How do you act around kids?
January 13, 2010 10:12 AM   Subscribe

I'm starting a pediatric rotation next week for nursing school, and I have pretty much no experience with children. Do you have any tips for a nurse dealing with kids of any age between 1 and 18?

I'll be spending half my time in schools (elementary and high school) doing preventive and educational work, and half my time on a general floor in a children's hospital (with patients from 1 year old up to 18).

While I did well in my developmental psych class, I've forgotten a lot of the material in the 18 months since I took it. And I have very little experience interacting with children: I never babysat, never had younger siblings/cousins/family friends to look after, never had close friends with a kid, obviously have no kids of my own.

I'm really nervous, because I don't know how to act around children. To me, they are confusing, non-rational beings who might explode without warning at any minute. I'm nervous even when I'm around children in a non-healthcare setting (like when friends of friends bring their 5-year-old to a group picnic); the thought of dealing with kids in a setting where they're sick, and people like me might do something painful to them, makes me even more nervous.

So, all you parents and nurses and pediatricians and childcare providers and teenagers: please give me any ideas you have for me, as a student nurse, on how to interact with kids and/or teens in the age ranges you know best. How can I make them less afraid? How can I be fun without being too cheesy? What else should I be aware of and do?
posted by vytae to Human Relations (30 answers total) 18 users marked this as a favorite
What were you like when you were a kid? What would you be like if you were in their position? If someone came near you very quickly, saying things you didn't understand or doing things that looked scary, what would you do? Same with someone speaking to you like you didn't understand.

Putting yourself in their shoes is a good start.
posted by Madamina at 10:21 AM on January 13, 2010

Get down to their level physically when you talk to them and look them in the eye.

Do not patronize them or talk to them in a sing-song voice. Talk to them like you would anyone else, but be prepared for their attention to wander. Repetition is your friend.

Distraction is often the best way to soothe a scared child.

Fun: if you have those cushioned tables with the paper you pull across them for each new patient, have some crayons with you. Kids like to draw on that paper because it feels like they are doing something forbidden. Tongue depressors and gloves, if you can get extras without getting in trouble, make drumsticks and puppet/balloon (let the kid do it, or the parent, because if you make a puppet or a balloon it probably will seem cheesy, since you're a stranger).

If you can find scrubs or whatever they call the headcover thing in slightly whimsical patterns, like Spongebob, younger kids will warm to you as well.
posted by misha at 10:23 AM on January 13, 2010 [1 favorite]

Seconding getting to a position where you can look them in the eye (either by bringing them up or you down), and especially seconding the getting them to "help" you suggestion. There is a world of difference between saying to a little kid "You need to sit still" and "I need you to help me out by being really still." In the first case you're telling them what to do, in the second case they're being helpful to the grownup doctor person!

And smile. Walk in smiling. Introduce yourself and make an attempt to shake their hand, though some of the little ones will be too shy, in which case just drop it. Also, kids love high fives, if that's feasible for hygiene purposes.
posted by brainmouse at 10:28 AM on January 13, 2010 [1 favorite]

I remember feeling just the way you do when I started interviewing children (about sexual asault, usually -- just the thing a child wants to tell a stranger about!)

First, remember you do have a base of knowledge: your own childhood. Dealing with kids will remind you of yourself at their age, and you will remember lots about how you saw the world.

Second, remember that the younger the child, the more the following will be true:

1) the cild will think in very concrete terms. Abstract ideas, including time, don't make sense to children. So talk in straightforward terms . . . this will be really quick rather than this will only take a few minutes, for example.

2) Children have a hard time distinguishing real and not real -- talking about whether something really happened or is make believe can help, for example, before you take a history.

3) Children up to age 25, don't have a big sense of consequences. For example, they have trouble understanding that doing something is not in their own self interest. It is easier to explain that something will make the child feel sick or get sick than to explain, for example, why sugary soda can cause disease.

