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Communication should be “child and young people-centered communication”
rather than “adult-centered communication.” Child and young people-centered
communication does not simply involve inserting child characters or speaking in
child-specic jargon. It means developing communication strategies that activate
appropriate ways of seeing, hearing, imagining, and creating for each age group.
The essence lies in creating communication strategies that engage the abilities of
observation, listening, imagination, and creativity specic to each developmental
stage, in order to be able to perceive and interpret the child and young people in
terms of intentional mental states: their needs, desires, feelings, beliefs, goals, purpose, and reasons [4].
In establishing and maintaining a relationship between doctors and pediatric
patients within the boundaries of respect, various techniques are recommended for
different age groups. However, it is important to view these techniques as tools that
can address needs rather than treating them as one-size-ts-all solutions to every
problem.
Certainly, effective communication with pediatric patients involves specic techniques across all age groups. When referring to or addressing a child, using their
name is essential. When doctors encounter a child patient, it is important to introduce themselves, state their role, and provide information about the purpose and
content of the meeting. This approach encourages collaboration between the medical professional, the child, and the family. Without this, families might withhold
certain information, assuming that some topics are of no concern to the physician.
Having a space in the examination room where the child can engage in play is benecial. However, there should not be excessively noisy or distracting items that
hinder the consultation and examination. When conversing with children, it is crucial to avoid accusatory, stigmatizing, authoritative, judgmental, critical, or condescending behavior. Communication barriers, such as providing excessive and
unsolicited information, conveying excessive reassurance, stubbornly defending a
particular perspective, using clichéd expressions, and asking closed-ended, short
questions that hinder the expression of the child’s emotions, should also be avoided.
Praising children should be done frequently, expressed genuinely, and encouraged
to be heard by others. Conversely, if criticism is necessary, it should be done in
private, communicated clearly, combined with justied praise, and avoided when
the child is upset. Waiting for the child to calm down is advised [5].
9.3 Characteristics ofCommunication withanInfant
In the presence of an infant, the behavior of healthcare professionals should be
adjusted in a way that considers the child an intentional mental agent. For this reason, when entering the examination room, the physician should enter slowly without frightening the child, because that ecosystem is a foreign one for him. During
the examination, the information provided by the caregiver should be listened to
attentively, and respectful behavior should be displayed. As parents or caregivers
spend more extended periods of time with the child, they can detect any problems
9 Communication withSick Children
115
related to the child’s health earlier. Babies, during this period, rely heavily on body
language, so their body movements should be observed closely. Approaching the
baby rapidly should be avoided, and a certain distance should be maintained. When
speaking to parents, a smiling expression and a gentle tone of voice should be used.
When interacting with the baby, maintaining eye contact and sitting at the same
level are crucial. The healthcare professional should always keep in mind to be open
and exible, and be able to adapt to any further interference proposed in this
model [6].
As discomfort might arise when transitioning to the examination table, if possible, physical examinations are better conducted with the baby in the mother’s arms
for the sake of comfort.
9.4 Communication Characteristics withPediatric Patients
When children are brought in for examination by their parents, involving the child
in the conversations and listening to their complaints is of utmost importance. While
listening to their complaints, it is benecial to understand how these complaints
make them feel in terms of their emotional states, as this helps the child express
themselves, build self-condence, and feel understood. If an apprehensive child is
encountered who prefers to remain silent, it is not appropriate to conduct the consultation solely with the parent as if the child is not present in the examination room.
If there is an object in the examination room that captures the child’s attention, initiating communication with the child through that object initially can enhance rapport and increase the child’s willingness to engage [6].
Children in this age group might be active and energetic. In such cases, redirecting the child’s focus to their movements is important, as parents’ attention might be
divided when recounting complaints, potentially leading to an incomplete medical
history. Similarly, the physician’s perception of the child’s behavior might become
negative, hindering the establishment of trust-based communication. Maintaining
eye contact with the child during the examination, playing with toys intermittently,
and most importantly, leaving the potentially unsettling examination component
until the end are advisable. Concluding the examination by rewarding the child can
be a highly effective practice [7].
