comm trouble in paediatrics

[johnny_blaze]

Hey guys

I’m currently on my paediatrics rotation at the moment and I’ve found that I’m having a bit of trouble with it. Most of it has to do with communication. I find it really difficult to take histories from children, I find myself just ignoring them and speaking to the parents. I get really frustrated because I cant seem to get the information I want from the child even though I’m using easy to understand language (ie. Non-medical terms). I feel like I cant seem to connect with kids... I guess I’m too used to speaking to adults.

I have no problem with babies obviously because they cant speak… I speak to the parents while they just lay there being cute

Does anyone else have a problem like this… or am I just hopeless with kids??

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[fourthyearmed]

I'm going into Peds. What I usually do if it's a school age child depends on how talkative the kid is. Some like to tell me themselves but usually they don't or they get details wrong (some just make stuff up randomly or answer yes to everything!) so I just let the parent do most of the history. Then when I get to the physical I ask the kid more questions in simpler terms while examining them and get them to point to where it hurts and describe the pain (like someone's stabbing you, punching you, etc.) You're not going to get the whole history from a kid so don't feel bad talking to the parents too. Make it a group effort!

 

[Febrifuge]

S/O: Difficulty feeling comfortable with and relating to kids.
A/P: Poss lack of understanding and common ground. Recommend Cartoon Network PRN, up to 2 hrs/day x 1wk. Check back to thread for f/u.

 

[k's mom]

A few tips from a medical-savvy mom who has seen the good and the bad at the pediatricians office:
1. You may think you are using kid-friendly language, but you most likely aren't. In fact, I will bet that the words you use aren't even adult-friendly. My husband has five years of parenting experience and he still falls back into "textbook" talk when chatting with our son.
2. how do you enter the room? If your attending isn't teaching you this stuff, listen up....say hello to the child first WITHOUT approaching them, then greet the parent. Sit down on a rolling chair BEFORE approaching the child and try to converse with the parent (helps the child understand that you have a "relationship" with the parent). ASK if you can take a look/listen/whatever to the child BEFORE scooting over to them.
3. I LOVE what my kids' pediatrician says to his medical students..NEVER do anything that hurts TWICE. If you don't get what you need the first try, let it go.
4. Practice your Donald Duck voice.
5. Carry bubbles in your pocket for young kids.
6. DO NOT EVER undress or pick-up a child yourself, even if the parent says it is okay.
7. If the child is school-aged, don't talk about them to their parents as if they aren't in the room...you will lose any and all credibility, because, unfortunately, most adults do this to them.
8. Work on learning to do portions of your physical exam with the child in the parent's lap...your attending SHOULD be teaching you how to do this!!!! If your attending treats the children like little adults, spend some time watching the nurses.
Good luck!

 

[edmadison]

A few tips from a medical-savvy mom who has seen the good and the bad at the pediatricians office:
1. You may think you are using kid-friendly language, but you most likely aren't. In fact, I will bet that the words you use aren't even adult-friendly. My husband has five years of parenting experience and he still falls back into "textbook" talk when chatting with our son.
2. how do you enter the room? If your attending isn't teaching you this stuff, listen up....say hello to the child first WITHOUT approaching them, then greet the parent. Sit down on a rolling chair BEFORE approaching the child and try to converse with the parent (helps the child understand that you have a "relationship" with the parent). ASK if you can take a look/listen/whatever to the child BEFORE scooting over to them.
3. I LOVE what my kids' pediatrician says to his medical students..NEVER do anything that hurts TWICE. If you don't get what you need the first try, let it go.
4. Practice your Donald Duck voice.
5. Carry bubbles in your pocket for young kids.
6. DO NOT EVER undress or pick-up a child yourself, even if the parent says it is okay.
7. If the child is school-aged, don't talk about them to their parents as if they aren't in the room...you will lose any and all credibility, because, unfortunately, most adults do this to them.
8. Work on learning to do portions of your physical exam with the child in the parent's lap...your attending SHOULD be teaching you how to do this!!!! If your attending treats the children like little adults, spend some time watching the nurses.
Good luck!

Wait, I thought children were just little adults.

