Children can be scary.
I’m not talking about the teleporting dolls of horror movies – just regular pediatric patients.Some people have the natural ability to relate to children, and others might feel like they’ve been knocked out of their usual rhythm of patient communication. How do you explain pathologies to a 10-year-old? How do you make a personal connection, take an efficient subjective history, and get patient buy-in?
As a PT student during a pandemic, trying to practice pediatrics on baby dolls and my adult classmates, I’m curious. After all, somewhere in the world there is a scientist who has dedicated a significant portion of his life to studying kleptoparasitism in kangaroo rats (Kline et al. 2018). Surely someone in the research community has figured out how to talk to kids?
In their book, The Art and Science of Motivation: A Therapist’s Guide to Working with Children, Ziviani et al. emphasize the importance of empowering children by including their input and values in the therapy plan. Older children and adolescents especially benefit from selecting their own personal goals for therapy.
Here are some general recommendations from the authors for talking with children:
Verbal messages: Use words that the child will understand, depending on their age. Talk about how the child feels about the session and their goals. Use language that is “realistic, empathetic, encouraging and responsive”.
Nonverbal messages: Avoid using a “sing-song” voice, speaking loudly or overbearingly, and interjecting while listening. Instead, make eye contact with the child, and use a calm, positive tone of voice. Use facial expressions and body language to show that you are interested and enthusiastic about the session. Take time to listen to your patient and pause to wait for their responses.
Autonomy: Giving children choices and listening to their perspectives
“There are a few things you’ve mentioned you’d like to do; what do you want to do the most?”
“What do you think might happen if…?”
“How are you going to do it?”
Relatedness: Empathetic listening, feedback
“It seems like this is hard for you….”
“Let’s see if we can figure this out together”
“Who can help you work on this?”
Competence: Affirm a child’s abilities
“Oops, it didn’t work out. Let’s think about other ways/strategies”
“What skills will help you to do it?”
“What will make you feel you can do it?”
I’ve summarized some general recommendations from Ziviani et al. by age:
Age 4: Try to match the child’s sentence length (avg. 4 words). Listen for descriptive words that the child uses and incorporate them into how you describe the therapy. Respect the child’s desire for independence. Understand that these children will become frustrated easily if they cannot accomplish a goal.
Age 5: Offer choices, and help the child find words for their emotions.
Age 6: Adult expectations influence the child’s self perception. Ask the child for explanations or directions, and ask about their feelings.
Age 7: The child describes personal experiences and understands 5-step directions. Use complex tasks and mirror the child’s developing gestures.
Age 8: The child is beginning to compare themselves to other children and seek social acceptance. Involve child in goal planning discussion and peer engagement.
Age 9-10: Use humor to make therapy more interesting.
Age 11-12: The child is developing responsibility and self-reflection. Encourage them to think about their behavior, thoughts and emotions, and to take more responsibility. Here are some specific phrases that Ziviani et al. suggest using. They are tailored to three psychological needs of a child: Autonomy, Relatedness and Competence (ARC).
We all want to feel like we are making choices in our care. We want to feel heard, and we need genuine encouragement. Kids need the same. There’s no need to fear.