaDiagnosis of permanent disabilityBirth defect

What is bad news in medicine?

Delivering Bad NewsThere 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

What to do?Introduce yourself, Look to comfort and privacyDetermine what the parents already knowTry to learn what the child knows about illnessDiscuss with parents whether to tell the child, who should tell, and what to tell (respect parents values) Give information in presence of the parentBe direct and honest

dont go over their heads

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What to do?Identify parents and siblings concernsAdopt to childs developmental stageIdentify the childs main concernPlay, tools, drawing express illness or disabilitySummarize and check understandingGive realistic hope

May be worried more than the child

To not sue you in court

Emphasis what the child will be able to do

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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

Do not be afraid of silence or tears

Explore patients emotions and give him time to respond

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What not to do ?Hurry

Condense information.

Use complex or medical language

Lie or be economical with the truth

Be blunt.

Guess the prognosis

Words can be like loaded pistols/guns

Give all the information in one go, Give too much information

(She has got 6 months, may be 7)

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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.

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).

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Good communication example

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