Seriously, I agree with this advice. You really have to ask simple questions. "Does it hurt deep inside or on the top?", "does it hurt all of the time, or some of the time?". Also, its important to remember the childs developement when interviewing them. Almost all three year-olds with endorse whatever you say, so you have to be care not to say, "Does it hurt here?" Try not to ask them yes/no questions -- make them make a choice. I like to test whether they will endorse by asking them a silly question, such as, "Is your name Bob?". When they say yes (and it isn't), I've got an important piece of information, plus the parents usually think its funny.

When doing the exam on pre-schoolers, I usually ask them what I'm suppose to do? If they don't answer, maybe I put the bell of my stethoscope on their head. It usually helps to break the ice. One other tip. Don't be rigid on the order of your physical. Do the easy non-invasive stuff first and work your way from their. For Pete's sake don't start by looking in their ears.

Ed

 

[Apollyon]

6. DO NOT EVER undress or pick-up a child yourself, even if the parent says it is okay.

Huh? This is an integral part of my exam (picking the child up), when I'm in the Peds ED. If the child is ~3 or under, I see if they have appropriate stranger anxiety (yes is a good sign - if they don't, that makes me think more sick than not sick). Moreover, in a child under 1, I can evaluate a lot of neuromuscular function. It's part of my gestalt.

Also, I keep saying that adults are simply large children.

 

[fang]

A few tips from a medical-savvy mom who has seen the good and the bad at the pediatricians office:
1. You may think you are using kid-friendly language, but you most likely aren't. In fact, I will bet that the words you use aren't even adult-friendly. My husband has five years of parenting experience and he still falls back into "textbook" talk when chatting with our son.
2. how do you enter the room? If your attending isn't teaching you this stuff, listen up....say hello to the child first WITHOUT approaching them, then greet the parent. Sit down on a rolling chair BEFORE approaching the child and try to converse with the parent (helps the child understand that you have a "relationship" with the parent). ASK if you can take a look/listen/whatever to the child BEFORE scooting over to them.
3. I LOVE what my kids' pediatrician says to his medical students..NEVER do anything that hurts TWICE. If you don't get what you need the first try, let it go.
4. Practice your Donald Duck voice.
5. Carry bubbles in your pocket for young kids.
6. DO NOT EVER undress or pick-up a child yourself, even if the parent says it is okay.
7. If the child is school-aged, don't talk about them to their parents as if they aren't in the room...you will lose any and all credibility, because, unfortunately, most adults do this to them.
8. Work on learning to do portions of your physical exam with the child in the parent's lap...your attending SHOULD be teaching you how to do this!!!! If your attending treats the children like little adults, spend some time watching the nurses.
Good luck!

Those are great tips about the body language. But I don't agree about doing something 2x... if you don't get what you need the 1st time and it's really important, don't you sort of have to do it again?? I guess I'd rather have the patient (and maybe their parents) think I'm mean rather than miss something.

 

[phoenixsupra]

A few tips from a medical-savvy mom who has seen the good and the bad at the pediatricians office:
1. You may think you are using kid-friendly language, but you most likely aren't. In fact, I will bet that the words you use aren't even adult-friendly. My husband has five years of parenting experience and he still falls back into "textbook" talk when chatting with our son.
2. how do you enter the room? If your attending isn't teaching you this stuff, listen up....say hello to the child first WITHOUT approaching them, then greet the parent. Sit down on a rolling chair BEFORE approaching the child and try to converse with the parent (helps the child understand that you have a "relationship" with the parent). ASK if you can take a look/listen/whatever to the child BEFORE scooting over to them.
3. I LOVE what my kids' pediatrician says to his medical students..NEVER do anything that hurts TWICE. If you don't get what you need the first try, let it go.
4. Practice your Donald Duck voice.
5. Carry bubbles in your pocket for young kids.
6. DO NOT EVER undress or pick-up a child yourself, even if the parent says it is okay.
7. If the child is school-aged, don't talk about them to their parents as if they aren't in the room...you will lose any and all credibility, because, unfortunately, most adults do this to them.
8. Work on learning to do portions of your physical exam with the child in the parent's lap...your attending SHOULD be teaching you how to do this!!!! If your attending treats the children like little adults, spend some time watching the nurses.
Good luck!