If you are friendly, use simple language, are concrete in what you say, and remember to ask about the things the child likes or is interested in (do you like movies? what is your favorite movie? What is your favorite TV show? Who do you like best on that show? What is your favorite thing to do in school?) you'll do great.

You may also want to cart some things kids enjoy playing with or that are OK for them to eat.

Have fun . . .kids are actually great and wonderful to work with.
posted by bearwife at 10:30 AM on January 13, 2010 [1 favorite]

Please talk to the child. Ask him/her what's wrong before you ask the parent. My kids get so annoyed, and have since they were little, when they feel like they're being marginalized. They can tell you where it hurts. If they can't, they'll look at their parent for help. But please, give them the chance to answer for themselves.

Smile more than you think you should. Be calm. Take a deep breath before you go into the room and put a smile on your face before you open the door.

Assume they're going to be frightened. Knowledge is power. Explain everything you're doing, especially to younger kids.

On preview, I love everything misha wrote. Learn how to make balloons out of the rubber gloves. You don't have to that for every kid, but I remember once when my daughter, who is totally and thoroughly needle-phobic, had to get a blood draw. She was hysterical. One of the nurses blew up a rubber glove and it really distracted her quite well.
posted by cooker girl at 10:32 AM on January 13, 2010 [2 favorites]

My experience as a parent is pretty limited, but I am going to chuck it in. My experience only addresses the inpatient/children's hospital aspect of the very young, i.e. pre-verbal kids. I lived with my daughter inpatient for say 15-20 days of every 30 for a few months, and here are some "DO's"

- Introduce yourself to the parents, and tell them exactly what your role in the child's care will be. (Note on preview: not contradicting cooker girl's advice. I am only really able to tell you what I think for pre-verbal kids, I defer for older kids).

- Just like you would tell a verbal patient what you are going to do before you do it, tell the parent. And generally, ask permission to do anything before you do it. It doesn't have to be super formal, just info-giving. I've seen something like "Hi, my name is vytae and I am a student nurse. I will be observing and assisting today. May I go ahead and do a vital signs check on your daughter?"

- Wear something shiny, bright colors, or fun around your neck, like with your ID clip. Be prepared to use it sort of a distraction toy.

- Be gentle, use gentle tones, be honest when something is going to hurt/be unpleasant for the baby, and ask the parents to help in terms of soothing the child or preparing the child. Smile.

-Know the child's name when you walk in the room, and address the child by name. It realllllllly makes it seem more like you care.

-Listen, and take symptoms/problems reported by parents seriously. Don't blow them off.

Our absolutely favorite nurse for our daughter, who has become a family friend, was nursing her when we first got the cancer diagnosis. She was SO kind to our daughter, held her, cuddled her, brought her a little toy. You don't have to go all out for every patient, but you've got to be kind. I think obviously all nurses take that to heart, but I do think it is especially important with pediatrics.
posted by bunnycup at 10:40 AM on January 13, 2010

My kids love the PA they see when they're sick. She talks to them like they're grown-up, asks them about school and then really listens to their answers, and she's up-front and honest about what's about to happen. She doesn't talk about them as though they aren't there. Her last diagnosis was "Well, Lily, you have tonsilitis again. You and I and your mom probably need to talk about getting your tonsils out."

I deal with teens all day, and can offer some advice there, too. Basically, treat them like adults. I know that patient confidentiality with minors is a sticky subject, but if they confide in you & ask you not to tell their parents, you should try to convince them to tell the parents themselves, and offer to join the conversation. Teens are very fickle with trust, so don't take it lightly.

Also, generally, have a sense of humor, don't take yourself too seriously, don't raise your voice.
posted by SamanthaK at 10:40 AM on January 13, 2010

I'm not a doctor, but I am a mom who takes her daughter to the doctor, so this is coming from that experience.

When you enter the room with the child, greet the child first, *then* the parent. This keeps the kid feeling in the loop.

