Dealing with kids

DillR

DillR

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How do you deal with a pt like this?

10 y/o f c/o Stomach pains, when I asked her to describe her pain all she could tell me was "it hurts and it won't stop" (x 10) I asked her to tell me where it hurt and she said "my stomach" and patted her belly. She couldn't tell me the last time she had a bowel movement and there was no trauma. That was all the information I could get out of her or the mother. The crew I was riding with found it pretty funny though. :glare:

It was a typical taxi ride but my question is: Do you guys have any tricks for obtaining information from kids?

Thanks :)
 
Put it in terms they understand (medical terminology is gonna be useless here) and try to establish a rapport with them. Talk to them about school, pop culture, anything but the current medical complaint. Slip a medical question in every once in a while. It's going to take a lot longer to get a good history than a typical adult.

Physical exam is extremely important in peds as well, at times more so than history.

As far as it being a taxi ride, why not medicate the kid? Just because they're not an adult is not good a reason to leave them in pain.
 
I always wonder what providers are thinking along those lines too. I had medics, (when I was BLS) that would talk families/parents into transporting via POV when the child had a severe lac, not bleeding any longer, but pt in severe pain. When I asked later I was told that it wasn't our job to treat pain. and they didn't want to make ED mad

When I became a medic I would give them IM morphine, or IN Fentanyl to take pain away. ED was always happy when patient wasn't screaming in pain.
 
Things I've learned about establishing a connection (or relationship or whatever) with kids

Don't lie to them. Lots of people lie because they think kids don't care or can't understand or can't handle whatever is going on. I understand it's sometimes necessary to omit information or not bring it up, but be honest when you do. Help them deal with it, if you have to. Kids will not trust a strange adult with a track record of lying to them. It doesnt' matter if you think you have a good reason, unfortunately.

Talk to them like a person. You wouldn't use a bunch of medical terms if you were talking to an adult, but you wouldn't talk in simple sentences the whole time either. Use your normal voice. You can probably use more medical terms than you'd think, anyhow. My students (who are hardly a bunch of honors kids) regularly startle me with the complex words they pick up and use.
 
Also remember what you think was just your everyday taxi call...that kids compensate VERY well.

There is no decompensating stage with children. They are good...good...still good.. then they can't handle it anymore and give up. It's a sudden drop not a gradual thing like adults.

Just be nice to them. Take their mind off it. An ambulance can be scary. Keep mom within eyesight.

We have a peds bag that has some stuffed animals in it along with our other peds supplies. It's amazing how much just kindness will do when trying to get them to talk about what hurts.

And not really in this case. But in more serious ones make sure you tell them that it isn't their fault they hurt. Or are sick.

I had a classmate who went on a clinical with a really bad off kid in a car accident. And the kid kept screaming "im sorry i promise ill be good i'll clean my room and everything.". It can be tough. No matter if it is your first kid call or millionth.
 
Yeah, I've had them apologize too.

Didn't see in the OP where the kid was actually seeming to be in distress or just reporting "times ten".

Have the pt draw a circle around where it hurts. If the circle includes the chin and the knees, have them "draw a littler one". Or, maybe they are too young to comply.

Ask yes or no questions, make 'em count. It's an art. Watch the parent as well. Let the pt hold and hand stuff to you.


We had a nine year old girl visiting her father fake a seizure. I established it by observation and exam, but peripheral vision on Mom revealed her looking like "Oh, here we go again". If I just went by Mom, though, what of the kid had a real one?
 
More than a taxi ride

DillR said:
How do you deal with a pt like this?

It was a typical taxi ride but my question is: Do you guys have any tricks for obtaining information from kids?)
Click to expand...

Whenever I have a patient that isn't being very descriptive of their problem, I will try and dig deeper by asking more questions.

Does it hurt all over your tummy or is it just in one spot? Can you point to the exact location of your pain? Is it constant or does it come and go? Is it a sharp pain or is it more like a cramp? Have you ever had pain like this before? What caused it?

You still need to do a full exam. Palpate all quadrants. Is it tender? Is there distention? Rebound tenderness?

PMHx?? Last bowel movement is good. Last meal? What did they have? Do they have their appendix? Any other medical conditions?

It should have been more than a taxi ride. Some places you are not allowed to give pain meds for abdominal pain. Did you start an I.V.?
 
wyoskibum said:
You still need to do a full exam. Palpate all quadrants. Is it tender? Is there distention? Rebound tenderness?
Click to expand...

Done. No Radation, pain localized to abd.

PMHx?? Last bowel movement is good. Last meal? What did they have? Do they have their appendix? Any other medical conditions?
Click to expand...

Last meal was ~2hrs before onset. Appendix intact.

It should have been more than a taxi ride. Some places you are not allowed to give pain meds for abdominal pain. Did you start an I.V.?
Click to expand...
This was a ride-along, I am not allowed to do any invasive procedures, but the EMT put an IV, gave her a toy, and talked to mom en route.

This was just a practice run for me, just trying to learn the tricks of the trade.:ph34r:

Thanks for all the help everybody who responded. ^_^
 
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