Lifelong Learning Programme

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.

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Training of Lecturers

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This training package is addressed to lecturers and trainers in the field of paediatrics on how to assist paediatric undergraduate and resident students in developing and consolidating their soft skills for improving the quality of paediatric services.

Communication with Children

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1.2. Communication with children
Communication with children should be age-adapted, holistic, positive and strengths-based, and inclusive, according to the following UNICEF principles:

Principle 1 - “communication for children should be age-appropriate and child-friendly” Guidelines for this principle include:
  • using child-appropriate language, characters, stories, music and humour;
  • encouraging and modelling positive interaction and critical thinking;
  • using special effects judiciously and wisely.

Principle 2 - “communication for children should address the child holistically,” and is supported by guidelines to:
  • use an integrated rather than single-issue approach to communication;
  • offer positive models for adults in their relationships with children as full human beings in their own right;
  • create “safe havens.” “Safe haven” communication is important because safety and security are foundations for developing and learning well. “Safe havens” are spaces where vulnerable children can go in a time of crisis. They can be physical, mental or emotional places where children feel that they are listened to and someone knows how they feel. They are places where children feel protected and safe from harm and can gain a sense of trust in the world and optimism about their lives.

Principle 3 - “communication for children should be positive and strengths-based,” and is supported by guidelines to:
  • build self-confidence as well as competence;
  • use positive modelling;
  • include children as active citizens learning about and modelling social justice;
  • do no harm.

Principle 4 - “communication for children should address the needs of all, including those who are most disadvantaged,” and is supported by guidelines to:
  • reflect the dignity of each and every child and adult, irrespective of religion, race, colour, language, nationality;
  • be inclusive: celebrate and value all types of diversity;
  • ensure communication is free of stereotypes;
  • reflect and nurture the positive aspects of local cultures and traditions.

For all groups, communication should invite children to see, imagine, hear and create.

Enhancing communication with sick children

Purvis (2009) addresses the communication challenges physicians may face when interacting with children and the importance of applying the four Es – engagement, empathy, enlistment, and education. He emphasizes the importance of communicating successfully with a child, stressing the significance of verbal, nonverbal and communication activities, the importance of considering the cognitive and developmental stages, and adapting to the specific needs of infants, children and teenagers.

Communication for children requires special skills, talent and training. Suffering children, alongside those who are experiencing abuse or whose wounds or fears emanate from physical pain, discrimination based on disability, ethnicity, are in need of safe havens and pediatrics, pediatricians and the healthcare staff should be aware of this and able and willing to provide these children with the much needed support and counselling, besides just strict medical intervention.

The best communication for children is often guided by what adult health care staff can learn from children. Therefore, the most important thing they can do is to grant them their undivided attention, spend time with them, observe them and ask them for feedback on their communication.

Giving the Child Choices (Empowering) To the extent possible, health care professionals should give the child some control of the examination, e.g.: “Do you want me to look at your eyes or ears first?” “Do you want your mom to hold your hand while I examine your leg?” “Do you want me to take off the bandage or do you want to do it?” Letting a toddler play with the stethoscope before you apply it to the chest, not only helps assure him or her that it’s not a threat but also gives the toddler some control over what is happening.

Keeping the Child Informed A running dialogue with the pediatric patient during the physical examination improves cooperation and helps alleviate anxiety. All of us want to know what is being done to our bodies during a medical procedure, and the physical exam is a procedure. Down to about age two years, the younger the child, the more the clinician needs to keep the child informed about what is being done and what will be done next. For a two- or three-year-old, it would be appropriate to say that you are now going to look in the other ear or listen to the child’s chest. For the older child or adolescent, you would probably just put your stethoscope to the chest and say, “Take a deep breath.” A friendly smile, gentle touch and small talk can be helpful for children of all ages, and nonsensical jokes will make the examination less frightening for the young child: “Well, I didn’t see any potatoes growing in your ear.” or “I thought I heard some barking in there (after listening to the abdomen). Children are generally both curious and concrete in their thinking. They will appreciate an explanation of what you are going to do and why. And explain what you find in developmentally appropriate language.

Weiss (2003) and the National Patient Safety Foundation (2013) propose several steps to improve communication with child patients:
  • Slow your speech and spend a little additional time with the patient and family. Sit rather than stand. Listen rather than speak.
  • Use plain, nonmedical language, e.g., high blood pressure rather than hypertension, heart doctor instead of cardiologist.
  • Use Analogies (e.g. “A pipe that is partially clogged doesn’t allow air or water to flow properly.”) can be used to illustrate an obstructed airway or blood vessel. When using a translator, instruct him or her to stay with the ordinary words you use and not substitute medical terms.
  • Use pictures as they enhance understanding and recall.
  • Review and repeat key points. Consider simple handouts, written at or below the 6th grade level.
  • Use teach-back or show-me techniques (Schillinger et al., 2003). Ask patients/parents to demonstrate understanding. Avoid asking, “Do you understand?” Patients will frequently answer “yes” even if they understand nothing (Weiss, 2003). Examples of Teach-back include: “What will you tell your baby doll about your tummy ache?” “I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure that I did.” “Please show me how you keep the thermometer.”
Weiss (2003) provides suggestions for preparing written materials for children and their families:
  • General content: limit to a few key points—what the patient or parent needs to know
  • Text: active voice; at or below 6th grade level: short words, sentences and paragraphs
  • Font: at least 12 point, simple font such as Arial or Times New Roman; do not use all upper case
Layout: avoid dense text, leave generous open spaces; simple illustrations as appropriate.

More information is also provided about the importance of:
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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.