Listening plays a pivotal role in establishing healthy communication with children. It is one of the fundamental ways of gaining information, understanding, and
learning. When communicating with children, it is crucial to listen carefully to what
they are trying to convey before saying anything to them. When a child perceives
that they are being listened to, they will nd it easier to express their emotions and
thoughts to the person in front of them [8]. In communication, paying attention to
both verbal and nonverbal messages of the other person is important. Alongside the
responses provided during listening, the listener’s body posture and physical presence in a listening stance also carry signicance. As one immerses oneself in the act
of listening, body posture, eye contact, facial expressions, head movements, physical proximity, and touch become inuential factors that directly shape the
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communication process [9]. Therefore, while being attentive listeners, individuals
should be mindful of their own nonverbal cues, as these nonverbal elements contribute greatly to the overall communication dynamic.
• Body posture: A relaxed body posture signies readiness and openness to listen. The
listener’s relaxed and natural demeanor can make the person being listened to feel
more comfortable and attended to. Maintaining eye contact with the person’s face
during communication will have a signicant impact on both the listener and the
speaker. When communicating with a child who has come to the hospital, it is cru-
cial for healthcare professionals to align themselves with the child’s height or raise
the child to their own eye level. Having the adult and child at the same distance
allows the removal of barriers, equalizing the positions of the child and the adult.
Being at the same level as the child who is speaking with the healthcare professional
enables the child to establish eye contact, notice the facial expressions of the speak-
ing adult, observe their gestures, and consequently focus on the conversation. This
alignment will help the child better comprehend what is being said to them.
• Eye contact: Establishing eye contact during communication is essential for the
child to better understand the adult and to grasp what the child is trying to con-
vey. Maintaining eye contact with a child who has come to the hospital while
communicating can make the child feel listened to by the person they are com-
municating with, consequently leading them to feel respected. If the adult avoids
making eye contact with the child, it could create a sense of insecurity in the child.
• Facial expression: A smiling face, a warm and friendly approach, and a genu-
inely kind facial expression can signicantly impact communication. Children,
especially in unfamiliar environments like hospitals, are greatly inuenced by
individuals who are approachable and wear a warm expression. Communication
with such individuals, who make them feel more comfortable and secure, might
be easier for children.
• Head movements: Nodding one’s head during listening is an expression of show-
ing interest in the speaker and what is being said. This action conveys the mes-
sage “I understand you” to the person being spoken to, allowing them to receive
the message that they are being understood. When healthcare professionals com-
municate with children and use head movements to express approval while lis-
tening, it can encourage the child to continue speaking.
• Physical proximity: When a child who has come to the hospital shares their con-
cerns, being physically close to them and engaging in a face-to-face conversation
can make them feel much more connected to the healthcare professional. This
sense of closeness can foster trust in the person they are speaking to, enabling
them to express themselves more comfortably and easily.
• Touch: Physical contact and touch in communication reect intimacy, emotions,
and closeness. It can also lead to sudden changes in emotional state. During com-
munication with a child, gestures like touching their shoulder or gently stroking
their head can make them more willing to engage in conversation. Touching
signies acknowledging an individual’s physical presence and expressing value.
However, it is important to remember to avoid any forms of touch that might
make the child uncomfortable.
9 Communication withSick Children
117
• Passive listening: In passive listening, nonverbal active listening behaviors are
exhibited, such as silence and attentive nonverbal gestures (nodding, leaning for-
ward, etc.), which demonstrate openness and attentiveness to the messages from
the other party. In passive listening, “silence” is a powerful element that allows
the person to have the opportunity to speak. It evokes a sense of acceptance in the
speaker, providing them with an opportunity to express themselves. When com-
municating with children, remaining silent can encourage them to continue
speaking. Children, especially when they have a problem, may nd it difcult to
express themselves and may require moments of silence. In some cases, the lis-
tener may need to provide certain reactions to indicate that they are actively lis-
tening, such as nodding, leaning forward, smiling, or using afrmations like
“yes” or “uh-huh.” Some individuals also need encouragement to speak. To sup-
port their conversation, using phrases like “I understand,” “Is that right?” “Tell
me more,” or “Do you want to continue?” can create an opening for them to share
further. Children who experience fear and anxiety during medical examinations
or treatments in a hospital setting might have difculty expressing themselves.
As healthcare professionals, remaining silent while listening and providing the
aforementioned reactions can facilitate communication.
• Active listening: Active listening is a form of listening where the listener indi-
cates that they understand or can understand the speaker by providing feedback,
paraphrasing, or repeating what the speaker has said. Active listening is an
extremely important aspect of communication and involves showing that the lis-
tener is engaged and paying attention. By actively participating in the conversa-
tion, the listener can demonstrate their comprehension and create a more effective
communication exchange.
