Supporting Children with Challenging Behaviors — Communication Strategies — Clinical Pathway: Primary Care

Supporting Children with Challenging Behaviors Clinical Pathway — Primary Care

Communication Strategies

Communicating with your child at a developmentally appropriate level will help to improve understanding and cooperation.

Communication with Patients

Action Rationale/Example
One Voice Multiple voices simultaneously can be overstimulating. Consider one person talking at a time during healthcare encounters.
Clear Expectations
  • “While mom gives you a tight hug, your job is to hold still like a statue.”
  • “I need to see a safe body and safe hands. That means, keeping your feet flat on the ground and resting your arms by your side.”
Simplify your language and use statements such as: First/Then “First, we’ll do your vitals, then the doctor will come in.”
Choices
  • Only offer choices when choices exist.
    • “It’s time for your vaccine, would you rather listen to your music or focus on your breathing?”
Validate Feelings
  • Provide undivided attention in a non-judgmental way
  • Clarify your understanding of child’s concerns
    • “It’s okay to feel scared right now.”
Positive Language
  • Avoid Threatening Language
    • Instead of saying, “If you can’t hold still, I’m going to need to bring in someone else.”
    • Consider saying, “It can be hard to keep our bodies still when we’re feeling ______. One of us can help your body stay as still and safe as possible by giving you a big hug.”
Praise
  • Offer specific praise for any positive behaviors you notice
    • e.g., cooperating, calming down, staying safe

Communication with Caregivers

Action Example
Addressing Care with Patient
  • Addressing the parent/caregiver when they have not told the child he is getting a vaccine
    • “I know it might seem easier to not tell him, however this might lead to negative behaviors for future visits to the office.”
    • “Even though it can be difficult information to hear, most children benefit by being prepared for stressful experiences. This will also increase his trust in you.”
Addressing Blame
  • Addressing the parent/caregiver when they are placing blame on the clinician
    • “I know it might seem easier to place the blame on me, however by doing so you are suggesting that your child’s healthcare team is against him. Let’s find a way to be on the same team so that he trusts us both.”
Rescheduling Visit
  • Addressing the caregiver when a visit needs to be rescheduled because of a behavioral escalation
    • “I know it takes a lot of coordination to get here, but I don’t feel safe to continue the visit today. We’re going to reschedule and put a plan in place to create a less stressful experience for him. Someone from the office will reach out to you in a few days.”

Patient Communication Examples

Confusion Phrases Why We Shouldn’t Use Them Recommended Phrases
“It’s okay” or
“You’re Fine”		 The child probably does not believe it is ok or fine during a painful procedure. “It’s okay to feel this way right now. Let’s figure out a way to make it easier.”
“Don’t Cry” Crying is okay when you’re upset. “It’s okay to cry when you’re upset or in pain, but it is still really important to try to stay still.”
“Be a big girl/boy” This statement suggest that the child is acting infantile by crying or reacting to something uncomfortable. “Other kids your age tell me they feel the same way. One of my patients told me it helped when…”
“I’m sorry” Saying I’m sorry means you are taking responsibility for doing something wrong when you are just doing your job. “I know that was difficult, but you held very still just like we talked about.”
“It’s not going to hurt” It might hurt. Something that might not hurt you, might hurt a child. “Some kids say that it feels like a small poke or pinch, but we are going to try to make it as comfortable as possible. Can you tell me how it feels for you when you’re done?”

Additional Communication Resources