Importance of Using a Patient-Centered Interaction Style

• Giving instructions to patients >12 gives the potential of having two receivers

• Even though they are children they still have an opinion

  • They are the only ones who know how the medication makes them feel

  • Allow them to make educated decisions in their care

• It is seen as positive when patient-centered care is used on children

• A review done by Tates and Meeuwesen (2001) should the child have little to no say in the majority of emergency room visits

• Parents are five times more likely to be pleased with a doctors visit if the doctor interacts with the child.

  • Also making the child more confident and forthcoming

Understanding the Cognitive Developmental Level of a Child

• Children progress through stages when developing cognitive skills

1. The sensory-motor stage

2. The preoperational stage

3. The concrete operational stage

4. The formal operational stage.

• Sensory Motor Stage: all learning is centered around the child

  • It is between the ages of birth till 2

  • Small connections between outside objects and themselves

• Preoperational Stage: they tend to only consider a single aspect of a situation typically to engage in “magical” thinking

  • Between the ages of 2-6

  • More connections to the concrete reality

  • Cause-and-effect has not yet set in

• Concrete operational Stage: being to distinguish from the internal and external world

  • Ages 7-12

  • Are starting to be able to participate in patient-centered care

  • Start becoming problem solvers

• Formal Operation Stage: are now capable of hypothetical and abstract thought

  • From ages 13+

  • Can reason logically and become responsible for their health a little more

  • Have more ability to control their health

• This is just a general time frame

• Some children develop faster or slower

  • To figure out where a child is ask them open-ended questions to really see where they are

General Principles for Communicating with and Empowering Children

• Most children by the age of 8 can actively participate in and contribute to their medical visits

• These are the strategies used by Bush and Hameen-Anttia (2009)

  1. Tell the parent that you are going to talk with the child.

  2. Start with some general questions about other things, such as their favorite movie, to establish rapport.

  3. Attempt to communicate at the child's developmental level.

  4. Ask open-ended questions so you can assess what the child understands and determine the child's cognitive level.

  5. Use simple declarative sentences for all children.

  6. If the child uses a drug delivery device, such as a metered dose inhaler, ask the child to demonstrate how to use it and then demonstrate how to use it correctly if needed.

  7. Ask the child whether he or she has questions for you.

     1. You can lead into this by telling the child a simple question that another child asked you

  8. Use the teach-back method to ensure that the child has understood you

  9. Augment verbal communication with written or digital materials.

  10. Don't give up. If you fail the first time, try again the next time. Pay attention to nonverbal communication.

• Children understand nonverbals before they understand words so be very mindful of your body language

  • One way to do better is to get on their level so they do not feel talked down to

What Children Want to Know About Their Medicines

• Toddler and Preschoolers

  • Start with an icebreaker

  • Be interested in what they are interested in

  • Use the teach-back method

    • Teach-back method: when you explain one thing and get them to summarize it in their own words

  • At this age, the kids can start recognizing their medication and acknowledge it can only be used with the help of an adult

• School-age Children

  • Once again start with an icebreaker

  • Then start asking open-end questions to see where they are developmentally

  • Depending on how used to medications they are can discern how much more they can be taught

  • The teach-back method is still used

  • It is shown that kids diagnosed with asthma at the age of 7 can almost completely tell someone else about their condition and medications

• Adolescence

  • They can start thinking on their own and can be present at certain doctors appointment without their parent present

  • They need to feel comfortable that anything they say to you will not be forwarded to their parents

  • Building trust is crucial