When you run diagnostics, even temperature and heart rate, give the child feedback on what you got -- "Wow, your heart is nice and strong!" "98.4, no fever, that's great!" Actually, tell the kid what you're doing, how it works, explain the whole deal -- "This is called a stethoscope; it's for listening to things inside your body, like your heart and your breathing. The sounds your body makes can tell me a lot about how things are working." "I'm going to poke and prod you a bit now; I'm feeling your tummy to make sure nothing in there feels weird." "OK, now I have to look at your bottom, because your bottom is part of your body and I want to make sure your whole body is healthy. (Mom|Dad), do you want to come over here for this part?"

Make sure to look at and address the child while you do this, even if she's pre-verbal. Receptive language comes before expressive language, and understanding of nonverbal cues like eye contact and tone of voice comes even before that. The key here is to make the kid feel respected and informed to the best of his cognitive ability. If he looks confused or scared at any point, try to back off and ask if there's anything else he'd like to know, unless it's something like a blood draw or a rectal exam that frankly is never going to be fun.

Overall, remember that the child is your patient, and the parent is the patient advocate. When kids feel like the doctor is only talking to the parent, they get weirded out, and pretty rightfully so.
posted by KathrynT at 10:46 AM on January 13, 2010

For younger kids, say up to about age 12:

Start sentences with their names. "Sasha, what do you think about this?" is better than "What do you think?" or "What do you think, Sasha?"

Make eye contact more than you would with adults.

Respect their personal space- I used to hate it when adults put their huge faces in my face when they talked to me. Know especially that if a kid is getting angry, the amount of space they want around their own face will increase (this is pretty instinctive, adults are like this too).

For little kids, say under 6:

Offer choices. "Sasha, would you like to drink apple juice, or milk, or water?" is better than "What do you want to drink?"

Pretend to be dumber than you are- little kids like it when they know more than adults. If a kid is being shy, for instance, you could pretend to ignore them but do something silly near them, like pick up a teacup and mumble to yourself, "Is this a hat?" and try to put it on your head. Once the kid giggles, you're in.
posted by pseudostrabismus at 10:55 AM on January 13, 2010 [1 favorite]

Lots of good tips here so far.
I would add:
Use their name, and talk to the child first rather than the parent (for kids older than, say 3 or so), it makes them feel important and gets them on your side right away.

Be relaxed. Just like a horse, a child will feel your apprehension and sense your mood.

Make eye contact, compliment their clothes, talk about the thing that they have brought along (most kids carry something for comfort, a toy, a stuffed animal, a book, etc).

You will also go a long way toward impressing the doc if you have made his job easier by relaxing the child. you don't have to impress these patients with knowledge, just with kindness, empathy and a calm.

Good luck.
posted by OHenryPacey at 11:01 AM on January 13, 2010

You're getting lots of little kid advice, so I'm going to give you some older kid advice too:

[add "in general" to the beginning of all of these sentences, but I'm going to pretend that you can talk about these things in universals...]

Teenagers do not like being talked down to. At all. Talk to them as if they were adults. Don't talk slow, don't do the big obvious voice goes up at the end thing. For the love of god don't ever call them "sweetie" or "cowboy" or anything like that. As with the little kids, explain what you're doing, but don't patronize. You can say "I'm going to do X, do you know what that means?" and then if they say yes say great and if they say no then explain more. But if you treat them -- or at least SEEM to be treating them -- fully like adults, they will appreciate it.

I would act differently around kids who seem to be really shy, being a bit more... coddly, but in general, I would start with the treating them like adults thing.
posted by brainmouse at 11:06 AM on January 13, 2010

When I used to have to draw blood from kids, there were a few things that invariably made the process easier:

1) Squat. I know other people have suggested this, but it cannot be stressed enough. Looking the kid in the eye will make everything else easier.

2) Speak to the child as if they are an adult. Use your regular old speaking voice, and try to engage them in conversation. This is just another way of letting them know you are on their level, like #1. I always found that using any kind of 'baby talk' lets the kid know that they can act like a baby because you expect them to. If they can, they will.