Oh no. Peds is up next for me. This is going to be difficult isn't it. Thanks for the advice. I don't have an overbearing style and kids generally like me. Will I be ok? Is there really a bunch of formula's for this or do kids like some people and not others?

Also, can anyone give me a list of "rules" like that one for dealing with peds docs. They're a little strange to me. I'd appreciate any pointers. Thanks.

 

[k's mom]

Huh? This is an integral part of my exam (picking the child up), when I'm in the Peds ED. If the child is ~3 or under, I see if they have appropriate stranger anxiety (yes is a good sign - if they don't, that makes me think more sick than not sick). Moreover, in a child under 1, I can evaluate a lot of neuromuscular function. It's part of my gestalt.

Also, I keep saying that adults are simply large children.

The original post asked about communicating with children in the clinic setting, which I took to mean well-child appointments, et. al.. You may get appropriate/timely information in the ED from this approach, but it is a guaranteed way to UP the child's level of stress and anxiety, not decrease it, which makes communicating more difficult. But, true...if they are REALLY sick, they couldn't care less about strangers picking them up. That really makes sense for distinguishing the listless from the "fakers". I like it!

 

[k's mom]

Oh no. Peds is up next for me. This is going to be difficult isn't it. Thanks for the advice. I don't have an overbearing style and kids generally like me. Will I be ok? Is there really a bunch of formula's for this or do kids like some people and not others?

Relax...kids can smell fear

You're right, kids like some people more than others, but there is also a fine line between being goofy (4 year olds generally love) and looking like an idiot (the "goofy" routine with most 8-year olds) Complex little beasts.
I obviously can't speak from a medical provider's standpoint, so please don't look at anything I say as a "formula". I simply listed things that have been done in the peds office that either worked or backfired miserably. It is so insanely obvious that 3rd years on clerkships...my husband is one of these, so no harm meant...are stressed about getting everything done correctly FOR THE ATTENDING, and presenting correctly, FOR THE ATTENDING. They are so focused on the DOCTORS and PAPERWORK that they don't seem to have the time/free brain cells to observe how the child reacts to the environment...things that aren't going to be on the shelf exam!
All I can suggest is to remember that your intern and attendings with have a lot more experience with children, and you shouldn't "force" anything. If blowing bubbles isn't up your alley, for goodness sake, don't do it...you've got enough on your plate

 

[k's mom]

Those are great tips about the body language. But I don't agree about doing something 2x... if you don't get what you need the 1st time and it's really important, don't you sort of have to do it again?? I guess I'd rather have the patient (and maybe their parents) think I'm mean rather than miss something.

This obviously only works because the attending/dept. chair TELLS the students to follow this advice. Won't work otherwise, unless you don't care about evaluations, I guess! Knowing the pediatrician, this is to help keep the level of stress in the examination room (parent/child/student) low. It also only refers to things that HURT or make the child scream. If it is vital/has to be done, but the child is hysterical, he makes it wait until as late in the visit as possible.

This is GOLDEN advice from edmadison:
"One other tip. Don't be rigid on the order of your physical. Do the easy non-invasive stuff first and work your way from their. For Pete's sake don't start by looking in their ears."

 

[phoenixsupra]

Relax...kids can smell fear

You're right, kids like some people more than others, but there is also a fine line between being goofy (4 year olds generally love) and looking like an idiot (the "goofy" routine with most 8-year olds) Complex little beasts.
I obviously can't speak from a medical provider's standpoint, so please don't look at anything I say as a "formula". I simply listed things that have been done in the peds office that either worked or backfired miserably. It is so insanely obvious that 3rd years on clerkships...my husband is one of these, so no harm meant...are stressed about getting everything done correctly FOR THE ATTENDING, and presenting correctly, FOR THE ATTENDING. They are so focused on the DOCTORS and PAPERWORK that they don't seem to have the time/free brain cells to observe how the child reacts to the environment...things that aren't going to be on the shelf exam!
All I can suggest is to remember that your intern and attendings with have a lot more experience with children, and you shouldn't "force" anything. If blowing bubbles isn't up your alley, for goodness sake, don't do it...you've got enough on your plate

Thanks. That's very helpful.