• We can exemplify active listening based on a dialogue between mother and child.
M: “Do you remember that today you have an appointment with the dentist?.
You’re getting braces on your teeth. Are you ready? We need to leave.”
C: “Mom, my stomach hurts. I don’t want to go…”
M: “I see, where does it hurts?, that can be an uncomfortable feeling.”
C: “Yes, I don’t like how it feels.”
M: “Do you think it might have something to do with going to the dentist?”
C: “Maybe. Will they give me a shot?”
M: “You’re wondering if they’ll give you a shot when they put on the braces.”
C: “Yes.”
M: “Not knowing what will happen can make you feel confused.”
C: “I don’t want to feel pain. Actually, I’m afraid of it hurting.”
M: “I understand you, I think that can be a frightening experience. When we
arrive you can ask the dentist what will happen and all the doubts you have
about the braces. Do you think that’s a good idea?”
As seen in the example above, the mother can put herself under his child’s skin to
understand his emotional and mental states, such as confusion, discomfort, and
fear about going to the dentist. Taking into consideration the developmental lev-
els of children while being curious about how the world looks from their per-
spective and how our own perspective may inuence how we see someone else’s
behavior is crucial. This way the child can have a safe haven, since the mother
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relates to the child’s mental states and intentions, as well as letting the child
know her own affects and behaviors toward him or her [10].
In conclusion, communication stands at the core of human life and is essential
for the continuation of relationships. When establishing effective and healthy communication with children, it is crucial to allow them the opportunity to be themselves as much as possible. Children who can communicate freely, openly, and
healthily with the people around them will be able to lead their lives in a happy and
successful manner according to their developmental potential. All adults who
approach children considering their emotions and motivations, while seeing their
reactions and behaviors, regardless of the context, will be able to establish effective
and healthy communication with them.
There are certain key strategies to keep in mind:
• How does the child or young person know that I want to listen to him/her?
• Help the child or young person and the family to get a shared understanding of
why he or she is there, its goals, and what the problem is.
• Be sure that the child or young person understands the choices available to him
or her and their pros and cons.
• Explore his/her views and preferences.
• Help them all to reach a shared agreement on key problems, plans, and what is
going to happen next.
References
1. Dwyer Hall, Holly. “Mentalization-based treatment for children: a time-limited approach: by
Nick Midgley, Karin Ensink, Karin Lindqvist, Norka Malberg, & Nicole Muller, Washington,
DC, American Psychological Association, 2017, 268.
2. Midgley, Nick; Ensink, Karin; Lindqvist, Karin; Malberg, Norka; Muller, Nicole.
Mentalization-Based Treatment for Children. American Psychological Association, 2011.
3. Barclay S.Recognizing and managing conict between patients, parents and health professionals. Pediatr Child Health. 2016;26(7):314–8.
4. Midgley, Nick, and Ioanna Vrouva, eds. Minding the child: Mentalization-based interventions
with children, young people and their families. Routledge, 2013.
5. Allen, Jon G. Mentalizing in the development and treatment of attachment trauma.
Routledge, 2018.
6. Ritter RH Jr, Reis MD, Rascoe TG.Interviewing techniques. In: Textbook of family medicine
e-book. Elsevier; 2011. p.166.
7. Lorin MI.General principles of communicating with pediatric patients and family members.
In: Communicating with pediatric patients and their families: the Texas Children’s Hospital
guide for physicians, nurses and other healthcare professionals; 2015. p.11–25.
8. Sacks D, Westwood M. An approach to interviewing adolescents. Paediatr Child Health.
2003;8(9):554–6.
9. Bernzweig J, Takayama JI, Phibbs C, Lewis C, Pantell RH. Gender differences in physician-patient communication. Evidence from pediatric visits. Arch Pediatr Adolesc Med.
1997;151:586–91.
10. Kolucki B, Lemish D. Communicating with children. UNICEF; 2011. ISBN:
978-0-578-09512-7.
Communication withSick Child’s Parents
10
CanCemalCingi
10.1 Introduction
Children, like adults, frequently inquire about the nature of their sickness, treatment, and eventual death. Answers to queries should be forthcoming, truthful, and
age-appropriate. Adolescent and child patients benet from age-appropriate explanations of their condition, symptom management, and end-of-life planning.
Adolescents are more likely to feel comfortable talking to doctors if they are actively
involved in their care planning [1, 2].