3) Tell them if you are going to hurt them. If you surprise them with a shot or something else painful they will probably freak out. A freaked-out kid will freak you out, and the kid's parents, and other kids. Bad scene.

One way to avoid the needle freak-out situation is to look at the kid's chart and find out exactly how old they are, then tell them that whatever age they are is old and well experienced. For instance, say the kid is 6, you'd say, "Hey, how old are you? 4, 5?" The kid replies, somewhat indignantly, "6!" Then you say, "Oh, 6! Well, this is going to be nothing, then. If you were 5 then we might have a problem, but since you're 6 you're old enough handle pretty much anything, don't you think?" The kid will almost always agree with you on this point, because it makes them feel old and strong. Then you can go about your business, making sure to keep talking to the kid and maintaining casual eye contact. I swear, this was the best trick I ever came up with for dealing with kids.

Remember, kids will look to you for cues about how to behave. If another adult is around that they know better than you, they will look to that person for cues as well. If you are the one with a job to do though, you cannot let a nearby nervous parent body-language the kid into an unmanageable heap. You need to be in charge of the situation to get your job done. A child will see you as the authority figure you are if you act the part, but they will also see if you are a nervous, hand-wringing basket-case, too, and they will act on that.

Lastly, 4) Some kids are just going to have a melt-down, that's all there is to that. It's nobody's fault, it just happens. Do your thing as quickly and efficiently as you can and hand the kid back to the parent they came in with and get on with your day. Don't waste your time feeling guilty about it, it happens.

Kids are actually a lot of fun to work with. They can be scary, sure, because they are small and fast and do stupid things in rapid-fire succession; but they are also funny and cute and a lot more insightful than people give them credit for. I understand why you are nervous, but this will very probably be something you really enjoy, in the end. Good luck.
posted by Pecinpah at 11:11 AM on January 13, 2010 [3 favorites]

Make sure you know your state's laws on minors' consent.
posted by Stewriffic at 11:28 AM on January 13, 2010

For younger kids:

1. Tell them what you're doing every step of the way. KathrynT's advice on that was really good...constantly saying "Now, I'm going to use ___ to do ____" or telling them what kinds of results you're seeing. It will give you somewhere to channel whatever nerves you have and will also let them know what you're doing.

2. Let them talk!!! Preferably not about anything relating to their health. And not just about school/what they want to be when they grow up...what their favorite ice cream is, if they have any pets, one place in the world they want to visit. IME, little kids love the opportunity to talk about random things about themselves and it gets their mind off of what you're doing or why they're there.
posted by kro at 11:31 AM on January 13, 2010

I'm a parent and a former nanny. The best advice I can give you is -- don't treat them like children. Don't condescend, and do treat them with respect. Talk to them pretty much the same way you would any adult you had just met. Don't lie to them, and do explain to them your reasons for doing things. Children are a lot smarter than most people ever give them credit for.

Also, the younger ones love toilet humor. Anything to do with the word poop will make them smile. I know, it sounds silly and may unprofessional, but that sort of thing shows them you're a human being, not a scary authority figure.

With teenagers, treat them like adults. You may be the only adult in their life that does that, and they will love you for it. Don't ever try to be cool, they will think less of you for it.

And as an example of the kind of thing most people do without thinking: unless they're very, very young, instead of saying "Do you want Mommy to be in here with us?", say "Do you want your mom to be in here with us?"
posted by fairywench at 11:44 AM on January 13, 2010

One bit of advice for squirmy pre-verbal children, if you can't get something done and it's not 100% necessary, give it up after three tries.

Baby Zizzle at one of his appointments just would not let the nurse practitioner look in his ears. Partly he was enthralled by the scope, partly he just wasn't in the mood. After three good efforts and it was clear he would just not cooperate, she moved on to something else and did it later. Knowing how he was behaving at the moment, if she had kept trying to look in his ears, it would have spelled disaster. So, if it's something that you don't need to do at the moment and the kid isn't cooperating and isn't old enough to understand how to cooperate, just move on to the next thing and try later.
posted by zizzle at 12:29 PM on January 13, 2010

Kids like to know why. Have a long list of answers to why questions.

