SWRK20630: Student Task by Staines, Daniel

Practice Tips

2021-04-08 10:18:12 UTC

To be able to use the right body language dependent on the child's age. I learnt the importance of this through an example of a time when I'd introduced myself whilst standing tall over the patient rather than getting down to their level.

Background

2021-04-09 14:46:10 UTC

I spent ages trying to distract and engage with a distressed child once after a low impact car accident ... I assumed that the child must be in real pain or shock because I just wasn’t able to distract or engage with them (even despite my mad blowing the candle out using a pupil torch skills). Later on in the job I found out this is normal behaviour for the child due to a history of autism. I learned I should ask if any such conditions early on to gauge whats normal.

Distraction

2021-04-09 15:26:33 UTC

I have found children in their own home environment are far more settled and cooperative then out of their secure comfort zone.
If whilst at home they are distressed by your presence it is easier to let them play with their toys or do as they wish in comfort and become more comfortable and relaxed with you being in their home before any assessment is completed. A big part of a child’s assessment is history gained from the parents/guardian.
If a child is willing to play and be distracted then initial clinical impression is not to worrying. That being said doesn’t mean they are not poorly. I have no problem with being paid to play with kids toys 🤣
I feel having young children myself gives me a head start in engagement and adaptability, and ultimately if they don’t like me hopefully they will like my crew mate, he does look funny! Sorry Nick.
That being said if all else fails and they’re too distressed they get the assessment at A&E.

Engagement

2021-04-09 16:35:31 UTC

As mentioned above I definitely feel children are easier to assess when they are in the comforts of their own home, this being said I've also found that the parent/guardian can also be a source of anxiety for the child if they themselves are stressed/anxious. By reassuring them and calming the environment I often find this settles the child as well.
I also find that if the child is anxious about you coming near them, mimicking the assessment you wish to conduct on their favourite toy or parent often reassures them, or even get the parent to take their temperature if they are really upset by you being there. Generally making everything a game for them to engage in seems to help, and rewarding them for their engagement (baloon glove, vomit bowl hat😂).

Out of hospital paediatrics

2021-04-09 21:28:45 UTC

In the past I had been eager to start hands on assessment of the child prior to gaining a full history off the parents.

Spend time gaining initial history off parents prior to any hands on assessment if after initial eyeballing of patient they don't appear 'big sick' from the patient assessment triangle.
Ask the parents what is normal for the child is crucial.
Take heed of the parental concern for the patient if even the patients appears well.
Although comprehensive history taking is often easiest from the parents I've often been surprised by what the child has been able to tell me if communication is optimised.

I've found the 3 minute toolkit on Spotting the Sick Child (2020) very useful. I still struggle with estimating a child's age from appearance and I guess only further experience will assist with improving that.

Because symptoms in paediatrics are often vague/non-specific such as vomiting/pyrexia physical examination plays a larger part in diagnosis compared to adults (Spotting the Sick Child, 2020).

I've learnt as I've grown in knowledge and confidence as a clinician that paediatrics can have complex physiology. Limitations of my practice in relation to assessment/treatment mean I have a very low threshold for referral for paediatrition review as per the EMAS (2020) paediatric clinical care policy.

References

Spotting the Sick Child, 2020. Spotting the Sick Child [Online]. 4th ed. Available at https://spottingthesickchild.com/ [Accessed 9 April 2021].

EMAS (East Midlands Ambulance Service), 2020. Paediatric clinical care policy [online from company intranet]. Intranet/Library (EMAS public drive) East Midlands Ambulance Service. Available at: https://www.emas.nhs.uk/insite/policies-and-procedures/policies/PaediatricCarePolicy.pdf [Accessed 9 April 2021].

Tips

2021-04-10 04:09:08 UTC

Stickers and colouring in sheets have been proven to be of some success for those who are able to and where parents have consented, often a sticker post each assessment can sometimes help with encouragement. Also i find using my stethoscope to count respiration is of great help at times and can also listen to the chest at the same time. I find using my stethoscope is of better help at times and listening posterior while they cuddle parent works well for the biggest majority. (Obviously each situation is different) but I find this helpful.
Distraction techniques.

Good History

2021-04-10 14:57:41 UTC

Children compensate very well, it is a true saying “they are ok one moment, then fall off a cliff edge”. Even when observations appear to be stable, a good history taking will help try and establish between big sick / little sick. Trust your instincts and treat /assess each child individually.

2021-04-11 10:20:37 UTC

I use a catheter mount attached to a nebuliser to reduce the noise made whilt administering salbutamol or ipratropium. And it mean it can be held flat too

2021-04-11 10:21:48 UTC

I always hae stickers in my pocket, best £3 spent. Also the classical glove balloons and pretending to assess a favourite Teddy or toy I find helps

Child assessment

2021-04-11 16:52:08 UTC

I have found asking your crew mate to do anything that may potentially upset the child is good, such as taking BM as they will be in the driving seat, the attending clinician makes a better rapport and the child always remember the one that hurt them.

I also back stickers, children seem to love them. Also something as simple as an NHS ballon aka a blown up glove, can entertain the child for a while especially babies.

When auscultating the child’s chest, I sometimes put the stethoscope on their head first and pretend I am listening to their thoughts, this makes them laugh and I have found puts some trust in you.

If they appear well I don’t go straight in for obs, having a play with them first and chatting to them makes them feel more at ease with you, and I always ask their permission if I can do obs, child or not they should still be asked for permission.

