Communication with children

Some reasons why it is a good idea to communicate with children during consultations

• To gain a more accurate understanding of the child’s perspective.
• Children are little experts in themselves and only they can offer certain information. Child can offer symptom profiles, especially of times where parents are not present, such as school.
• An opportunity to assess the child’s knowledge levels, assess the child’s logic and understanding, assess skills in symptom control and implementation of treatments, assess any gaps in knowledge or misunderstandings, assess the child’s emotional attitudes towards their condition.
• Assess the child’s own issues and problems with their condition and avoids assumptions about what psycho-social problems are present. It also may help understand more about treatment non-compliance etc.
• It’s good practice.

Time constraints and some ideas on how to work within them

Some basic skills in verbal and non-verbal communication can help structure the time you have in a consultation.

• When you want to open up communication in order to gain the patients perspectives, their understandings etc. OPEN questions are ideal. These questions are ‘open’ as no answer is implied in the question. These questions can often reveal information or issues that have not been considered previously.
  Example, ‘Can you tell me how you have been feeling since you had the operation’
• However, when time is tight and you require some specific information from a patient it may be useful to avoid open questions and use more CLOSED questions. These are questions where there is usually only a short answer required. They allow specific information to be attained, but can result in the answer patient thinks you expect.
  Example, ‘Can you tell me if you have had any pain in your leg since the operation’
• Sometimes children will not feel confident talking to a doctor or know what to say. They may say they’re okay when they’re not just like some adults) and/or might be saying, “I’m fine” to simply take the pressure of questioning off them.
• Try to help children along by
  • Asking them a question and offering multiple answers,
    Example, ‘Children can feel different things after an operation. Some children feel tired, or in pain, or feel sick. Have you felt any of these’
  • Help children explain their symptoms by using rating scales for them to indicate the severity of their symptoms such as pain, how sad they have been feeling, how much the condition has been stopping them from doing things this week etc.
  • Try to use multi-sensory methods of communication. This can often get important and complicated information across to children and parents in lees time. It can also facilitate memory after the consultation has ended and can reduce the anxiety usually associated with talking to adults. Use props, such as drawings, dolls, and models. Show children how to use inhalers etc. Use a dolls house with dolls to create a scenario and ask the children what the dolly should do in this situation.
  • To reduce the chance of misunderstanding usually resulting in the need for further appointments try checking the child’s understanding at intervals during the consultation.
    Example, ‘I’ve said a lot of things today and this is a lot to remember. Before we go any further could you tell me what you can remember already’

Key Messages

• Use the child’s age as a starting point to predicting their understanding.
• Offer children information they need in a way that will match their level of understanding. Be aware of the unfamiliarity of the consultation setting and children not used to questioning adults in authority.
• Constantly check children’s understanding during the consultation. Ask them to tell you aspects of what they have heard – or ask them to show you.
• Use real-life situations to explore aspects of their self-care and symptom control eg when “Neighbours” is on, in the schoolyard, after cleaning their teeth.
• As children grow older, check their understanding to avoid gaps developing.
• Meet with parents separate to the child to offer more detailed information to avoid anxieties developing in children through lack of understanding.
• Look to real-life problems for children – give them permission to air them and then problem-solve solutions. (eg inconvenience of medication)
• Try to balance offering information to increase personal control versus emotional ability to take this on – intellectually advanced children may not be emotionally able to take personal control.

Reading list

General Texts

• Toddler Training. A Parent’s Guide To The First Four Years. Dr Christopher Green. Vermilion London.
• Beyond Toddlerdam. Keeping Five to Twelve Year Olds On The Rails. Dr Christopher Green. Vermilion London.
• Child & Adolescent Psychiatry. Rutter Hersov: Blackwell Scientific Publications.
• Residential Care – Philip Barker.

Tools for Working With Children

• Draw On Your Own Emotions. Creative Ways To Explore, Express and Understand Important feelings -Margot Sunderland & Philip Engleheart Winslow.
• Creative Therapy. Activities With Children and Adolescents – Angela Hobday & Kate Oliver. ACER

Leaflets

• Action For Sick Children – Various leaflets written for children and parents with an emphasis on physical health. 300 Kingston Road, London – 0800 0744519
  Some leaflet titles include:
  • Helping children cope with pain
  • Helping children cope with needles
  • You and your GP
  • What to expect when your child goes into hospital
  • Going to outpatients
  • What to do in an emergency.
• Young Minds – Various leaflets written for children and parents with a focus on mental health. 102 – 108 Clerkenwell Road, London. -0171 3368445
  Some leaflet titles include:
  • In school stay cool
  • Bullying why it matters
  • Worried about a young person’s eating problems?
  • Do you ever feel depressed
  • Children and young people get depressed too.
• Mental Health Growing Up – 36 fact sheets for parents, teachers and young people covering the spectrum of child mental health.
• From The Royal College of Psychiatrists
  Fact sheets titles include:
  • The restless and excitable young child
  • Children who wet and soil themselves
  • Sleep problems in childhood and adolescence
  • Divorce and separation of parents – the impact on children and adolescents
  • Dealing with tantrums.