You: "Okay Sammy, I am going to poke you with this needle so that we can put medicine right into your body. It's called an IV and it will only hurt for just a second, but I'm going to need you to hold really still. Here, can you hold my stethoscope so I don't drop it?"

Sammy: "Why do you have to poke me, why can't I just drink the medicine?"

You: "Well Sammy, first of all this medicine tastes really gross. Second, if we put it right into your arm it will make you feel better faster because it will go right into your blood instead of into your tummy first."

Sammy: "Why does it have to go in my blood?"

You: "Your blood will carry the medicine through your veins just like a truck on the highway. When I put the medicine in your arm we're just loading up the trucks."

This example is using language for a 3-8 year old. Older than that you can use bigger words. Try to think of analogies that make sense to a kid. Real world examples that they will understand.

Don't be surprised if a child with serious medical problems knows your job better than you do. Especially the teenagers. They will probably know all the ins and outs of being hospitalized. With the older kids it might be in your favor to tell them that you are new at working with kids and ask them how you're doing. They will probably give you some good feedback and it will help diffuse the situation.
posted by TooFewShoes at 12:44 PM on January 13, 2010 [1 favorite]

Be cheerful. Even when I was 20 and had to have my first surgery (a major operation), the pre-op nurses being very smiley and cheerful made a huge difference to me.

If you have to give them a shot, have them blow like they're blowing bubbles while you give the shot. It works.

If you go to check on a patient and they're in the playroom, and you get to go to the playroom to talk to them, try to play a little bit (even if it's just for a minute) and enjoy yourself. It might help your anxiety.

I loved my peds rotation in nursing school. I really can't give you any advice on teenagers because by luck of the draw I just somehow ended up with all kids under 10.
posted by IndigoRain at 1:24 PM on January 13, 2010

Almost all of this is great advice. I'd also add just one thing that may help you on the anxiety front:

Remember, when it comes right down to it, kids are just people. (I'm not being facetious; it's amazing how easy it is to forget this principle when encountering a group of people one doesn't have experience with). Children are unusually small people with relatively less life experience, but they are people. So if you find yourself uncertain what to do, think about what you would do for any other person, and do that. This general principle explains most of the advice here: don't be condescending. Explain things. Be calm. Get on their level. And it should be somewhat reassuring to you, too: after all, you have tons of experience dealing with people!
posted by forza at 1:29 PM on January 13, 2010

Oh, and I thought of a good trick. If you're dealing with kids younger than, say, 8 or so, it almost always helps to be "silly." Kids this age love silliness, as long as you play it so they're in on the joke rather than believing you're playing one on them. And you can make any situation silly. For instance, say you have to take a kid's blood pressure, you could introduce the blood pressure cuff as Mr. Huggy, and say he is a magical cuff: he likes to hug kids' arms and this tells doctors important information. Then make him do a little animated dance as you walk him over to the kids' arm, and enlist the kid's aid in making Mr. Huggy happy.

Obviously, this doesn't work for older kids, but very young ones love general silliness like this. Also, enlisting them to help you can do wonders for getting them to be agreeable.
posted by forza at 1:34 PM on January 13, 2010

All the advice here looks great! Something I haven't seen mentioned yet: Does the children's hospital you'll be working at have a Child Life department? If so, you'll likely see and work with Child Life Specialists. They are trained to help children and their families cope with hospitals stays, treatment, medical challenges, etc. You might want to see if you can chat briefly with someone from the department.
posted by wiskunde at 2:01 PM on January 13, 2010

Forza: This is good advice, but occasionally, it can backfire on you. A friend of mine had a 7 year old son with extremely severe tonsillitis that required a few days in the hospital, and when the nurse said "This is the blood pressure cuff, it's going to give your arm a hug," Patrick said "OH PLEASE." So sometimes you have to kind of wing it, particularly if you have a patient who has spent a lot of time in medical settings already.
posted by KathrynT at 2:06 PM on January 13, 2010

One more thought about something you didn't ask about . . . after I had worked with kids for a few years, I started worrying about all the kids I saw in normal life. I would wonder if they were being abused. So then I started hanging around with the younger folks (infant to 15 was the age range then) at family fathering and doing some Big Sister stuff, to remind myself there are lots of healthy kids in the world. Surprise, I discovered I really enjoyed kids!

