Monday, 4 July 2011

Children are not mini adults...

...A survival guide for paediatrics.

1) If you look "different" in any way, children will ask questions about it, and parents will (for the most part) get embarrassed. You've probably come up against it at the supermarket already, but if you haven't, have a think about what to say to "why is that lady using a stick / chair? etc". Something simple such as "my legs don't work the same way as yours" works for younger children, and simply "I am disabled" for older.

Decide to what extent you will answer follow-up questions as well. To non-medics I tend to say that "I have a problem with my joints", and this seems to work fine with children. (Medics, I tend to tell what I have, purely because it's not well-known and I want more people to have at least heard of it!)

2) I try to be welcoming to questions and curiosity from kids, because I think that's it's a really good opportunity to de-mystify disability. If kids are staring, or parents get embarrassed, I tend to ask the wee ones what colour my stick is. It seems to open up some good conversations.

3) I did talk to a couple of parents who said it was really good for their disabled child to see a disabled medical student. I didn't know what to say to that, but it made me a bit happy. This isn't really a tip so much as something to bear in mind.

4) Depending on your life experiences, some of the issues that are raised in paediatrics may raise some difficult feelings. Recognising non-accidental injury, for example, will almost certainly be raised.The pictures shows a young girl of about 3, dressed in red, kneeling over
a baby, dressed in white, who is lying on the floor. The girl is playing
with a syringe (no needle though, don't worry!), and mum is watching
over them, her left wrist loosely bandaged by the wee doctor.
Picture by uncoolbob on flickr.

5) The MDT is highly valued within paediatrics, and specialist community nurses are the back bone of chronic disease management in kids. Depending on access issues, home visits may not be possible for you, but nurses often also run clinics from a hospital base, or are part of consultant-led clinics (e.g. diabetes clinic).

6) I found it really frustrating how much better coordinated childrens services are than adult. There's no easy answer to this, but it's not just you. Don't be afraid to voice these frustrations, because most paediatricians share it, because they see the anxiety that surrounds the transition between.

7) If you've not spent much time with babies before, and you're nervous around them, get the nurses to teach you how to change nappies / give bottle feeds. If you muck in, you'll get plenty of experience, and the nurses / auxillaries will love you. (If you like cuddles, barter one nappy change for one bottle feed like me!)

8) Spend time in the play room or with play therapists to hang out with some toddlers. Being able to make a child smile will make clinical exams so much easier - a relaxed child is way easier to examine, and a relaxed parent gives a better history. The easiest way to get a child on side is to say "who is that on your Tshirt? / what is your teddy's name? / what colour are your shoes? is that your favourite colour?". Always ask the child their name and age before (if they can't answer) asking the parent (unless they're very obviously 8 weeks old!).

9) But, if you choose to take this kind of hands on approach, remember : have a change of top around in case you get peed or puked on. (Or know where the scrubs live!)

10) Also, know your limits in terms of lifting babies / children. Don't hurt yourself (by lifting a particularly weighty, but tiny-looking 2y/o like me...) and really try not to drop them!


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  2. I would add - know what children of different ages will and won't understand/believe. As mentioned, if you have a visible difference you *will* get asked what about it and you need to have a sensible answer ready. For example, when asked about the scars on your arms (I know it's not a disability but it's an example I'm familiar with, so bear with me) you don't try to explain self injury to a two year old, and you don't brush off a twelve year old's enquiry with "oh, nothing".

    Working this example further, for small children I would recommend something along the lines of "I had an accident". For teenagers, particularly teenagers with m/h issues of their own, you need to be honest - "I was depressed when I was younger" or "I used to have some bad habits" is fine. Be aware that some kids will know more or will already recognise what they're asking about and just want to know whether you're going to be honest with them. Kids in hospital are often familiar with people using crutches or sticks for example, and may want more detail about your specific legs and why they don't work.

    If the parents are in the room when you answer questions of this kind, be aware of their reaction to what you're saying. It's best not to annoy them by saying something they think is inappropriate, but at the same time, your relationship with the child is important and will disintegrate if the child thinks you're lying to them or not taking them seriously.

    Oh, and remember - children will *always* ask about anything you don't want to talk about. Every time. In detail.

  3. Yeah, it's such a tricky one! And you're right, they just never stop asking questions...

    A kid on the train yesterday (maybe a year old) was reaching for my stick, and when I gave it him, he wouldn't let go. When I had to take it back he started crying, bless him!

    You just need a firm, convincing story that you can stick to in the face of interrogation. I think sometimes there's no harm in saying "I'd rather not talk about it" or "we're to talk about you not me". That works quite well with older kids, and it's possible to do without leaving them feeling alienated...