Need advice on kids

[Joseph Ransohof]

So far, my interactions with kids have not been positive. My Peds rotations in a few months. I need tricks anyone uses to deal with the pediatric population. I have not interacted with alot of pediatrics in my life. Yes . I know. It is odd but it happens. Give me some pearls or tricks to deal with the little ones. Do not be shy, PM me advice even if you have to.

---

Members don't see this ad.

 

[umass rower]

A few quick tips for working with kids (especially the toddler & school age kids, where non-pediatric-minded people seem to struggle most):
1. Put yourself at their eye level as much as possible. Most kids are at least a little afraid of the doctor, and looming over them by 2-3 feet is not going to assuage that fear. You can squat, kneel, or sit, depending on the situation.
2. Talk directly to the kids, using age-appropriate vocabulary. Kids don't like being ignored, and appreciate being included in their own care to some extent.
3. Discuss something non-medical to open. Comment on their shoes, or their name, or their hairstyle. For school-age kids in clinic, you can simply ask them about their day.
4. If your institution allows it, ditch the white coat. Seriously, I finish residency in a few months, and my long white coats are still sitting in plastic in a closet. I've never worn them. You, too, will survive.
5. For some toddlers, it helps to demonstrate exam techniques on parents or yourself to make them feel less invasive. Sometimes for the really young ones it's enough to hand them the working end of your stethoscope so they realize it's not going to hurt them. For a 3 or 4 year old, enlist them to help put the diaphragm in the right spots.
6. Accept that no matter how good you are with kids, you can't win them all. I usually do pretty well, but on a busy day in clinic I usually have at least one child that bursts into tears the moment we make eye contact.

 

[Joseph Ransohof]

A few quick tips for working with kids (especially the toddler & school age kids, where non-pediatric-minded people seem to struggle most):
1. Put yourself at their eye level as much as possible. Most kids are at least a little afraid of the doctor, and looming over them by 2-3 feet is not going to assuage that fear. You can squat, kneel, or sit, depending on the situation.
2. Talk directly to the kids, using age-appropriate vocabulary. Kids don't like being ignored, and appreciate being included in their own care to some extent.
3. Discuss something non-medical to open. Comment on their shoes, or their name, or their hairstyle. For school-age kids in clinic, you can simply ask them about their day.
4. If your institution allows it, ditch the white coat. Seriously, I finish residency in a few months, and my long white coats are still sitting in plastic in a closet. I've never worn them. You, too, will survive.
5. For some toddlers, it helps to demonstrate exam techniques on parents or yourself to make them feel less invasive. Sometimes for the really young ones it's enough to hand them the working end of your stethoscope so they realize it's not going to hurt them. For a 3 or 4 year old, enlist them to help put the diaphragm in the right spots.
6. Accept that no matter how good you are with kids, you can't win them all. I usually do pretty well, but on a busy day in clinic I usually have at least one child that bursts into tears the moment we make eye contact.

Thank you umass rower,
I honestly do not understand kids. Your pearls will help me alot . If you or anyone else anything to add go ahead. People are more than welcomed to add more pearls and insight into the ped population. Learn how to deal with peds and obgyn. I will take all my peds advice from here and then move over to the obgyn residents blog for obgyn advice. Thank you umass rower.

 

[McGillGrad]

Excellent advice above, but I'll add this...

You are not dealing directly with the kids most of the time. They are not reliable reporters, even as adolescents, and the most useful information that is gleaned from children is their vitals and general appearance. You will be talking to the guardians most of the time so I would not worry too much about being less-than-patch-adams when it comes to children.

 

[J-Rad]

Just try your best to relax. I would addend UMassRower's # 2 to say: realize that there are some ages at which there is normal stranger anxiety; sort of 6ish-18ish months. With this group you may find ignoring them to be beneficial early in the encounter. The quicker you go after them, the more they are likely to react negatively. Also, the more you can do your exam in the parent's lap, the better. While it isn't the textbook PE, you're often going to get more than you would with them flailing and crying on the table. And then just go back to #6. This group will have the highest proportion of the one's you just can't do anything right (in their eyes) with.

I also disagree with McGill. Many children, down to about age 6-7 can be excellent contributors to the HPI. There are times when their story will be more important, or of at least equal importance, to the parental history. As a cardiologist I infrequently find the parental history of chest pain or palpitations to be the most important piece of data (and, frequently, I'm really getting the parental history of anxiety over the complaint). Most average intelligence teenagers are perfectly good historians, though you may have to work a little harder to establish the rapport to get the info. It may also be appropriate to get the parent(s) out of the room. Discuss with your preceptor how to do that and if they want you engaging in those particular encounters.

 

[Sweet Tea]

I agree with UMass and J-Rad. Sadly, there's no "one true way to make all children offer their ears for inspection". Kids are moving targets, which is why many of us are drawn to pediatrics. Let the kids guide you; if they're hiding on mom's lap, they probably don't want an in-your-face-clown approach. If they run up to you to show you their toys, meet their energy level. Older kids, say, 9 and up, and especially teenagers will appreciate you starting the interview with them instead of asking mom what the issue is. You can build a lot of trust in older kids just by showing that you value their opinion.

The one piece of advice I have for all age groups is to try to be as relaxed as possible. If they pick up that you're nervous or scared (and they will pick it up), it will only make it that much more difficult.