Why I consider the “routine approach” wrong?

The traditional way causes confrontation.

Let’s have a closer look at how this confrontational experience in the child as well as in the parent is triggered.

Procedure of history taking

The traditional way causes confrontation.
Confrontation during history taking can be triggered by:

Ignoring the child
Leaving the child waiting, bored and without any directions or task.

As a result of this, the child will seek to end the boredom and will cause parental distraction out of the desperate need to get attention.

This will often raise the tension between parents and their child. This friction might even cause an open conflict. Here, the parent wants to have quiet and wants to listen, while the child does not know what to do.

Procedure of examination

The traditional way causes confrontation.
Confrontation during examination might be triggered by:

Handling the child as if they were passive objects.
Ignoring the child’s expression of fear, or defensiveness.
Ignoring the child’s need for explanation, especially in the pre-verbal age.
Responding to lack of cooperation of the child only with an increase of restraining.

The parent’s biggest fear is “Will it work?”, “Will the doctor be able to examine my child?”.

After a lengthy medical history, we feel the squeeze of our time retrains. Now, we just want to get over with the examination, with as much medical information as possible. Unfortunately, after we have bored the child, our chances for them to cooperate with us are very dim.
We have set ourselves up for failure.

This way of “being handled” in essence dehumanises the paediatric patient.
If anything, similar would be done to an adult (being immobilized, mouth forceful opened, being forced to gag), we would consider that torture. But children do “shout” non-verbally before they start crying.

Procedure of counselling/ prescribing

The traditional way causes confrontation.
Confrontation can occur when:

We ignore the medical concepts of parents.
We just tell them, what, we think, are the next steps.
The chance is high;
- That they will not take the medication at all
- They will not take it for the full duration
- They will not perform the exercises
- They will ignore the advice at home

This all happened, although the parent did not give any reply in the office.

Parents have their own ideas about the possible cause and necessary treatment. When their contribution is merely ignored, the chance that they subscribe to any treatment plan is diminished.

In the end, it is our treatment plan, not theirs.

What is the alternative?

A way to cooperation

Procedure of history taking

The traditional way causes confrontation.

Cooperation might be reached by:

Inviting the young patients to contribute:
- their view
- observations
- ideas on their problem.
Only when the child doesn’t want to talk or contribute, we could ask the child, if it is “OK” for them if we ask their parents instead.

When adults are talking, it is boring for children.
(Just remember how family meeting bored you, when you were about 4 years old, all this talking.)

To avoid boredom, the child should get a task, they can master. I have described examples of toys I am using regularly in this post.

Procedure of examination

The traditional way causes confrontation.

Cooperation can be achieved when:

We keep the anxiety level of the child as low as possible, from the moment that they enter the room
The child is encouraged to approach the doctor and to climb the examination chair by itself.
We introduce any instrument first via the hands of the child. This gives the child control over their body.
By feeling the instrument with the hand, the child “gets a grip” on the situation.
If we show the examination on a monitor, the child can observe the process.
This way, the layout of the examination can contribute to a successful examination.

Generally, we first announce every step and then perform it. The reason for this approach is, that the child gets certainty during the whole process.

Last not least the praises!

For the child, it is very important to be praised for every small contribution it makes on the way.
By this way, the child again experiences some control over the things that are happening to itself.

Procedure of counselling/ prescribing

The traditional way causes confrontation.

A base of trust and respect is inevitable for good cooperation between all parties involved in the consultation.

In the previous posts, the practical steps have been described how to achieve this.
During the consultation, the concerns of the parent and the child should be verbalized and considered while the proposition for the treatment plan is made.