Paediatric Consultation

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Paediatric Consultation
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Introduction

• Before you start you need to work at gaining the
  childs trust and co-operation
• Start by introducing yourself to the child and
  their teddy to put them at ease does teddy have
  a name?
• Talk to the child in a manner appropriate to
  their age
• When taking a history, observe the child / teddy
  also
• Aim to develop a rapport with the child and gain
  his/her confidence

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How to start the consultation

• Position child and teddy sat in front of you
• Are they sat comfortably? Are they distracted?
• Elicit the childs agenda for consultation
• E.g. Can you tell me whats wrong with teddy?
• Play and gather information
• Use closed questions or closed questions with
  choices
• e.g. Can you tell me exactly where the pain
  iscan you point to it?

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What response can you expect?

• They are likely to digress, be easily distracted
  and may misbehave!
• This age group can get bored easily and have a
  limited attention span.
• Own Illness
• Try Im only a Doctor for teddies but I will
  tell your teacher and she/he can tell your mum or
  dad
• Wont stop talking
• Be directive thank you for bringing teddy but I
  must see the next one!
• Crying Child
• Try reassuring and comforting, ask if they want
  to bring a friend in, hand over to teacher.
• Silent Child
• Try prompts can you tell me what's wrong with
  teddy? can you point to where it hurts teddy.
• Let them just look at the props we have at
  consultations

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Why do some doctors find paediatric
consultations difficult?

• Dont know what to say to a child or how to say
  it without using complex medical language
• Children may be difficult or unmanageable to
  examine (e.g. may scream or wriggle)
• Parents may be difficult to deal with (e.g. fear
  of losing their child)
• If there are signs of abuse or deprivation, the
  doctor may feel uncertain about raising the
  subject

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General tips!

• Non-verbal
• make eye contact with child and try to match your
  body language
• Verbal
• build rapport, be friendly, try to use language
  that is congruent with childs
• Use of props
• Play games, let them play and touch props

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General tips!

• Be confident
• Be flexible
• use the child responses to guide you rather than
  strictly systematic in your approach
• Always remember to pay attention to childs
  cognitive development
• Appreciate that children are likely to be wary of
  a physical examination
• start on teddy first and then if they are happy
  try it on the child
• Try not to over-excite them (easily done and
  particularly important in waiting room area)
• Be directive - Use distraction and interrupt to
  keep them on the subject
• Think about language /terminology you use does
  it match with the childs language

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Dress code

• Smart work wear the same as you would wear on
  placement or at an OSCE
• Bring your own stethoscope along
• Dont forget your NHS Medical Student Badge

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MOST IMPORTANTLY
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HAVE FUNThank you for listening