Dr. Ni Putu Siadi Purniti, Sp.

A(K)
 Children : Growth and development

Limitation
of interaction with
environment

Limitation of communication

Clinicians : difficulty in
communicating information at
the appropriate developmental
level
 Dual Patient

Patient Clinicians
 Multi Patient

Clinicians

Parents
Grand mother/father
Babysiter, etc Children
TALKING WITH PARENTS
 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
 The parents story should be facilitated
by empathetic responses.

Avoid : interruptions, subject changes,

judgmental comments, and not make
prematurely diagnostic.
a. Elicit the reasons for the parents for the
visit (main complain)
b. Elicit the parents expectations for the visit

c. Guide but do not dominate the discourse

Fundamental four dan Sacred

seven
 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
 During a acute illness, the interview
must be focused
High fever, seizure
Ask : How did you handle that?
 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
 The parents : need explain about illness
of the child, diagnose, cause and how to
manage

Advice giving and counseling can be

giving continuing process :
the first mention, during the physical
examination and at the end of the visit
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.
1. In hospitalized children : Reduce
surgical morbidity and improve
physiologic and behavioral
outcomes
2. Health educations programs
3. Improved coping with disease,
fewer days of school missed, and
better functional health status
 Clinician
should be
concern of growth and
development
Exp: malnutrition, look
anemia, weakness , child
not eye contact, hyperactive
etc

Support diagnose
Children go to Hospital stress

defence mechanism

Coping

Def : as emotional, cognitive, or

behavioral efforts to alleviate
stress
Coping :
1. Direct efforts to modify the sources of
problems
Exp: running away or hiding

2. Internal strategies
Exp: The childs belief that he is not very
sick
1. Under age 5 years
Use direct behavioral coping
(running away)

2. Age 5-9 years

Use more sophisticated direct strategies
e.g . the doctor that the medicine tastes bad
3. Over age 9 years
Use more internal coping strategies, such
as distraction and reframing a problem

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
Table 2. 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 childs understanding
of the reason for the visit
A Agenda Set an agenda early in the visit to help ensure that the
parents concerns are addressed
C Control Help the child feel control over the visit (e.g. 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
childs 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; reinforce the childs jobs
related to health care; explore any potential problems in
the plan with the child and parent
THE PIAGETIAN STAGES
OF COGNITIVE
DEVELOPMENT
1. 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 childs condition will
be reassuring to the parent
2. 2-6 Years old (preoperational stages)

Children confuse cause and effect

They focus on the perceptual salience, 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 clinicians
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 adolescents

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