Paediatric assessment tricks.

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This thread may not be as frivolous as it first appears. Those who do lots of Paeds, especially kids with lots of medical problems should get it.

When assessing the child, especially the very young, autistic or terrified child, one must first gain their trust. Lots of kids I see have been through the mill, medic wise, in quite a big way and have quite severe "white coat syndrome". Further, when I'm in the multidisciplinery clinic there are not one but three of us (pod, physio and orthotist) which can be scary in itself. I think being a man is a disadvantage here also.

Its very, very hard to get a good mechanical assessment on a child who won't let you near them.

Thus in the interest of sharing good practice, what methods have colleagues developed to get the children comfortable enough with you to let you assess them?

I used to do magic tricks. Not hard to learn a few basic palms and switches and you can buy simple tricks which basically do themselves. I gave up on that in the end though as the window of interest was quite small. My present "carrot" is modeling balloons, which have a much wider age appeal and seem to be going down well. Very easy to learn as well.

Anyone else got any such incentives they use?

 

hi robert i have a tub of lollies from macro chuka chips and some kids stickers that say i was good at the clinic today etc etc.if that does not work we resort to beating them. no only joking.

 

I have a small teddy in my room which i examine first, failing that I examine the childs own teddy/dolly/Makka pakka etc.

I used to have an action man in my room but too many people talked!

 

At one time i did only paeds for about 4 years and I used magic as a way of distraction. Older kids loved it but the littlies didn't get it. Realised that I was doing it more for me than anyone else.

Never thought of doing balloons although I do it for my own kids so, great idea

I tend to just use my Encyclopaedic knowledge of Peppa Pig, Wow wow wubzy, 3rd and bird, Dora the explorer, Handy Manny and a host of other childrens TV programmes to ingratiate myself.

Or, I have been known to download animal apps for my phone to show them and they are distracted for a bit. The Zoo animals app for android works quite well. Just make sure your phone has a strong cover!

 

Just to throw something not yet mentioned into this insightful discussion.

While I appreciate how difficult it may be to have a child to relax enough to be aprropriately assessed/evaluated/examined I personally think we have to be certain the child concerned is permitted to assert their right to say no at any point. I do not for a moment believe any clinician would force an intervention on a child but I do think it wise to offer 'gifts' via the attending adult.

It is difficult to teach children about safety without scaring them witless but I honestly think that offering children a colourful or sweet reward for complying with an adults request is standing on dodgy ground.

I love the idea of every adult a child encounters in life being their friend with their best interest at heart but if their perception of good & kind is confirmed by nice man/lady giving them treats then a chance future meeting with someone less kind could colour their future differently.

I'm not suggesting not to be kind, playful, fun & encouraging just that treats are provided to the parent/carer to dispense.

I give children the choice of stickers & pass them to mum, dad etc. I have children & bad stuff can & does happen.

Just my thoughts.

Kindest regards,

Mandy.

PS. Robert may I have two poodles (pink) & 1 LARGE (green) heffalump please. x

 

I think the environment plays a huge role and hate exam

 

Never ever do we offer any consumables, the parents may not like that approach or the child may have a reaction of some kind(?) to the product.

We have a number of ways we deal with children, pending their behavior, intellect and what we need to do.

We often start with them next to a large fish tank, sitting on mums lap if they are very young, throw some food, to the fish that is and l can just about do anything l want whilst they watch.

Gait assessment in an open clinic room with toys either end, 8 mtrs long, with the 1.2 meter Shrek seated for that all important "lets have a look at his feet first"

But to the most part we make it fun, they want to come back and see me

 

I find if the child seems scared or unwilling, assessing mom and dad first seems to work.
They see it is okay on mom and dad and it is not so bad, its the unknown that scares them.
Also we do have a good selection of toys and childrens books which i find also helps.

Jaynes

 

well bugger me cant even give akid alolly what a very mixed up world we live in the kid might be allergic to said lolly what acrock of u no what every adult is a possible peado these scenarios never cross my mind im to busy working to consider all these
wierd possibilities which will never arise. ps all primary care buildings in england removed all toys and magazines because of swine flu one of my pts died of swine flu so the cuddly toys might not be agood idea seems you cant do right no matter what you do.

 

I'm glad you mentioned these points, Mandy, particularly saying that the child should have the choice to say 'no'.

