Dr. Ni Putu Siadi Purniti, Sp.


 Children : Growth and development
 Limitation of interaction with
 Limitation of communication

Clinician’s : difficulty in
communicating information
at the appropriate
developmental level

 Dual Patient
Patient s

 Multi Patient Clinicians Parents Grand mother/father Babysiter. etc Children .


 Listening  Facilitating the dialogue  Using common courtesy  Talking with the child  Dealing with acute illnesses  Redirecting the interview  Counseling and reassurance  Closure .

 Active listening  Letting the parent know that you are listening  Check your body language  Eye contact  Responding to nonverbal expression of parent affect .

and not make prematurely diagnostic. judgmental comments.  Avoid : interruptions. The parent’s story should be facilitated by empathetic responses. subject changes. .

a. Guide but do not dominate the discourse Fundamental four dan Sacred seven . Elicit the parents expectations for the visit c. Elicit the reasons for the parents for the visit (main complain) b.

 Greeting  Introduction your self  Set agenda jointly .

Early in the visit an appropriate approach must be made to the child To porpuse : Building of good relations Indirect to help make diagnostic .

seizure  Ask : “How did you handle that?” . During a acute illness. the interview must be focused  High fever.

 After the episode is over and the parents less likely to anxieties more complete and forceful information can be given  Explaned of the therapy: benefits. advers even. cost and etc .

 Keep control of the interview  When the discussion gets off tract the clinician needs to redirect the discourse “There are some other information I need right now so we can decide about the treatment for this illness” .

cause and how to manage  Advice giving and counseling can be giving continuing process : the first mention. The parents : need explain about illness of the child. during the physical examination and at the end of the visit . diagnose.

Cost ? Availability ? .

 Summarize the relevant points  Education  Invite questions  Jointly setting the agenda visits .

Talking with children .

Goals The primary goal of open communication is the establishment of therapeutic alliance with children and parent. fewer days of school missed. 1.Health educations programs 3.Improved coping with disease. and better functional health status .Inhospitalized children : Reduce surgical morbidity and improve physiologic and behavioral outcomes 2.

child not eye contact. hyperactive etc Support diagnose . look anemia. Clinician should be concern of growth and development Exp: malnutrition. weakness .

Children go to Hospital stress defence mechanism Coping Def : as emotional. or behavioral efforts to alleviate stress . cognitive.

Internal strategies Exp: The child’s belief that he is not very sick . Direct efforts to modify the sources of problems Exp: running away or hiding 2.Coping : 1.

Age 5-9 years  Use more sophisticated direct strategies e. Under age 5 years  Use direct behavioral coping (running away) 2.1. the doctor that the medicine tastes bad .g .

e.g. An adolescent with diabetes that her illness has advantages because it helps her to stay thin .

ESTABLISHING THERAPEUTIC COMMUNICATION One useful strategy for developing a therapeutic alliance with children and their parents is to use the TEACHER method of communication .

knowing what will and will not happen). to help decrease fear and increase cooperation H Health plan Establish a health plan with child and parent to meet the child’s needs and limitations E Explain Explain the health plan to the child in a way she or he can understand R Rehearse Have the child rehearse the health plan as a way of assessing understanding. TEACHER : A method for enhancing communication with pediatric patients and their parents T Trust Build trust and rapport with the child by asking non threatening questions not related illness E Elicit Elicit information from both parent and child regarding parental fears and concerns and the child’s understanding of the reason for the visit A Agenda Set an agenda early in the visit to help ensure that the parent’s concerns are addressed C Control Help the child feel control over the visit (e. reinforce the child’s jobs related to health care.Table 2.g. explore any potential problems in the plan with the child and parent .


Sensorimotor stages  Learning occurs through sensory experience  They want to hold and examine instrument  A soft tone of voice and gentle handling Careful examination and frequent comments about the child’s condition will be reassuring to the parent .1.

2-6 Years old (preoperational stages)  Children confuse cause and effect  They focus on the perceptual salience.2. not the logical content  Perceive illness and medical procedures as punishments for being bed  Information for children should be concrete and reassuring .

TRUST : Establishing trust with preschoolers involves using direct verbal praise and allowing the child to have some control over the visit e.g. by listening with the stethoscope to clinician’s heart .

3. 7-10 years old (concrete operational stage)  Children appear able to tolerate medical visit better  They are very much focused on the concrete aspects of situation .

TRUST :  It is useful at this stages to begin to give them more control over their health and to anticipate their concerns  Make sure that both parent and child are involved .

TRUST :  Make gathering in setting the agenda and establishing a health plan  Explained to child : examination will be done .

 Children begin to be able to reflect on their own thought processes and to understand how the body works  Growing independence and ability to make decisions .

Trust :  The clinician should solicit the adolescent’s opinion . needs. and limitations before recommending a course of action  Make sure that the adolescent understands the health plan and feels comfortable trying it out .