Status is granted by meeting the needs of the child and their parents.
So, what does the child and their parents require?
In the first place, we need to be seen.
When do we know that we are seen?
We are seen for sure, when the person who sees us callus by our name and knows our story.
How do I do that?
In practice, this is how it works for me:
- Immediately before the consultation, I familiarize myself with the main question of the appointment as described in the referral letter.
- I also memorize the child’s first name as well as the family name.
- Additionally, I make the effort to meet and greet the patient in the waiting area.
They came to the hospital to see me; therefore, I think, it is only fair, that I make the investment to meet them “half-way”.
I grant status by taking care of the (paediatric) patients and the parent’s needs.
What do they require?
The child and their parents are typically preoccupied with two different aspects:
- The child’s main question is : Will it hurt?
- The parent’s main question is: Will this encounter work? Will my child cooperate?
Granting status with body-language
I grant a status, when I meet my patient at eye level.
For adults that would be the normal way, but for any young children, I would need to adjust my height by crunching down.
When we apply the same principle for a ward round, it would mean to apply this principle while the patient is lying in the bed.
Therefore, we would need to sit beside the bed in a separate chair to meet the reclined patient at eye-level!
Granting status by calling them by name
Young children, between 2 and 12 years, react typically quite positively, when I call them by their first name. I also wave at them, especially from a distance.
Why do I need the waving?
The waving allows them, to check me out while they approach me.
I aim to show all non-verbal signs, I have available which any friend can display (open gestures, smile, or even continuous waving, crunching down). Doing this, I try to let them see that I am no threat, I maybe a stranger, but I am not dangerous.
Status is granted by meeting the needs of the child and their parents.
What is the effect of this approach?
In general, the child approaches me, after I called them. While they walk towards me, they can choose their pace. This makes the moment of meeting me less threatening.
For them to come towards me, I need to remain interesting. I typically achieve this, by maintaining my smile, I repeat their name until they make eye contact with me and stretch out my hand for a handshake.
What does this non-verbal communication say?
Every aspect of me (my voice, smile, and gestures) needs to transport the information that I am ”non-threatening” and “appealing”.
I aim for the child’s attention and talk directly to them. At this state, I almost ignore the parents.
In general, this approach is sufficient for most children, to come close enough for the greeting/ shaking of hands and for my explanation of the further steps.
What if the child stops at a distance?
Status is granted by meeting the needs of the child.
If a young child hesitates to approach me, I say out loud, that it is OK, to take their time.
When they try to hide behind a parental leg, I maintain my crunched position. I also confirm out loud, that it is OK, for them to check me out first.
Often, I turn the table on the hiding child, by briefly playing hide-and-seek around the parental’s legs. The aim here is to really emphasize the message that it is “OK” to not want to shake hands or to keep their distance.
I have noticed that frequently the child sighs, after I have spoken my words, and that their tension decreases at that moment.
What if the child remains afraid?
When I sense fear in the child’s movements, I typically tell them immediately, that I do not have needles and that nothing that I might need to do will hurt them.
Be aware, I can make this no-pain promise only, when I am certain, that I can follow it up.
By verbalizing their fear, of a painful encounter with me, I take care of their need for reassurance.
Regularly, even apprehensive children show a more open body-language after this information.
What about teenagers?
Teenagers are slightly different. They are emotionally in between identities.
They are not any more children and would hate to be approached childishly. On the other hand, they are not adults either.
My approach is typically to immediately admit that I am not as cool as they are. This admittance is easy because to a teenager I would be one of the irrelevant grown-ups along with their parents.
The result is often a smile by the teenager!
Furthermore, I persist in speaking with them, almost entirely ignoring their parental companion. This focus also emphasizes the role that they play in their own treatment relationship with me.
What about the parents?
The child as a patient is at this stage my partner for the verbal and non-verbal communication. For me, it is crucial to ignore the parents in the first place. The parents need to wait at this stage because I neither look at them nor speak with them until the connection with the child has been established. By doing so, I also take care of the parent’s first main worry (Will this work?).
The parents typically respond to the interaction with surprise and curiosity (easy gain!) but in general, they just wait for the situation to unfold. When they see that their child is gaining confidence in me and that the interaction is evolving well, they typically relax as well. Some parents even join the conversation by crunching down as well.
Before we leave the waiting area, of course, I greet the parents also by name and invite them into the consultation room. And by then the child is often happy to walk with me into the next room and the parent just follows.
In a nutshell:
Status is granted by meeting at eye-level, by name, and providing an explanation of what is about to happen.
Communication lives on comments … fancy to share yours?