Children’s communication needs to consider their age, stage of development,
and any neurological abnormalities they may have. The child should be the focus of
all communication, while parents may also be involved in discussions about care
depending on the child’s age. When addressing the child’s care, including all appropriate family members is essential [3].
One method to use when communicating with kids is [1]
• Please communicate with the youngster at their developmental level [4].
• Draw, read, and play with age-appropriate toys and games for your child [5].
• Communicate openly and earn trust by providing straightforward answers to
queries.
• Spend quality time together and talk about things other than their health.
• Be willing to listen to and rehash conversations regarding care; give kids a break
from their parents and other caregivers [6].
C. C. Cingi (*)
Communication Design and Management Department, Faculty of Communication Sciences,
Anadolu University, Eskisehir, Turkey
© The Author(s), under exclusive license to Springer Nature
Switzerland AG 2024
H. Yüksel et al. (eds.), Pediatric Airway Diseases, Comprehensive ENT,
https://doi.org/10.1007/978-3-031-74853-0_10
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C. C. Cingi
10.2 Communication withFamily
Parents of children with terminal illnesses say that challenges in talking to doctors
and nurses about the child’s impending death rank high on their list of sources of
stress [7]. Including family members in the care planning process is essential to having open discussions about treatment options. It can be challenging to gauge the
child’s and their parents’ comprehension while discussing the child’s life-limiting
disease in the same conversation [1, 8].
When communicating with families in the aftermath of a child’s death, it’s essential to keep a few things in mind:
• Be straightforward, concise, and empathic when conveying the child’s health
information. Plan the conversations, considering timing and surroundings
• Assess prior knowledge and what needs to be shared
• Allow for silence and acknowledge emotions
• Plan for future meetings
• Assess prior knowledge and what needs to be discussed
• Be clear, concise, and empathetic when delivering information about the child’s
condition [9]
10.3 Communication Tips forParents ofPediatric Patients
Let Them Warm Up to You
When coming in for their initial visit, many young patients experience anxiety. You
want them to feel at ease, so allow them time to get to know you and the setting.
This is a perfect use case for your waiting area! Having something fun for kids
to do while they wait is a signicant benet. But once they’re inside the examination
room, their nerves could start to act up again.
Engage these patients in conversation about anything but their illness. This facilitates communication and sets the stage for a future working partnership. Please
provide them with off-topic inquiries during your visit.
This may concern their academics, extracurriculars, or weekend plans. You might
also inquire about their entertainment preferences, such as their preferred lm or book.
Asking inquiries along these lines will encourage conversation on familiar
ground. It’s an excellent opportunity to connect with them more individually. The
patient’s condence in you and comfort with the visit will increase. In addition, this
will demonstrate to the parents that you are concerned for their child [10].
10.3.1 Create aRelaxing Setting
It’s not a direct method of communication, but it can make things go more smoothly.
Exam rooms, especially for toddlers, are stressful due to the strong odors and intense
lighting. If they are anxious to begin with, something else will be needed.
10 Communication withSick Child’s Parents
121
However, if you improve their surroundings, they will be more at ease. Decorating
waiting areas and appointment rooms with lighthearted themes might help patients
feel more at ease.
Small, sanitized toys or plush animals that kids can hold throughout the exam
may also help children relax.
Talking to patients is the most remarkable approach to gauging their level of
relaxation. Please inquire as to whether or not there is anything you can do for the
patient to improve their level of ease. As a result, people may feel more comfortable
opening up to you.
It’s a helpful tool for guring out how to make the facility safer for future patients.
When people are at ease, they are more receptive to communicating with you [10].
10.3.2 Talk toThem Where They’re At
There is a wide range of linguistic competence among age groups. Babies and toddlers don’t talk like school-aged kids. Teenagers are still considered pediatric
patients, although their communication styles differ signicantly from younger
children’s.
Guests of all ages will have a better time if you tailor your message to their
demographic. Acting goofy in front of the youngest pediatric patients can help them
feel more at ease.
Having something in common with a youngster their age makes them feel more
at ease around you.
Adopt an adult tone when conversing with adolescent students. They demand
that grown-ups treat them equally, not like children. Teenagers are more likely to
listen to advice when it is delivered with respect and as though they are adults.
However, any disparities in development must be taken into account. Tailoring
your approach to each child patient is essential, as some may be mature beyond
their years.
Patients who are developmentally delayed may also have difculty maintaining
a conversation at a typical adult level. Therefore, it is crucial to tailor your communication to the patient’s age and stage of development [10].
