One of the first things I remember learning in PT school about the pediatric population is that children are not just small adults. Their minds and bodies are unique and require a different level of expertise from the therapist working with them. It is one thing to be able to physically treat a child, but it is another to be able to capture their attention, enter their world, and tap into all they have to offer. That’s the trick, really, is to enter their world, not to bring them into yours.
A child will be most successful in an environment they understand and feel comfortable and supported in. Imagine yourself as a small child, working with an unfamiliar adult who is trying to teach you an unnatural task in a language you do not understand. How successful are you going to be? Now add on another element that could further limit your success; maybe it's a receptive language delay, hearing loss or visual impairment, or decreased attention due to hyperactivity.
These are factors the children we work with could very well be living with, and it is our job to make sure we foster success by modifying our communicative approaches. With all children, there are a few basic guidelines that should be followed to increase your efficacy, and we have five tips for speaking to your pediatric patients.
If you're still considering pediatric PT and have some questions, here's everything that you want to know about a pediatric PT residency!
Keep It Simple
Children aren’t interested in the fancy medical jargon connected their therapy services. Framing PT as playtime rather than medical necessity is a great way to get children to buy-in and participate in therapy. Things you may explain to an adult, like the rationale behind exercises, aren’t necessary for most children. If they do question a certain activity, keep your explanations as general as “to get stronger” or “to be faster.”
By being creative with your instructions, and bringing them to an age-appropriate level of engagement, you can actually be more clear with what you’d like the child to do. You could say, “we’re going to stand still on the rocking board for 30 seconds,” or “we’re going to stand on this pirate ship until all the sharks swim away! Let’s make sure we keep our bodies calm and still so the sharks don’t see us.”
“Each child is a unique individual, who deserves to be reached in the manner they are most supported and engaged.”
With the first example, there is little motivation for the child to keep a calm body, and 30 seconds is an awfully long time for them to stand still. By making it into an engaging game, we’re more likely to elicit interest and focus, while still giving clear instruction. Bonus points if you can incorporate one of the child’s known interests, like a certain a superhero or television character!
It’s also important to note that children may associate medical professionals with uncomfortable procedures, and this can immediately stigmatize adults who introduce themselves as “doctor.” A typical title in pediatrics is Miss or Mister followed by your first name. “Going to play in PT with Mr. Joe” is a lot less intimidating than “going to a PT appointment with Dr. Joe.” So while many of us have worked hard for that DPT after our names, you likely won’t hear the “D” much if you choose to work in pediatrics.
Keep It Positive
Children respond better to praise than they do to punishment, so finding the positives in each session to reinforce appropriate behavior is key. It’s easy to take a moment to praise a child for walking nicely, waiting patiently, and being a good listener, and if they’re praised for these traits, then they’re likely to carry them through each session.
If a child is trying their best with a task but missing the mark, comments like, “I’m so happy to see how hard you’re working. Keep it up!” Or, “This is very tricky, and you’re doing awesome!” can go a long way. It’s important in these moments that you don’t show any frustration or impatience with the child. Allowing them to problem solve and attempt a task multiple times is important for their learning.
If it’s necessary to redirect or correct a child during a session, remember that it’s more productive to offer a positive alternative than it is to scold. “No” is a word that some children can be desensitized to by the time they reach your door, and it doesn’t tell the child what they should be doing. Try these positive alternatives instead:
Keep It Engaging
Think of the elements that make up popular children’s songs or television shows. They are lively, dramatic, colorful, and whimsical. A pediatric therapist should strive to embody those elements through their facial expressions, voice, and body language. Incorporating popular nursery rhymes into gross motor activities can be done easily, like creating motions to go along with “Wheels on the Bus,” “Head, Shoulders, Knees, and Toes,” or even the catchy (but maddening) “Baby Shark”.
Your physical position can also foster engagement. Being at eye-level naturally encourages greater eye contact, and working at their height also creates a more inviting, less authoritative energy. Again, framing therapy as peer play has the potential to elicit much greater effort from a child.
Keep It Accessible
When we converse in our everyday lives, we use multiple forms of communication, often without realizing it. We, of course, use spoken word, but we also utilize our vocal intonation, facial expression, head and hand gestures, and posture. These elements help get our point across clearly. Some children may have a hard time picking up on these additional cues, especially children with autism. If communicating verbally is proving to be challenging, try another way:
Frequently used pediatric vocabulary:
- More/all done
- Balance beam
- Please/thank you/no thank you
Keep It Effective
No single method is guaranteed to work for any child, so it’s important to keep an open mind when experimenting with your language. Some children may respond really well to all the engaging methods in our third example, but other children may become overstimulated by these methods and do better in a quiet, more monotonous environment. Trial and error is the only way to find what will work best for each patient.
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It’s important to note that using a simple, alternative form of communication, like basic sign language or picture symbols, will take time to learn, and should not be ruled out after one or two sessions. Take note of how the child responds to the system, and if after a few weeks no significant progress has been noted, it’s time to try another approach. If the child is also receiving speech or occupational therapy services, working with these other providers will be critical, as they have greater expertise and insight within this domain. Consider some of the tips here on collaborating with OTs!
Working in pediatrics is undoubtedly a rewarding experience, especially on the days we really click with our kids. Bringing the best out of a child starts with effective communication, which can mean anything, depending on who you work with! Each child is a unique individual, who deserves to be reached in the manner they feel the most supported and engaged. As their therapist, it’s your job to discover how they define “effective,” and run with it. That might mean relating any and every activity to a certain feisty pig with a British accent, but if it gets the job done, consider your message received.