Pediatric assessments

[emstim84]

Hey guys, I have a quick question as far as peds assessments go in p-school and beyond. After about 5 months of didactic, when we have roughly 2 months to go, they're going to have what they call a "kids day". For the last 4 hours of the 8 hour days we have, basically everyone is invited to bring their kids and let them run around screaming and play while the paramedic students try to assess them. We have to get 8 assessments to get full credit.

Anyway, I'm just curious what tips and tricks everyone has to do pediatric assessments since kids really don't care about the future or whether you say what you're doing is helping them or not, they just care about the present, so how do you guys get them to slow down enough to get a H&P done? I'm thinking of bringing candy to school and using bribes, if nothing else, but I'd like to learn some better techniques than that. I haven't really had too much experience with kids while being an EMT because I've worked for a transport company that does IFTs and 99% of our patients are elderly. I also quite honestly don't like kids at all so I can't just fall back on being really cheerful around them due to liking them since I don't.

I'm sure I'm not the only health care provider who dislikes kids so hopefully those like me have some useful methods to get pediatric assessments and treatments done in a professional manner. I'm not really concerned about the 8 assessments for full credit...at this point I'm primarily interested in methods that will work in the field as well and not just the classroom since I believe every patient should get the same quality of care and I'd love to be able to provide it.

 

[mikeN]

Have you taken PEPPS yet?

 

[medicdan]

....Candy? Glove Baloons?

Seriously, assessments in class and the field are going to be completely different. In the field on pediatric calls you are likey to encounter a crying/screeming child, who is uncomfortable, either from pain or from the strange surroundings and people around them, scared, etc. Encourage them, at least while assessing them to be in their parent's lap, and ask the parent to console.
Consider finding a good distraction, age appropriate, which can be anything from a penlight to a glove balloon to a teddy bear (some companies carry them). If the child/teen is old enough, or even if not, explain what you are doing (ask to help you by pointing to where their heart is when listening to the chest), why it's important, etc. If old enough, ask questions to distract. Ask about school, friends, toys, what they want to be when they grow up, etc. With older children and teenagers, err on the side of treating them maturely, as many respect that.
Oh, and never lie. Please, for all of us.

Good Luck!

 

[Ridryder911]

On kids assessment are performed toe to head instead of head to toe. This is to allow to gain trust and confidence. Learn Erickson's development (psych) and recognize their idiosynchrosy of what stage they are in.

I personally keep a small toy that can be clipped upon my stethoscope and allow the child to play with it and make a game with it. As well listen to back with a caregiver holding them, and work your way to the front.

As you will learn different ages require different techniques as their psyche changes.

Also be very CAREFUL about balloons made out of gloves or even balloons they have known to be dangerous as well as possible latex allergies.

R/r 911

 

[Epi-do]

Like Rid, I try to keep some sort of small toy handy. Also, with the slightly older kids, do some homework and find out what kids that age are typically into - i.e. cartoon characters, sports, games - and talk to them about that. If they are school aged, ask where they go to school, about teachers, favorite classes, etc. Tell them what you are going to do before you do it. Remember that younger kids need things explained more simply. DO NOT make promises you cannot keep, and NEVER, EVER lie to a child. That is the quickest way to loose their trust, and subsequently, their cooperation.

 

[Wee-EMT]

I make chidren cry all the time! As soon as they see the uniform, the tears come flowing.....or it could just be me?? If you can, keep stickers close by (under the seat, in your pocket, ect) That some times help, if not get a fun looking pen. I had a pen with a massive orange lily on it and that entertained them long enough to get my primary done.

 

[daedalus]

On kids assessment are performed toe to head instead of head to toe. This is to allow to gain trust and confidence. Learn Erickson's development (psych) and recognize their idiosynchrosy of what stage they are in.

I personally keep a small toy that can be clipped upon my stethoscope and allow the child to play with it and make a game with it. As well listen to back with a caregiver holding them, and work your way to the front.

As you will learn different ages require different techniques as their psyche changes.

Also be very CAREFUL about balloons made out of gloves or even balloons they have known to be dangerous as well as possible latex allergies.

R/r 911

Our agency just received a memo from a major hospital chain in the area to stop creating glove balloons. It was very stern.

 

[BossyCow]

You just can't B.S a kid. They generally have an honesty/sincerity meter that goes off at the slightest hint of dishonesty. I've found that most kids will react well to being straight with them, use simple direct communication that is clear and short. I've also had good luck with talking to the parent while the child sits in their lap. Also doing whatever you need to do, pulse taking, auscultating, temp, BP to the parent first then the child.

But, when push comes to shove, if the kid is seriously hurt or ill, you need to do what you need to do weighing the confrontation vs the end result needed. The worst case of this I had was a really nasty bleed and a 4 year old who kept wanting to pull the dressing off.

 

[Airwaygoddess]

Kiddos......

No rubber gloves or balloons, they can choke on them, but if you want a simple distrastion for the little ones and if they are not critical, you can blow soap bubbles for them. This helps with getting vital signs and also can also use it to check for breath sounds if you need them to taks a deep breath. ( either blow the bubbles or blow at the bubble)
Just be careful, they can be slippery on a tile floor. As everyone here has said before, never lie to a child, it is better to be honest and to tell them what you are going to do with a simple and direct reason why something has to be done. I know as an adult I want to be told what is going on BEFORE being touched, I know children can be the way........

 

[Dominion]

I always carried an age appropriate toy, if I didn't need it at that point in time I'd let them play with my stethoscope.

 

[IcantThinkofAname]

Well I have more experience as a parent than an EMT so I can tell you this...don't talk to the child like he/she is an adult, but don't talk to them like they're idiots either. Ask them what they're into, why, etc., and you can actually get a lot done while they answer.

You said you don't like kids...they will probably pick up on that - kids have a weirdly astute b.s. meter and they don't like disingenuous people. So just try to be straightforward and honest.

The idea of bringing a little toy or gadget is good, but not all kids like bears or trucks, etc. HOWEVER, most kids like buttons and stuff like that. My son will play with my cell phone forever...if you have something like that it might help.

But yeah, toe to head assessment to gain trust and don't expect them to settle down and act like adults just because you ask them to.