Communications Pediatrics station

Communication in Pediatrics

Importance

Effective communication between a child, parents, and the pediatric team can:

• Increase diagnostic accuracy
• Improve patient adherence to treatment
• Reduce litigation
• Enhance patient satisfaction
• Improve overall health outcomes

Communication skills are essential in pediatric practice and, like other medical skills, can be learned and improved through training and regular practice.

Important Tools for Effective Communication in Pediatrics

• Create a comfortable environment and build rapport (warm up to both the child and parents).
• Use appropriate body language.
• Communicate at the developmental level of both the child and the parents.
• Use empathic statements to communicate concern.
• Use reflective listening to show you have heard the patient’s concerns by reflecting their core message.
• Use silent listening when appropriate.
• Use open-ended statements to encourage dialogue.
• Maintain the child’s level: do not lean over the child; sit at the same level and maintain appropriate eye contact.

Ten Tips for Effective Patient Communication

• Clarification
• Summarization (including providing leaflets)
• Providing clear information
• Positive feedback
• Reassurance
• Follow-up

Structured Approach to a Pediatric Clinical Communication

1. Introduction and rapport (greet, warm up, make eye contact)
2. Clarify your role
3. Conduct the interview
4. Check prior knowledge
5. Address the patient’s and parent’s concerns
6. Provide appropriate explanation and negotiation of the plan
7. Ensure accuracy of information
8. Summarize the discussion
9. Provide written information
10. Arrange follow-up

Scenario 1 — Abdullah (Asthma)

Case summary

• Abdullah is a 5-year-old diagnosed with mild intermittent asthma.
• He has been using salbutamol via spacer PRN.
• He was admitted 3 days ago for an exacerbation and was treated according to guideline with oral steroids and salbutamol via nebulizer.
• Prior to this exacerbation, Abdullah had increased his use of inhaled salbutamol to up to 4 times daily.
• He is otherwise healthy; weight and height at the 25th percentile.
• The medical team has decided to step up treatment and add prophylactic inhaled corticosteroid (ICS).

Task

• Discuss the new plan with the mother and address all her questions and concerns about ICS.

Suggested clinician script and points to cover

1. Opening and rapport

   • “How was your journey to the hospital?”
   • “I am Dr. Salma. I’m here to discuss the new plan for Abdullah.”

2. Elicit current understanding

   • “What do you know so far about Abdullah’s condition?”

3. Acknowledge feelings and provide empathy

   • “I’m so sorry you are feeling upset/worried.”

4. Explain rationale for ICS

   • Explain that inhaled corticosteroids act in the airways and have less systemic absorption than oral or topical steroids.
   • Explain that Abdullah’s lung secretions and symptoms have worsened to a point that preventive (maintenance) ICS is indicated.
   • “If controlled, exacerbations would be reduced. Currently he is not responding sufficiently to salbutamol alone — what do you think about that?”

5. Address concerns about complications and side effects

   • Validate the mother’s concern: “You are a good mother for asking about complications.”
   • Reassure about the small systemic dose with inhaled delivery: “The amount entering the rest of the body is very small.”
   • State monitoring plans: “We will continue to monitor his blood pressure, blood sugar, and other relevant parameters as much as we can.”
   • Ask for the mother’s thoughts: “What do you think about that?”

6. If the mother thinks inhaler alone is enough

   • “I understand you are worried. However, the frequency of salbutamol use (how many times this week?) suggests his asthma is not controlled and we need to step up medication.”

7. Discuss local side effects and when to return

   • “If you notice toothache, oral thrush, or other concerns, come to the doctor.”

8. Address concerns about growth and systemic effects

   • “I know you are a good mother, but asthma exacerbations themselves can affect growth and health. This ICS is inhaled, not oral.”
   • Ask: “Why do you think it will affect growth? What specifically worries you?”

9. If the parent fears coercion

   • “No one will force you. You will choose what is best for your child. I will give you reliable resources to read, and we will arrange follow-up. I hope you will come back so we can start the medication if you agree.”

10. Documentation and follow-up

• If the parent refuses treatment, document the refusal clearly.
• Arrange follow-up if/when the mother decides to return or has further questions.

Scenario 2 — Yara (Education: Correct Use of Spacer/Aerochamber)

Points to cover

• Demonstrate how to use the spacer/aerochamber.
• Consider whether a mask (facemask) is needed for younger children; decide based on the child’s age and cooperation.
• If this is the first time using the inhaler: test and check expiratory function as appropriate, then place the inhaler in the aerochamber.
• Model the technique with the child and have the mother copy the steps.

Step-by-step process (practical demonstration)

1. Stand up tall (if an infant, hold in a sitting position).
2. Remove the mouthpiece cover from the inhaler.
3. Shake the inhaler 4 to 5 times.
4. Insert the inhaler into the spacer.
5. Seal the mask over the child’s mouth and nose, or have the child put the mouthpiece in the mouth and form a good seal.
6. Press down once to release one puff of medicine.
7. Continue to hold the mask sealed on the face while the child breathes 5–6 normal breaths.
8. Remove the mask and wait (note: texts vary; guidance elsewhere mentions waiting 30 seconds to 1 minute) to allow the medicine to reach the lungs.
9. Repeat these steps for each additional puff required for the dose.

Additional notes

• Use an illustrative image for the steps when teaching (insert picture during education).
• Device replacement: change the spacer/aerochamber every 6 months if used daily; if not used daily, change every 12 months.
• When administering multiple puffs: give 5 breaths after each puff, then wait (30 seconds to 1 minute as above) and repeat as needed.
• Provide a leaflet or other educational material for home reference.

Cleaning process

• Provide written instructions and a leaflet for cleaning and maintenance (specific cleaning steps should be provided according to the device manufacturer).

Other Examples of Communication Scenarios

1. Speak with a mother whose child was just diagnosed with hemophilia:

   • Topics: routes of injections (IM vs subcutaneous), need for regular checks, skin changes, red flags, avoidance of aspirin, dehydration, pallor, behavioral changes.
   • First aid education: how to raise the bleeding limb, apply pressure, and when to go to emergency for replacement therapy.
   • Address parental feelings of guilt and genetic counseling concepts (probability and inheritance considerations).

2. Speak with a mother whose child has just been diagnosed with lower UTI:

   • Instructions: measures to avoid recurrence, correct wiping techniques, address constipation as a predisposing factor, and focus on avoiding predisposing behaviors while treating the infection.

3. Speak with a parent who refuses vaccination:

   • Discuss the importance of immunization and potential consequences of vaccine-preventable diseases (e.g., deafness, disability from polio).
   • Explore specific vaccine concerns (some refuse specific vaccines, others refuse all).
   • Provide balanced information, address fears, and offer follow-up discussion.

Documenting and Follow-up

• Always document the discussion, the information provided, parental concerns, and whether consent or refusal was given.
• Provide written materials and arrange timely follow-up to reassess understanding and adherence.