Lifelong Learning Programme

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Training for Paediatricians and Paediatric Students

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This training package is addressed to students and medical practitioners in paediatrics on how to autonomously learn, develop and consolidate their soft skills for improving the quality of paediatric services.

Communication with Children

Table of Content

1.1 – Greeting Child Patients and Introductions (Using Loving Tones, Smiling, Simple Language, in a Sitting Position)
Physician—patient interaction during the medical interview is essential in establishing the rapport necessary for a successful relationship. Physicians are generally encouraged to shake hands with patients, address patients by name, and identify themselves. Addressing a child by his/her name is also a sign of respect and professionalism which may also make the child open up and cooperate (Fischer, 2009).

The greeting is the first form of verbal and nonverbal communication and is a valuable tool to support the physician-patient relationship (Eymann, 2011). Greeting is the first step in creating rapport with a child patient and is the first step in realizing a successful interview.

The pediatric medical interview is quite different from the adult medical interview. In the pediatric interview (PI), the interaction involves the child, parent, and physician triad, creating a different dynamic from that of the one-on-one interaction of the adult interview. Second, the different developmental stages of children require variations in approach that are quite different from techniques used in interviews with adults. Because of these differences, the interview techniques used by pediatricians across age groups are not as standard as those used by physicians in adult interviews. (Mendelsohn, 1999) As children mature, pediatricians more frequently conduct at least part of the interview without the parent present

Several pieces of advice are given in the literature about how to greet children according to age:
  • A white coat can be intimidating and scary especially for a young child, therefore pediatricians could consider wearing a coat of a different colour, if the hospital policy allows it. If you are wearing a stethoscope, you may allow a small child to touch and play a little with it or have a toy-stethoscope for the child to play with
  • A genuine smile usually breaks barriers and can go a long way in establishing rapport
  • Upon entering the room, introductions should begin with the physician and then patient and parent providing their names. If others are in the room, the physician should learn their names and relationship to the patient.
  • Socialize first: Show interest in the child or adolescent by talking about non-medical topics such as play, games (smaller children) or school, books and sports (school children) and asking about his or her interests. You can start from items around the child, books, toys or pictures. Mention things to show that you are familiar with the patient and family, as well as with their medical issues.
  • The individual rapport-building strategies most frequently used with infants are talking, touching the child, making sounds, sharing toys, and holding the child; with preschool-aged patients was talking to the child; sharing toys and giving a drawing project. Individual strategies used to build rapport with adolescents included engaging them in discussions about friends, feelings, music, movies, and school. Strategies used for calming the upset or disruptive child are much the same as those used for building rapport. (Mendelsohn, 1999). Two key techniques for establishing rapport include keeping eye contact with the child or adolescent and beginning the conversation with a topic that they may find interesting. Simple questions for school-aged children such as “how old are you” or “what do you like to do at school” will help increase their comfort in interacting with someone they do not know. Each of these may increase the child's level of engagement and increase the likelihood they will ask and answer further questions. Children and adolescents should be treated with respect and spoken to in the same tone of voice used for adults. (Stivers, 2012)


Tips for maintaing rapport (Stivers, 2012)

It is the pediatrician’s job to ensure that the information is provided at a level that can be understood, to ensure patient safety as well as keep a child or adolescent engaged in their own medical care and decision making. (Bell, 2016) Teaching health information to children empowers them to actively participate in their health care and provides self-management skills that will assist them in keeping themselves well throughout their lives (Curry, 2006) Generally, children can begin to participate in communication about their health care and medicines at 3 years of age.(Borzekowski, 2009)
  • The pediatrician uses loving tones
  • He/she is sitting at the child’s level, assumes an open, relaxed posture, does not look at the watch or the door and uses simple language. Sitting conveys the fact that he/she is not in a hurry.
  • Even though the physician may have washed his or her hands before entering the room, after introductions are concluded and some or all of the history is obtained, the physician should repeat the hand washing process, making it readily visible to patient and family. If the physician is using his or her own stethoscope, he or she should clean it with an alcohol swab before placing it on the skin of the patient. First impressions are lasting impressions.
Practical Applications
Scenario 1 – Greeting and introductions (using loving tones, smiling, simple language, in a sitting position) The scenario describes a first encounter between a pediatrician and child patient.
Ilinca, a 5-year-old girl, presents fever for approximately 2 days, dry cough and loss of appetite. Therefore, her mother takes her to the pediatrician. In a quiet medical office surrounded by multiple colored toys, the pediatrician (dressed with a teddy bear/white coat), wearing a green stethoscope and a gentle smile on her face, receives Ilinca and her mother. The scenario will underline the importance of greeting and introductions, using adequate open body language, loving and calm tone, maintaining rapport and friendly attitude in communication.
Softskills in the video: friendly attitude – the pediatrician allows the child patient to use the stethoscope, genuine smile, socializing: showing interest in the child by talking about non-medical topics first, rapport building (touching the child), addressing child by name as a sign of respect.
The Transcript in English is available
Scenario 2 – Greeting and introductions (using loving tones, smiling, simple language, in a sitting position) The scenario describes ant encounter between a pediatrician and child in-patient. In a quiet ward, with cartoon painted walls, there is a 5-year-old girl lying in a small bed surrounded by toys. She was admitted the night before for severe abdominal pain and vomiting.
The pediatrician enters the room, smiles, and introduces herself.The scenario will underline the importance of greeting and introductions, using adequate open body language, loving and calm tone, maintaining rapport and friendly attitude in communication.
Softskills in the video: information is provided at a level that can be understood, the pediatrician uses loving tones, she is sitting at the child’s level and addresses child patient by name.
The Transcript in English is available
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This project has been funded with support from the European Commission. This web site reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.