10.3.3 The Appointment Process, Explained
Young patients may feel uneasy because of the unknown. A step-by-step explanation of the procedure can help calm their nerves about what’s to come.
Preparing children for even the most basic of situations will assist. Make sure
they know the stethoscope will likely be cool to the touch before you use it on them.
During the uncomfortable sections of the appointment, you can try talking to the
patient to divert them.
You can even let them assist you through the scheduled time. Kids learn best via
doing. Allow them to participate in some aspects of the appointment even if they
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cannot replace a doctor. This will help them feel safer and more condent. They will
have a good time, a bonus [9].
C. C. Cingi
10.3.4 Don’t Misuse theTerms
Always try to utilize simple, straightforward language. This material is more for the
parents of very young patients. Many people aren’t familiar with medical terminology, so using more straightforward language when communicating with their parents is crucial.
If you explain it to older children properly, they may be able to understand.
You’ll need to utilize more straightforward language or nd a way to connect it to a
concept they already know and comprehend [10].
The use of appropriate body language is an integral part of effective communication. If you can, sit down with your pediatric patients so you’re both on the
same level.
Their concerns and fears won’t be eased if you stand over them. If you need help
getting to the kids’ level, have them sit on their parents’ laps instead.
When speaking to the patient, make direct eye contact with them. Your focus
should be on the patient, not on the parents. Parents must remain involved in the
discussion. However, kids need to realize that their care is tailored to them.
Only communicating while wearing the mask won’t help, either. Drop it whenever you can, engage in conversation, and ash a grin. These subtle cues convey a
lot. You don’t want to provide a bad image that would make your young patients
nervous by reading your face. Despite the gravity of the issue, strive to have a positive outlook [10].
10.3.5 Parental Involvement
Although the juvenile patient is your primary concern, you should also talk to their
parents. Because children look to their parents for leadership, this is critical.
The presence of a person the youngster knows and trusts in the talk will likely put
them at ease [10].
10.3.6 Consult theParent onAnything
We discussed how various children are at different stages of growth before. The
easiest way to speak with the youngster in this situation is rst to talk with the parent to nd out where the kid is. Their parents will have the most insight into their
children’s communication styles.
Parents can break the ice with their reserved or reticent children. If you ask a
patient’s parents what’s bothering them, you can better understand how to put them
at ease.
10 Communication withSick Child’s Parents
When youngsters have questions they can’t gure out, they might turn to their
parents for guidance. To ask a child about their health history is to put them on the
spot and likely increase their anxiety levels. Children may not know their parents’
medical history, allergies, or vaccinations, but their parents would [10].
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10.3.7 Treat Your Parents withRespect
Most parents would do whatever to ensure their kids are safe and healthy. They can
be as challenging to deal with as the patient themselves when they are as anxious as
their children. They could jump to conclusions and become annoyed or uneasy. The
patient may become distressed as a result.
Have a private dialogue with the parents outside of the patient’s presence. You
should remain calm and patient even if the parent is worried or upset.
They’re more likely upset about the circumstance than angry with you. Help
them comprehend by responding to their inquiries and providing explanations
where necessary. Give them resources that can help them learn as well [10].
10.4 Coordinating Care When Your Child Is Ill
The fact that their kid will become sick occasionally is a given for all parents. It’s
common for youngsters to contract a cold from a classmate and then spread it to
their family at home. Many parents have experienced this, as it is practically inevitable at certain seasons of the year.
A sick child can throw a wrench into a co-parenting couple’s plans and cause
tension in the household. Read these valuable guidelines for co-parenting a sick
child [11] before your child contracts their subsequent illness.
10.4.1 Discuss Your Child-Care Arrangements withEach Other
Your child may need to stay home from school if their illness is severe. They may
also be too exhausted to be transported between the homes of their parents [11].
In such cases, your parenting plan or visiting arrangements must be worked out
between you and your co-parent. Your parenting plan may have provisions for this,
so you should look there. Keep up with the routine if your youngster is healthy
enough to travel between houses or for a visit [11].
If your child is genuinely ill, you should decide as a family. If your child
needs to relax and recover, staying in their current location may be preferable.
The stress will make their disease worse and last longer. Communicating clearly
and keeping good records of parenting decisions that depart from the norm is
essential.
It is usually up to the parent the child is staying with to make arrangements for
the child to miss school. If you cannot take care of your child full-time, talk to your