Allow the child to approach the unknown to get engagement started.
I really can’t overemphasize how important the first seconds of the consultation are!
I have written at length about this in a previous post.
During this time, the child decides whether to engage with me or not.
Where and how engagement starts
As I have indicated before, I prefer to start any consultation in the waiting area.
Here I call out the family name, and immediately afterwards I call the first name of the child and repeat the family name again.
While I do this, I scan the room for any adult’s reaction to my call.
The next thing that happens is that the parent looks for the child, and I can by following their gaze identify my patient.
Making the first contact
As a sender of the message, the next thing I do is to call the child’s given name and to frantically to wave at them.
This is a “child’s – way” of showing “I am friendly”.
Here, verbal and non-verbal communication come together to show, that
- I am not a threat
- I seem to behave odd
- (worse even?) I seem to behave like a child
During COVID, I even used the face mask to my advantage, as shown in the picture here.
How do they respond?
The interaction starts with the first response of the child to my friendly non-verbal signals.
Therefore, I put significant effort into nudging the tone of the encounter towards friendliness and cooperation. This is in the direction I want the whole meeting to go. Despite my effort, I am not controlling the answer of the patient. The choice is theirs!
To allow the child to approach the unknown, gives the agency about their feelings and offers the chance for cooperation.
When they decide to trust me
I always feel privileged when a child decides to trust me.
They show it, by walking towards me.
Allowing them an active role during this moment of approach, they can decide how fast they come. This allows them the time to check me out first.
They can also decide, how close to me, they dare to come in the first place. This grants them the personal space they need. This gives them some sense of control over the whole situation and by doing so, they remain relaxed and open.
How do I “lure” them closer?
My next move would be, to invite them as close as I need them. I do that, for example, by commenting on their outfit. An example would be: “Wow, you have dinosaurs on your shirt? May I have a closer look?”
Here as well, I allow the child to approach the unknown, but I try to become less “unknown” and more “friend” to them.
Anything that puts the child in a position of “power” and me in a position of “need” helps to gain their trust.
And last not least, I offer them to shake my hand.
About 80% of the children will take that chance.
By doing so, I demystify myself and make myself approachable.
What if they don’t want to shake hands?
In case that the child does not want to shake hands, I will accept their refusal.
I typically say: “Oh, you don’t want to shake my hand? That is fine!”
Often the more anxious children respond very well when I accept their boundary like this.
They now know that they have a say and that their voice is heard.
By doing so, I grant the child a status in our meeting.
Trigger curiosity
At that moment, I will try to trigger more curiosity, by saying “I have something cool I need to show you.”
Here I pause, to build up suspense!
“I have a telly where you can see your ear, how cool is that?”
Even when the child has been reluctant to engage with me up to now, with this passing minutes, they have calmed down.
They had a chance to look at me, and they had an option to think about my proposal of “ear-television”.
They remain calm when they know what to expect.
My final statement during this greeting is: “Shall we go and have a look?” and, “Are you doing a high-five with me?”
At this stage, 99% of the children accept the high-five and are willing to come with me into my examination room.
By allowing them to approach me at their own pace, I give them the space that they needed, and they pay me back with trust and cooperation.
How to deal with fear
Sometimes the child does not come along and appears to be frightened about the situation, even with my emphasized “friendliness”.
In this case, I would need to identify what might be the cause for fear at that moment.
The most frequent causes are:
- Fear of pain
- Fear of loss of control in this uncommon situation
In the first instance, they are thinking typically about a vaccination or similar unpleasant experience with previous health care providers.
I counter that by saying, “I don’t have needles and I will not give you any jab!”
By verbalizing this fear of pain or specifically vaccinations, I noted that the tension in my (paediatric) patients melts away.
I need to assure the child that nothing I might do will cause any pain (and I would need to stick to my promise!).
In the second instance, it often helps, when I tell the child, that I will tell them step by step, everything that is going to happen.
I emphasize, that we are in this together as a team.
With this sentence, I hand over some predictability about the next minutes to the (paediatric) patient, and I grant certainty.
In general, I “seal” these agreements with a “high-five”.
In a nutshell:
To allow the child to approach the unknown, allows them control over the encounter and reduces fear!
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