December 2000 Bulletin
Match your style to age of child patient
Suckers and soft tone voice for toddlers; older child can be examined as an adult
Communicating with children can be challenging for most nonpediatric orthopaedists.
"It really is a special encounter when you’re dealing with children," explains James H. Beaty, MD, president of the Pediatric Orthopaedic Society of North America and professor of orthopaedics at the University of Tennessee and Campbell Clinic. "That’s because toddlers or pre-school age children cannot articulate their condition and they’re also afraid of white coats. With children, you have to communicate with their parents, grandparents and/or other caregivers. Whereas with adults, you’re dealing with the adult one-on-one, rather than with a group of people."
For example, a child who is limping might be too young to give an orthopaedist a history, notes Dr. Beaty. "Sometimes the child can’t even tell you where he or she hurts," he says. "Or the child may or may not have pain, can’t tell you where the pain is and what are the symptoms."
Here are some tips from Dr. Beaty to help you communicate more effectively with toddlers on up to teenagers.
Toddlers
- Create a safe, non-threatening environment so toddlers won’t feel afraid. Have toys in the exam room and suckers to soothe them.
- Do not take a toddler out of their parent’s lap or put them on the examination table. It might scare the child. Have the parent/caregiver sit on the exam table with the child in their lap; then, examine the child.
- Sit on the stool where you are below the level of the child. This way, you’re not an imposing figure looking down on them.
- Use a soft tone of voice; don’t get too close to the child so you don’t scare the child.
- If the toddler is agitated, walk out of the room until the child calms down. Then, resume the exam.
- Examine the child in a very gentle, non-threatening manner. Examine the limb that doesn’t hurt first. This not only gives you a comparison, but you’ve laid your hands on the child without hurting or threatening the child. Then, examine the injured limb.
History
- Sometimes a parent/caregiver doesn’t know the child’s symptoms and can’t give you a history but he or she might know how long the toddler’s injury has existed. With a limited history of the child, the office visit might take longer.
Diagnosis/treatment
- With communication limitations, conduct tests and X-rays. When recommending treatment to the child’s family tell them, "If this were my child, this is what I would do."
Ages 4-12
- The younger children in this age group can answer some questions, while the older children can often give you a history. Otherwise, the parents/caregivers can help you get answers.
- With the younger child, have their parent/caregiver stand at the head of the table while examining the child. The older children can be examined like an adult.
History
- For the younger child in this age category, you will still depend on the family for some history; however, the older child will be able to give you a more reliable history.
Diagnosis/treatment
- Communicate with the child and their family.
Ages 13 on up
- Have the teenager sit on the table, converse, make eye contact and occasionally glance at the parent/ caregiver. Make the teenager feel that he/she is truly the patient and focus of the discussion.
History
- Get on the same wavelength with a teenager so they’ll open-up and answer questions. Talk about sports or other hobbies to develop rapport.
- Be aware that you may not always be getting a reliable history from a teenager.
Diagnosis/treatment
- Communicate with the teenager by saying, "If you were my son or my daughter, ‘this is what I would do.’ This gains the teenager’s confidence and trust. And parents know you’re recommending treatment that you really thought about and would recommend if it was your injured child.
"Although some of this might sound like common sense, it’s amazing that if you go through the same process with toddlers as you do with adults, the visit might be difficult," stresses Dr. Beaty. "So adapt the visit to their age and your style."
Successful physician-communicators tell what they do and a consultant offers helpful tips on how to "rate" with your patients. See Communicate.
Communicate welcomes suggestions about future topics for the column on patient-physician communications. Send your suggestions to the Bulletin at AAOS, 6300 N. River Rd., Rosemont, Ill. 60018.