facilitate the building of trust and rapport. To start, get down to the child’s eye level, to listen to and validate concerns from the child and their family, and to maintain an aura of reassurance and positivity. Ameliorating the concerns of a child’s parent or guardian can not only improve the satisfaction and level of distress of the family, but also demonstrate to the child that you can be trusted. While speaking to the child directly, continue the work of building trust and rapport by taking an active interest in the child in a developmentally appropriate manner. Asking your patient about any recreational objects they have brought with them is an excellent first step. Questions and compliments regarding a book, game, toy, or character on a child’s clothing can go a long way toward demonstrating to the patient that you are not a threat and help to encourage them to speak freely once questioned about their pertinent medical issues.
to carefully assess the child’s reaction and adapt as necessary. In summary, the goal of building trust and rapport is not only to help you to gather pertinent medical information, but also to soothe your patient and assuage the anxiety of them and their family. Small, often overlooked things such as colorful scrub caps, entertainment like coloring books or movies when available, and colorful surroundings can be the difference between a simple hospital stay without complication, and an experience which may leave a child with a lifetime of trauma. Though simple, these actions may shift the experience from a nightmare to nothing more than a mundane trip to the doctor’s office. Using Age-Appropriate Communication When speaking to pediatric patients, it is important that the physician tailor the language, tone, and content of the conversation to the child’s age, cognitive ability, and developmental stage. Keep it simple. Though older patients may desire a more comprehensive understanding of their medical care, most young children have a fundamental trust of authority, and a profound lack of critical and abstract thinking abilities. Thus, refraining from overexplaining, and using a simple rationale is often more valuable than delving into technical details. As mentioned previously, maintaining outward positivity is key to a successful pediatric encounter. As such, try to frame instructions or redirection in a positive way. Phrases such as “No thank you, let’s do this instead”, “Nice try, let’s try to do even better next time!”, “Inside voice please”, or “Let’s make sure we have our listening ears on” will not only help to ease the child’s fears of rejection and the unfamiliar, but assist in making for a positive, productive encounter with high patient and family satisfaction. Along the same line, rephrasing instructions to transform commands into games will help to bring a bit of fun into an otherwise frightening experience. Instead of asking a child to “please stand still”, try saying “Let’s see if you can pretend to be a statue!” or “Now we need to stand so still that a T. rex can’t see us!”. Children are constantly trying to prove their individual competency to their peers and authority figures.
Thus, by providing pediatric patients with an opportunity to demonstrate their capabilities, no matter how mundane, the children’s motivation to participate in your exam will become tied to their intrinsic desire to demonstrate competence. As children inherently seek to exert and demonstrate control over their own lives, providing them with choices is a simple way to increase compliance. However, if presented with an open-ended question, a child may give an answer which is not feasible or appropriate. For instance, if you ask a child which kind of juice they would like to take their medication with, an answer of “kumquat” will leave the physician with no choice but to rephrase the question and disappoint the child. Instead, giving the child a finite number of choices such as “would you like apple juice or orange juice?” will allow them to still feel as though they are making decisions for themselves while subtly confining their expectations and allowing the encounter to progress. Providing Clear and Consistent Information Providing clear and consistent information is vital to ensuring that pediatric patients and their families understand the information and instructions being presented to them. Physicians should always try to use plain language, avoid medical jargon, repeat and summarize important information, and confirm the patient’s understanding. The utilization of the “teach back” method when appropriate, where the individual being addressed is asked to repeat their understanding of the physician’s statements in their own words is a valuable tool in confirming and solidifying the understanding of patients and their families. As a final point, when caring for children with autism, it is imperative that you be direct and avoid idioms, metaphors, or other turns of phrase which may not be properly understood by neurodivergent individuals. Using Nonverbal Communication Nonverbal communication, such as facial expressions, tone of voice, and body language, can convey emotions and reinforce the message being presented. Healthcare providers should
Developing trust and rapport with children is crucial for facilitating the administration of anesthesia, particularly during the induction of general anesthesia.
use nonverbal cues to convey empathy, respect, and reassurance to the child and their family. As previously stated, maintaining a positive demeanor, a cheery affect, and a calm sense of confidence is a valuable method of placing patients and their families at ease. Despite any feelings of anxiety or apprehension which you may feel in regard to a patient or procedure, it is imperative that a physician appears confident and competent. While keeping trauma-informed care in mind, a simple act of physical contact such as lightly touching the child’s shoulder or holding their hand can make a world of difference when comforting a frightened child. When confronted with an overtly frightened child, removing your white coat if you are wearing one, allowing a trusted family member to comfort the child, and physically giving the child space and a chance to calm down can assist in preventing both trauma and perioperative delays. In addition, modeling behaviors or actions which you would like the child to repeat is often an effective way of maintaining efficiency and cooperation in a patient encounter. When available and appropriate, the use of visual aids such as pictures, diagrams, symbols, or letter boards may be extremely valuable tools of communication, especially when caring for patients with limited or difficult communication.
Playfully introducing a child to the anesthesia face mask may allay their apprehension.
Lastly, do not take yourself too seriously when speaking to pediatric patients. The same attributes which make you qualified to provide excellent medical care are also often sources of distrust and apprehension. As such, playing games, being engaging and bubbly, and overall allowing yourself to act a bit silly will not only help you to connect to a frightened child, but allow you to gather crucial medical information more efficiently. While being engaging can help to build rapport with most children, it is important
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COMMUNICATION TECHNIQUES FOR PEDIATRIC PATIENTS 59
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