Communication and Health Assessment of the Child and Family

1. Communication and Health Assessment of the Child and Family Chapter 6

2. Principles of Communication • Make communication developmentally appropriate • Rely on nonverbal behavior more than verbal • Get on child’s eye level but avoid staring at child • Approach child gently/quietly. Give them time to warm up to you. Use transition objects or play techniques. • Always be truthful • Give child choices as appropriate

3. Involve Child in Communication

4. Principles of Communication (cont’d) • Avoid analogies and metaphors • Give instructions clearly • Give instructions in positive manner • Avoid long sentences, medical jargon, colloquialisms; think about “scary words” See handout on choosing language. • Allow younger children to be close to parent • Give older child opportunity to talk without parents present

5. Principles of Communication cont’d • Allow children to express feelings and fears • Offer praise, encouragement, and rewards • Use a variety of communication techniques—see pp. 115-116. • Be culturally sensitive—see p. 109

6. Developmentally Appropriate Communication • Infants • Non-verbal • Crying as communication • Pick up adults non-verbal behaviors • If under 6 months, will usually respond to anyone. • If over 6 months, stranger anxiety exists

7. Developmentally Appropriate Communication • Early childhood • Focus on CHILD in your communication • Need “warm-up” time. May be uncooperative • Use words he will recognize; use short, familiar, and concrete terms • Be consistent: don’t smile when doing painful things • Allow child to handle most equipment • Keep fearful equipment out of sight until it is needed.

8. Developmentally Appropriate Communication (cont’d) • School-age years • High level of curiosity; likes to help • Give explanations and reasons • Explain how things work; allow handling of most equipment • Allow to express feelings • Respect privacy • Generally behave well and communicate effectively

9. Developmentally Appropriate Communication (cont’d) • Adolescent • Be honest with them • Aware of privacy needs • Think about developmental regression • Importance of peers • Listen to them and respect their views • Avoid judging or criticizing; tolerate differences • Pick your battles • Avoid the third degree

10. Play • Children’s “work” • Child’s “developmental workshop” • As therapeutic intervention • As stress reliever for child/family • As pain reliever/distracter • As barometer of illness

11. Therapeutic Art

12. Therapeutic Art • One of the most valuable forms of communication • Can tell about child’s situation both from seeing what he draws and what he says about it. Remember to take into account other information about family. • Important points: first figure, size of figures, order, position, exclusion, accentuated parts, absence of parts, size and place of drawing, stroke type, erasures, cross-hatching (p. 116)

13. Communicating with Parents

14. Communicating with Parents • Most information comes from them • If parent sees a problem, pay attention • Listen actively; listen for information directed “over the child’s head.” • Try to be a facilitator in arriving at a solution to the problem rather than always giving your ideas • Remember to use open-ended questions that start with “what” “how” “tell me about”

15. The Health History • Pediatric health history has similar and different components from adult history (p. 117 and 119) • If pain is part of chief complaint, see p. 116 • Complete family assessments are indicated in the following instances: • Comprehensive checkups • Developmental delays • Child abuse/behavioral or emotional probs • Children with stressful events and major life changes • New home care patients

16. The Health History (cont’d) • Family Assessments gather information about: • Family composition • Home environment • Occupation and education of members • Cultural and religious elements • Family interactions including who makes decisions, how members communicate, how they solve problems, disciplinary methods, and support for each other

17. The Health History (cont’d) • Nutritional Assessment • Especially important for patients with evidence of nutritional problems (p. 128-129) • Dietary recalls are frequently unreliable • Most common is 24h but is only useful if day is typical; 3 day diaries are more helpful • May also use specific history questions as seen on p. 126 or a food frequency record on p. 127. • Other methods for assessing nutritional status include anthropometrics and labs