Child Counselling and Communication Skill in Pediatrics for Doctors & Nurses

Practising counselling and communication skill in paediatrics is very important. The clients are the mother or both parents and the Health care provider is usually a paediatrician or nurse or even a health assistant. The caregiver mother or father has every right to know the related information regarding the health and well being of the child. Counselling begins from the very moment of first seeing the child. Good communication skills will make sure that the child is taken care of properly. A simple and easily understood local language is essential for proper communication and counselling. It is said that good communication is good medicine.

The Counselling skills: There are 4 skills required to make good communication with the parents. The first 2 skills are needed to be well versed about the child’s health problem. The other 2 skills are required for making the parents confident to take a decision.

The skills are

1. Listening skill
2. Learning skill
3. Building confidence
4. Giving support

Principles of counselling

1. Mother is allowed to talk more.
2. More concentrating on mothers feeling.
3. Mother’s could not be hurt or humiliated.
4. Mothers are given one or two suggestions.
5. Mothers made confident in taking a decision.

Child Counselling and Communication Skill

Introduction and rapport building

Introduce yourself to the mother and ask how is she doing? Knowing the educational background or baseline knowledge is helpful.

Listening and Learning skill

1. The Doctor and mother should sit at the same level preferably in a chair.
2. The doctor should not make a hurry.
3. Casually touching the child showing care
4. Sitting close without any barrier such as a table in between them.
5. Use responses and gestures which show interest such as nodding head or smiling at mother or using simples responses such as Mmm or Aha.
6. Ask open questions. Open questions are usually started with what, how when where why etc. Open questions provide more information and start the discussions. For example, how are you feeding your baby?
7. Empathize means the capacity to understand and share the feelings of the mother. For example, the mother felt much disturbed last night as her child cried a lot. The doctor can respond by telling “you had a long sleepless night and it was really disturbing for you”.
8. Reflecting back on the mother’s utterance signifies interest doctors to what mother mentioned.

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Building Confidence and Giving Support

1. Accept what a mother thinks and feels.

   Accepting means responding in a neutral way, and not agreeing or disagreeing. Reflecting back and responses and gestures which show interest are both useful ways to show acceptance, as well as being useful listening
   and learning skills. Sometimes a mother has a mistaken idea that you do not agree with. If you disagree with her or criticise, you make her feel that she is wrong. This reduces her confidence. If you agree with her, it is difficult later to suggest something different. It is more helpful to accept what she thinks. If you accept that she is upset, it makes her feel that it is alright to feel the way she does, so it does not reduce her confidence.

2. Recognize and praise what a mother and baby are doing right.

   As a Doctor, We see only what we think people are doing wrong, and we try to correct them. As counsellors, we must learn to look for and recognize what mothers and babies do right. Then we should praise or show approval of the good practices. It will build up her confidence in her. She will keep doing the right thing and It makes it easier for her to accept suggestions later. For example, a mother gives family food along with commercial food. The doctor or nurse can praise her for giving family food.

3. Give practical help.

   Sometimes practical help is better than saying anything. It may not be possible for doctors always but nurses and other domiciliary health care providers do this. For example:
   1. When a mother feels tired or dirty or uncomfortable.
   2. When she is hungry or thirsty.
   3. When she has had a lot of advice already.
   4. When you want to show support and acceptance.
   5. When she has a clear practical problem.

   Some ways to give practical help are these:
   – Help to make her clean and comfortable.
   – Give her a warm drink or something to eat.
   – Hold the baby while she gets comfortable.

4. Give a little, relevant information

   When you give a mother information, remember these points.
   – Tell her things that she can do today, not in a few weeks time.
   – Try to give only one or two pieces of information at a time, especially if she is tired, and has already received a lot of advice.
   – Wait until you have built her confidence, by accepting what she says, and praising what she and her baby do right. You do not need to give new information or correct a mistaken idea immediately.
   – Give information in a positive way, so that it does not sound critical. This is especially important if you want to correct a mistaken idea.
   For example, the cost of commercial food is about 50 taka where homemade family food can be given for much less money.

5. Use simple language

   Use simple familiar terms to explain things to mothers. Remember that most people do not understand the technical terms that health workers use. Scientific terms are rarely understood by women of villages.

6. Make one or two suggestions, not commands.

   Be careful not to tell or command a mother to do something. This does not help her to feel confident. Instead, when you counsel a mother, suggest what she could do differently. Then she can decide if she will try it or not. This leaves her feeling in control and helps her to feel confident. For example, you may think to start family food which is providing an equal amount of calories and see how things go in the next few weeks.

Feedback and Final Greetings

Tell the mother what she would tell her husband after returning home about the interaction with the doctors. Give thanks to mother for her time and consideration.

Advantages of Good Communication

1. Patient satisfaction, leading to regular visits and
   referrals.
2. Feeling of empowerment and control.
3. Adherence to treatment plans.
4. Loyalty even if treatment is not immediately
   effective.
5. Fewer chances of complaints and legal action in the
   event of a mistake.

What Patients Want

1. Clarity and directness.
2. Listening.
3. Honesty
4. More and better information about their illness, treatment plan, and expected outcome.
5. More openness about the hazards and side-effects of treatment.
6. More information about the relief of symptoms and other concerns.
7. Advice on what they can do to help themselves.
8. Information on other treatments available.
9. A supportive, non-judgmental, empathetic doctor.

Key Points of Communication Skills

Communication skills contribute to good medical care and patient satisfaction.
Communication skills contribute to a doctor’s respect, a patient’s faith, and adherence to treatment.
Doctors with good communication skills have better clinical and commercial success, less stress, and more
job satisfaction.

Source: Professor A R M Lutful Kabir Sir and Internet

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PDF Download

1. Communication Skills – Talking to Parents
2. Breastfeeding counseling: a training course – Participant’s Manual

Related Link:

Communication skills in pediatrics – the relationship between pediatrician and child

Thanks Everyone