2021-04-11 20:46:20 UTC

Always try and avoid babies crying during BMs by tickling their toes before/after and distracting them with a toy - works a treat. Always got stickers in my pocket for if they're older

2021-04-11 20:47:53 UTC

Reassuring parents - Happy Parent = Happy Child

Always strip the child off

2021-04-12 10:28:56 UTC

I ensure I ALWAYS strip children down to their nappies/underwear! This way I never miss any rash’s or bruising. Also this technique exposes the child so that you can easily see their respiratory efforts.

2021-04-12 18:22:15 UTC

I always try to get the patent’s parent/care provider involved in assisting with any OBS or intervention. The child is more likely to accept a paed pulse sensor, tympanic thermometer, light shone in eyes, Calpol administration when it’s from someone they know and trust.

2021-09-15 14:00:30 UTC

So far I’ve learnt that when attending a child if they are laid quiet and lethargic 9/10 times they are poorly. Try and be very specific with the questions to the parents as a child can go downhill very quickly and we need to be aware of how fats the changes to the child have happened etc.

Always talk to the parents and the child if they are upbeat and happy playing. engage with the child just as much it’s important you build both the child’s and parents trust. If the child isn’t too sick and they have siblings engage in conversation with them as well usually if their siblings aren’t worried or scared of the people all dressed in green the child will feel more laid back.

Children will always be very inquisitive particularly if they are older and are not the patients. Be open with them( within reason) and explain what is happening. Particularly your older children they are more intelligent than you think

2021-09-15 14:02:35 UTC

Don’t forget if the child is over the age of two and healthy enough sometimes if you can get them to be seen by their GP that day or other suitable health places it saves many families the trouble travelling to the hospital particularly if it’s one parent and several children

2021-09-15 15:12:34 UTC

Engage with the child on their level, get down on the floor so that you aren’t standing over them as this can be intimidating. If they are well enough, try and talk to them about their likes and dislikes - favourite toys or characters as this can allow you to build trust with the child and they are more likely to be cooperative with your assessment. It can also be helpful to try and involve the child in the assessment, let them help with things where possible and distract them with things like the light on a sats probe as this can make gaining observations easier for both crew and patient.

2021-09-15 18:56:34 UTC

Don't stand over them, if they are sat down get down to their level. Maybe let their parent/carer do a lot of the hands on care if they are wary. Use softer voice

2021-09-15 19:26:36 UTC

It’s important to get down to the child’s level and make sure you’re smiling (it’s hard through a mask but possible to smile through your eyes). This helps you appear less intimidating. Use the child’s name, keep eye contact (not too intense) and keep reassuring them to put them at ease. Let them have a part in what you’re doing, even as simple as letting them play with your stethoscope, it also helps in relaxing them. Phrase instructions as “helping” e.g “can you help me by staying still?” Be realistic but also upbeat, don’t lie to the child and tell them it won’t hurt say… “this’ll probably hurt just a bit”, keep stickers in your pockets to reward them after the job. This will make it easier if they ever have another ambulance in the future as they would’ve had a positive experience. Finally, don’t be afraid to speak to the child. As you would with any patient discuss any interests using the room as clues, this definitely helps if you have your own children or younger siblings as you’re more up to beat with things.

2021-09-15 19:32:01 UTC

Get down to their level rather than talk down to them, talk to them in simple words that only they would understand, if they take interest in a particular piece of equipment such as a stethoscope, allow them to have a look. When taking sats, if child is scared of the probe, try it on mother first so they can see it doesn’t hurt

2021-09-15 19:59:36 UTC

I try and engage with them through their toys, so if they are nervous about something being done for example their temperature, then I’ll pretend I’m taking their teddy’s temperature, or I’ll take mums temperature for example. Get down to their level, talk in a silly voice, smile.

2021-09-15 20:01:43 UTC

I also do tricks for example with my pen torch, I’ll pretend I’m blowing it out, or blowing on it & it lights up. Sounds a bit stupid but trust me it gets them really interested!! Had a kid once that was being a bit shy etc. Showed them that ‘trick’ and then gave them my pen torch, they were fascinated for ages & after that they really came out of their shell!

With older children I think it's really important to ask them to explain how they feel or what they think is wrong with them to avoid parents putting words in their mouths. (Although, you can always get more information from the parents!)

2021-09-15 21:41:46 UTC

2021-09-16 11:19:10 UTC

When taking a child’s temperature I ask them to think of a number and say that I’m scanning their brain to guess what it is and that the beep is the answer coming through. Then we laugh when the answer is wrong and I say they’ve got a magic mind to beat the machine.

2021-09-16 13:00:26 UTC

Get down to their level and let them play with equipment to get comfortable with it. Allow them to choose what examination to do next so they feel in control. Involve care givers to build more trust

2021-09-30 13:41:47 UTC

After a visual inspection of the child, I try and play with them as a friend, with toys, books, noises, I like to use distractions such as tissues and peek a boo. Sometimes if they create with having their temp taken, I will do it to mummy/daddy or myself first so they can see it’s not scary.

Taking a BM

2021-10-03 17:32:58 UTC

Always take a BM on a sick/unwell child due to the underdeveloped organs and capacity for glycogen storage, children don't compensate!

One trick I've found useful is after engaging with the child and noticing they like Dinosaurs, Superheros, Princesses etc to ask for a tiny spot of blood to check how much Dinosaurs blood they have, or how many princess points they have. I've found children really engage with this well!

Oh wow! 6.4 dinosaur levels, I bet you've got a real loud ROAR! Give me a big roar!

Relating to the child

2026-01-13 13:03:15 UTC

If you notice reference to any tv shows or characters bond with the child over this .