Communication with Children and Families

Question 1

What is done to make a good introduction with children?

Answer 1

• Be friendly and smile
• Acknowledge child early on
• Get down on their level
• Utilise play
• Ask about child’s agenda
• Reflect on your own agenda

Question 2

What is done in a good examination of infants?

Answer 2

• Consider your facial expressions
• Child well positioned and comfortable
• Use of toys/distraction
• Maintains dialogue throughout
• Respond to child’s actions (smiles/eye contact)
• Describes normality
• Utilises parental skill of distracting child
• Reflects consideration of child and parents agenda

Question 3

What is done in a bad examination of infants?

Answer 3

• Examined on bed away from parent
• No interaction with child
• No use of toys
• Use of medical jargon
• Description potentially perceived as pathology
• Unrealistic expectation
• Reflects focus on own agenda
• Persistence despite distress

Question 4

What is done in a good examination of toddlers?

Answer 4

• Well positioned on parents knee (accepts suboptimal to avoid distress)
• Utilises play (illustration and distraction)
• Maintains dialogue throughout (always observing)
• Gradual exposure (listens through clothing)
• Eye contact (listens to back, positioned at front)
• Changes order depending on child (auscultation, palpation, percussion)
• Stops when child upset, settles, and resume

Question 5

What is ineffective communication?

Answer 5

• Parents perspective
  
  • Doctor focused on their own agenda
  • Illness trivialised (“just a cold”) – make perents feel guilty
  • Hospital agenda placed above child’s own needs
  • Questions and increasing concerns dismissed
  • Unsure about next steps are ineffective closure
• Doctors perspective
  
  • Doctor busy and has other tasks to do
  • Night shift compromises cognitive processes
  • Wants to prevent illness admissions
  • Recognises the needs of other unwell patients

Question 6

What is effective communication?

Answer 6

• Patients perspective
  
  • Doctor acknowledges challenges/stress of hospital admission
  • Allows parent to speak and finish point made
  • Concern acknowledged
  • Aware of recurrence and sibling risk
  • Big worries (meningitis/epilepsy) addressed without needing to ask
  • Hears key information (no harm) several times
  • Clearly explanation of next steps
  • Given opportunity for further questions
• Doctors perspective
  
  • Shows insight into parenteral perspective
  • Seeks to clarify the parental understanding
  • Clearly describes condition acknowledging understandable concern
  • Addresses recurrence/sibling risk but emphasises key negatives
  • Proactively anticipates concern (meningitis/epilepsy)
  • Focuses on markers of health
  • Explains the role/lack of role of investigations
  • Clearly describes next steps
  • Repeats key information
  • Provides opportunity for questions