Fair support is not equal support.
Everybody needs personalised support.
The amount of support that is needed depends on:
- age (toddler, child, teenager, parent)
- physical ability (limited mobility, visual or auditive impairment)
- intellectual capacity (imbalance in the IQ, described previously)
- language skill (English as foreign language, limited vocabulary)
- need for safety (anxiety, emotional imbalance)
Fair support is not equal support
I would need to customize the specific support for either the examination and explanation every time, due to the different personalities, and differently for a toddler compared to a teenager.
Fairness related to age
Fair support is not equal support.
One example of this individualized approach is that I try to get even any 18-month-old child to climb on the examination chair by themselves.
Why?
My goal is that when the child climbs the examination chair by themselves, this is the approach to a new environment, that is least threatening. They explore my examination chair for themselves without being pushed or passively placed.
In practical terms, the chair needs to be accessible for the child. In this case, I provide a step or stairs for the child to make the climb possible.
Fairness related to physical ability
Fair support is not equal support.
- When the child uses a wheel-chair, I would need to assess, whether they allow me to examine them in their chair.
Alternatively, I ask them (and their parents) if they prefer that I do the examination on my examination chair. - When someone can’t hear me, I would need bold gestures, to explain what is going to happen.
- If my patient can’t see me, I would need to verbally explain every time I am about to touch them, just to warn them.
Fairness related to intellectual capacity
Fair support is not equal support.
This frequently means that I need to adjust my wording to the capacity of the child and their parents.
Here the rule applies, that communication is always judged by the recipient, never by the sender!
Fairness related to language skill
Not everybody I see in my clinic speaks English as first language. Frequently, the parents are not speaking English fluently enough for a detailed conversation.
Neither do I “speak” British Sign Language (BSL). Whenever the language is a barrier for communication, we would need to address it. For example, by using an interpreter, either in person or via a telephone interpreter. This would often require more time in the clinic.
But, fair support is not equal support.
Fairness related to the need for safety (emotional imbalance)
The fearful child is closed towards communication. They are not interested in cooperating with me.
I have previously written, on another blog, what the purpose of fear is.
Fairness towards the child and the role of parents
Fair support is not equal support.
The parent is definitely a critical contributor to the success or failure of the treatment relationship with the child.
When I approach the child first, I let the parent wait in the initial phase of the encounter.
By this way:
- they can check me out
- they see, if I care about their biggest fear: whether the child will cooperate with me, or not
With this pause for them, I also give them a chance to catch their breath. They get time to calm down. This allows them afterwards to focus optimally on our conversation.
This approach deals with their needs “already”.
Fairness encountering autistic children
A special group are children with severe autism: per definition, these children struggle to connect and to interact with a stranger.
In this case, the parent is the interpreter of the child.
They are the expert on their child, and so my interaction would involve them more actively from the start than usual.
Fair support here is evidently not equal support.
In these circumstances, I acknowledge the parent (mostly the mother) as an expert on this specific child.
The parent knows best how to interpret the behaviour of their son or daughter. For an optimal treatment relationship, it is crucial to establish a levelled field between me as the medical expert and the parent as the individual child’s expert.
In these situations, I ask for and listen to their suggestions on how to interact with my patient. They know best how I can communicate the above-mentioned steps of status, certainty, autonomy, relatedness, and the fairness in a way that this child can benefit from the approach.
Just one trick: I have noted, that although non-verbal autistic children do not shake hands, they frequently giggle, when I start to shake their feet, without forcing eye-contact!
In a nutshell:
Fair support is not equal support.
We grant fairness, by providing the level of support that the individual child needs.
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