Someone mentioned 'white coat syndrome'. Some adults have this, never mind children, so if you have the option a non-white uniform is probably a good idea.

 

Re the balloons - I have found that inflating a latex glove and than drawing a mouth below the thumb and adding a couple of eyes to give the appearance of a 'punk' balloon certainly amuses the kids

 

Ah the esoteric art of glove modeling. Also good for blowing up and getting them to play football with. Kick, run, kick run. Covert assessment. Very nice.

Lots of good tips there.

I been doing monkeys today. And let me tell you, the monkey's face is flippin hard! Makes the teddy look simple by comparison. Lots of pinch twists.

Lolliepops!? I used to do that and you'd think i was offering them a rattlesnake to play with!

I'll remember to pass them through the parents though. Thats not a bad point.

 

I was at a child protection meeting once and there was a lot of discussion about consent with regard to treating children. The upshot was, if a child said they didn't want to be examined that you were risking (spurious) legal action if you did proceed, even with the consent of the parents. The reality is that you are unlikely to have any action if the parents are consenting but it was possible.

Having heard that, I stopped just grabbing childrens feet and going for it regrdless of how much kicking etc they were doing. I worked in special needs schools so parents weren't there to consent.

Quite often now, I don't do anything if the child is flat refusing to let me have a look. I chat to the parents, make some jokes and have some fun with the child and bring them back. On a couple of occasions, the second time they have returned I have not been able to do anything as the child's reaction to me was the same but this was in the minority of cases. Sometimes the familiarity with the environment and clinician is enough to allow the child to be more compliant the next time.

 

Hmm, no idea what happened to my response, it was a lot longer than that.

I agree so much with Twirly, kids deserve respect. If they say no, then it is no but at the same time, I give them the chance to change their minds. Kids with autism will always say no.

I think the environment plays a big role. I have gym type room which has plenty of play equipment. I can watch a child crawl through a tunnel, climb, jump on a mini-tramp, navigate obstacles including stepping up and down, squat etc. All of which lets me see the foot, legs and trunk move through their ranges and strength.

Another is the use of social stories. I can give the parent a story to read through the child what we will do complete with pictures of the room and equipment. Very helpful for kids while really need it.

 

Talk to the child. Many make the mistake of discussing the child's issues with the parent only. Gain a child's trust by talking TO them and looking them in the eye. Once I do this I eventually ask them to give me a high five and assuring them that I don't have any needles hiding in my pocket. This usually breaks the ice. I also rely on my staff to make the child and the staff comfortable.

You have to educate your staff as well. DON'T schedule children's appointments right before lunch or towards the end of the day before dinner. Hungry children are cranky children. I tend to like young children's appointments first thing in the AM or right after lunch to avoid the hungry child and the "walk me up during a nap" child.

 

i have a box of balls of all shapes and sizes, with a variety of 'character' pictures. They're easy to clean and easy to replace/update.

Thomas the Tank engine is a very popular ball, and if the kids don't want to play ball and have the assessment they just play ball; i 'ignore' them while talking with the parents. (keeping an eye on them playing)

Or i tell them i am great at juggling and just throw the balls all over, makes them laugh. acting like a clown helps, though i draw the line at dressing like mr tumble.

The only downside is when they leave, once i overheard a mum said to her little girl " did you have fun playing with the mans balls?"

i also have washable crayons and colouring-in stuff if they prefer, but that just keeps them sat still.

 

And what's the point in that?:drinks

Kids don't get pain from walking up and down slowly in a straight line. They get it from playing. If you want to see the problem, watch them playing! I'm with you mate. Offer them your balls every time.

 

I beg to differ. A young lad I used to see got such bad pain from walking slowly( in more or less a straight line) to school that social services paid for him to have a taxi every morning to take him the 400-500 yard journey.............he was however, keen to get involved and play football because he should have rights like any other "normal child"

Can you believe cr@p like that. Sheesh, talk about screwing the system. I'm with you Paul, let em go and play and keep the surreptitious eye on them.

Robin

 

Hi All,

Found the biggest issue was with the younger children and agree that distraction works.
Have used a dancing Elmo, especially as the children will dance with him, walking, dancing, single leg stance - works well. But one down side after 5 or 6 patients you may want to kill the dancing and very loud singing Elmo !

 

Hmm ... that sounds just a little too judgemental ...

Why were you seeing him?