My current job has me working with children, which is kind of a weird shock after years in environments where a “young” patient is 40 years old. Here’s my impressions so far:
Birth – 1 year: Essentially a small cute animal. Handle accordingly; gently and affectionately, but relying heavily on the caregivers and with no real expectation of cooperation.
Age 1 – 2: Hates you. Hates you so much. You can smile, you can coo, you can attempt to soothe; they hate you anyway, because you’re a stranger and you’re scary and you’re touching them. There’s no winning this so just get it over with as quickly and non-traumatically as possible.
Age 3 – 5: Nervous around medical things, but possible to soothe. Easily upset, but also easily distracted from the thing that upset them. Smartphone cartoons and “who wants a sticker?!!?!?” are key management techniques.
Age 6 – 10: Really cool, actually. I did not realize kids were this cool. Around this age they tend to be fairly outgoing, and super curious and eager to learn. Absolutely do not babytalk; instead, flatter them with how grown-up they are, teach them some Fun Gross Medical Facts, and introduce potentially frightening experiences with “hey, you want to see something really cool?”
Age 11 – 14: Extremely variable. Can be very childish or very mature, or rapidly switch from one mode to the other. At this point you can almost treat them as an adult, just… a really sensitive and unpredictable adult. Do not, under any circumstances, offer stickers. (But they might grab one out of the bin anyway.)
Age 15 – 18: Basically an adult with severely limited life experience. Treat as an adult who needs a little extra education with their care. Keep parents out of the room as much as possible, unless the kid wants them there. At this point you can go ahead and offer stickers again, because they’ll probably think it’s funny. And they’ll want one. Deep down, everyone wants a sticker.
This is adorable and true. Also for age 1-2: get the correct flavour of medication or suffer the consequences.
This maps quite closely onto my pediatrics experience. Especially the part about getting medication falvors right. GOD but have I been spraypainted too many times with “strawberry”-flabored ampicillin. (And is it ever a pain in the butt to get out of a white uniform.)
Am I the only person on the planet who instantly gets along with 97% of toddlers? See, here’s the thing about kids age about, oh, 9 months to 2 ½ with a LOT of “squish” into other groups at the ends of that time gap. Mostly kids who are okay at walking but still not super functional with expressive speech.
Kids that age are SMART. They understand a TON of their native language. They don’t have really good ways of expressing things, but they’re super aware of body language and detect fear and nervousness almost instantly.
So being confident of yourself is GOOD. It is reassuring.
Talking to them as you would to any person who you know understands you is GOOD. It’s okay to emphasize the important words. Pick up some baby signs if you’re working with this group, LOTS of babies are being taught rudimentary ASL signs (not grammar, just one word nouns and verbs and the occasional two word phrase). They won’t use them with you if they think you won’t understand, but the sign for “hurt” is important in a medical setting anyway. Hurt goes wherever the hurt is (you sign it over the tummy or at the ear or whatever for tummy aches and earaches.) You don’t have to go squeaky or fake with this age group, but repeating important words if they don’t seem to understand right away helps kids learn language and they like people who help them learn language.
Being honest and not emotionally loading things is good. “We’re going to do a shot and it might hurt for a second, but it’s going to be really fast and then we’ll be all done.”
Kids this age respond well to silly surprise. Peek-a-boo and funny faces are good. You’re looking for surprise and unexpected, not fright.
They also respond to people getting on their level. I find myself repeating what they say a lot, for clarity, and this is not patronizing, it’s letting them know that you understand. Never underestimate the value of showing kids you understand. I’ve seen kids throwing frustrated tantrums absolutely stop when I said, “Are you really upset because you can’t say the words and you have something you want to tell us?”
And the response? The kid chilled out completely and said, “yes.”
When there are choices, use Choice Hands with not-very-verbal kids. If you have the physical things to choose from, you say, “Do you want x” (present thing) “or do you want Y” present thing in other hand.
But you don’t have to have the actual things. “Do you want a sticker”(hold out hand) or a toy (hold out other hand). If they get the concept, they’ll point at the hand that represents what they want.
Sample conversation with a crying child might be
“Do you hurt” “Or something else” (something else)
“Are you sad” “Or something else” (something else)
“Are you afraid?” “Or something else” (afraid)I’ve seen 18 month olds speaking in complete sentences, the main difference between those kids and other kids who aren’t isn’t necessarily smarts, it’s more often motor control. The brain is in rapid wiring mode and what gets installed/pruned in what order varies from kid to kid, but language comprehension usually leads language expression by a lot.
I’ve seen medical professionals walk into a room and frighten my children almost instantly, and I’ve seen medical professionals walk in, set my kid at ease and have them laughing through an exam. I would say the biggest difference is that the ones who get the kids laughing genuinely like and respect children and show them that.
Awesome stuff from @jenroses (as usual).
One thing I want to point out is this bit:Sample conversation with a crying child might be
“Do you hurt” “Or something else” (something else)
“Are you sad” “Or something else” (something else)
“Are you afraid?” “Or something else” (afraid)It also applies to autistics that have been trained to say “yes” (ABA therapy) so the “or something else” is really important. Give them (children or autistics that have been trained) ways to say “something else”. Yes/no questions are a starting point, but probing gently will give you more accurate answers.
child handling for the childless nurse
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just moving along like everyone else 