Anyway,I also suggest you take care of yourself . . . hang with some regular kids too, not just sick or potentially sick kids. You'll enjoy it, honest.
posted by bearwife at 2:33 PM on January 13, 2010 [1 favorite]

Don't offer them a choice if there really isn't one.

Example: "Susie, can I give you this shot now?" When Susie says "NO", you're stuck. (As it were.)

I'm also in my peds clinical for nursing school right now, and I also have very little experience with kids, and I'm having a blast!
posted by shiny blue object at 3:29 PM on January 13, 2010

Small tip which a paediatric nurse taught me -- when you give kids liquid medicines, angle the syringe into the side of their mouth, toward their cheek, not straight toward the back of their mouth. They don't choke on it and they feel better about it in general because they get to choose when to swallow.
posted by AmbroseChapel at 6:59 PM on January 13, 2010

Oh, and a personal gripe, but you might as well hear it -- my little boy had to have an IV recently. The doctor and nurse moved him into the procedure room, and I swear to god, spent the next eight to ten minutes faffing about looking for the right needles and tubes, and oh, where's that sticky-tape gone, have we got a number three bandage? Number two? Maybe there's some number three in that cupboard over there, not that cupboard, the other one.

He had a three-minute procedure, but he spent nearly fifteen minutes in that room, most of it just nervous waiting.

So please, I'm sure you're not like that, but it would be a really good idea to have your ducks in a row before you take the patient into the Room Of Pain.
posted by AmbroseChapel at 7:06 PM on January 13, 2010

From a (somewhat) experienced nurse:
-Your absolute best resource is your preceptor/mentor. Look to them to see how they interact with the kids and the parents. Ask for feedback and accept it, then act on it.
-Parents can sometimes be a nuisance. You will have at least one set during your clinical that will freak out at you or just make you feel bad. Try to remember, even if they seem nuts, that they are in a bad situation and might take it out on anyone near by.
-If you can, let younger children handle the medical equipment. If they touch it and it doesn't hurt or bite, they will trust it more. For instance, let them hold the BP cuff or the bulb for a bit to get used to it. Obviously don't do this with sharps, etc.
-The most important part of the child psych/development class that you should review are Piaget's stages of human development. They are by no means fool-proof or true for all kids, but they will give you a much better idea of how each age group experiences illness. It can at least help you with your plan-of-care write up (instructors generally love it when you can come up with some answers involving nursing/psych theory during debriefing).

As per usual, feel free to me-mail me with any questions regarding this or nursing in general.
posted by nursegracer at 9:54 PM on January 13, 2010

Response by poster: It's great to hear from such a variety of perspectives, both parents and professionals. These ideas are all really interesting and useful, and have eased my mind a lot. I'm off to review Piaget and practice balancing non-hat things on my head -- thanks to everyone!
posted by vytae at 7:41 PM on January 14, 2010

Ack, re-reading this, I realize I meant to put down Erikson's stages, not Piaget's, although they are both pretty helpful to consider from a theoretical perspective.
posted by nursegracer at 6:44 PM on January 29, 2010

Response by poster: Don't worry, nursegracer -- it turns out they had us reading lots about both Erikson and Piaget for the first week of the semester.

Thanks again to everyone for the great suggestions. I've already had great success with finding ways for kids to "help" by holding things, and by offering choices whenever they are available. And it turns out it feels way more normal to talk to kids at eye level anyway, so that one's a cinch. You guys are the best.
posted by vytae at 3:53 PM on January 31, 2010

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