What You Should Know: Connecting With Pediatric Patients

What You Should Know is an ongoing series covering a range of informational topics relevant to current and future healthcare professionals.
Even for student doctors who are in training to be pediatricians or specialists in pediatric health, connecting meaningfully with these small patients can sometimes be difficult. However, this connection is necessary to establish if a doctor’s goal is to give their patient the best care possible.
It is helpful, then, to take a look at what experts say about how doctors can connect to their pediatric patients.

Helpful Techniques
An excellent, older treatise on this issue was actually written for speech language pathologists assessing children, but it can be easily applied to doctors in the clinical situation as well. The paper, entitled “Establishing Rapport with Young Children During Speech and Language Diagnostic Tests”, notes that many young clinicians mistakenly believe that building rapport is a matter of getting their patient to like them. The authors gently point out that rapport is, in fact, about “establishing good communication and a harmonious, cooperative relationship”.
Based on past evidence and experience, the authors suggest that in order to build rapport with pediatric clients, a clinician should consider the use of any of the following techniques to put children at their ease and establish a bond of trust:
1. Confidence. A clinician that behaves in an assured, calm manner can help reassure a child and calm their fears. This can sometimes be harder for student doctors, who are still gaining confidence in their own skills.
2.  Encouragement. Offering verbal support to a child when they are answering questions or participating in an exam can make them more comfortable.
3. Adaption of Style or Approach. Not every child will be comfortable with the same manner–an experienced clinician will be able to adapt that manner to one which is best for his or her patient.
4.  Friendliness. An open, friendly expression, smiles, and a likeable manner can also help to reassure children who may be feeling afraid or confused about what is happening to them.
5.  Expression of Interest in the Child. For older children, asking about a child’s interests and actively listening can also build rapport.
6.  Making the Experience as Enjoyable as Possible for the Child. Chances are, if a child is at the doctor’s office or in the hospital, this is not going to be a good experience for them! Doing whatever you can to make it more pleasant or less uncomfortable is also a good method to build trust.
7.  Prior Contact with Child (if possible). Seeing the same child for several visits or over some length of time, the child will be more likely to be more comfortable and familiar with you.
8.  Small Talk. Don’t dive into the medical talk right away. Even with time constraints, taking a few minutes out to talk about the child’s school, interests or hobbies also helps strengthen the rapport.
9.  Use of Toys. Some doctors may feel more comfortable with this technique than others, but the use of toys like stuffed animals, sock puppets or dolls can be a powerful tool for connecting with a child and making a scary situation less so.
The authors note that clinicians who are well-prepared before their interaction fare better and make the experience easier for both themselves and their patient.
The Emotional Side of Rapport
The techniques listed above can help student doctors–or indeed any clinician–to make a connection or ease the fears of a young patient. However, apart from just techniques, there is an emotional aspect to connecting with a pediatric patient–which some medical professionals might find to be outside their comfort zone.
Dr. John Purvis, writing on the American Academy of Orthopedic Surgeons site, notes that while this connection comes easily to some physicians, others can really struggle. He himself discusses the emotional aspects of building this connection in terms of  engagement and empathy with the child.
For engagement, Dr. Purvis specifies making a good first impression on the child when entering the room, coming in with a warm smile and taking an active interest in the patient. If a child is small, sit down or even get down on the floor to talk to them at their level and maintain eye contact. This kind of body language can help a child feel less intimidated and more willing to interact.
Empathy is vital to rapport, but may be the hardest thing of all to achieve. To establish empathy, he advises (even with time constraints) to listen to a child’s stories and try to understand where they are coming from. Asking age-appropriate questions and being patient while the child answers is also incredibly important–as is giving age appropriate answers to any questions that the child might have! Therapeutic touch can show empathy in a powerful way. Purvis acknowledges that these skills take time to develop and are largely built on clinical experience.
Using this combination of techniques and emotional engagement with the child can help even doctors who feel uncomfortable with younger patients to overcome this discomfort and care for their patients in an effective manner.
References
Pattison, G. and Powell, T. Establishing Rapport with Young Children During Speech and
Language Diagnostic Evaluations. National Student Speech Language Association
Journal. 1989/1990 17(4) 77-80
Purvis, J. Engaging with Younger Patient. American Academy of Orthopedic Surgeons website.
2014.

Brian Wu

Brian Wu graduated from the University of Maryland with a Bachelor’s of Science in Physiology and Neurobiology, and graduated from the Keck School of Medicine (University of Southern California) with an MD with a focus on holistic care and treatment. He currently holds a PhD in integrative biology and disease for his research in exercise physiology and rehabilitation.

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