Image: Flickr/Greg Westfall

I love dogs. And kids. Both have an uncanny sixth sense to make a snap judgment about you in just seconds. Blow it and you will set back your relationship and their feelings for a long time! After 25 years being a neurologist, oncologist, and pediatrician, I have six rules that I follow every time I meet with a child, parents usually included.

 

  1. Remember when you were 5. If you’re thinking and acting like an adult in front of the child, you will likely put yourself in an awkward relationship. Kids want friends who can relate to them. You must find a way to engage kids for who they are. Be a detective and find out when you meet (or even before) what and who they like, or what makes them happy. Think back to when you were age 5. Would you want some random old person popping in and knowing nothing about you?
  1. Talk with them, not around them. Never ever introduce yourself first to parents but always first to the child. Make clear to the child, and parents, who is the center of attention. Talk first with the child. Why are you here? What can I do for you? I will make quite clear from my speech as well as body position and motions that the child is my center of attention. I will direct as much of the meeting as possible at an emotionally and age appropriate level through the child. Every child, no matter how young, deserves to be included in the conversation when physically present and not “talked about” like they are not even there. When you do need to discuss matters with the child’s parents, asking a child’s permission to speak privately with their parents (almost never refused) will go a long way for earning buy-in from the child.
  1. Speak their language. Nothing would scare me more than someone entering my room and speaking to others about something in a language I don’t understand. You need to speak “kids.” Use small words. The center of attention, or locus of control (see no. 2), must be the child, and he or she must understand what you are saying. Be positive, upbeat, and funny.
  1. Get on their level in their safe space. Would you appreciate someone walking into your bedroom and poking you? Or tossing you onto a table with crinkly, noisy paper? Always find a space where a child feels safe for examination, or even the asking of questions. Get on the floor (if you can’t do that, your clothes are too expensive to be around children!) or ask mom or dad to hold the child. Approach gently, calmly, and happily. Back off as you need to do.
  1. Don’t promise what you can’t deliver and never lie. While you need to be upbeat and positive, you can’t promise something won’t hurt or be an intrusion. Be upbeat and positive, but don’t throw a nurse or physician colleague under the bus with false expectations that you promised. Being honest doesn’t necessarily mean sharing all information, but that what is shared needs to be honest and shared at the level they can digest. Kids will appreciate your saying that you really don’t know what is going on, if in fact, that is the case.
  1. Never give up hope. Would you want someone to do that for you? There is always a possibility to find one small thing to be hopeful for even in the most dire circumstances. Be positive! Balancing reality with hope is tricky, but sometimes just choosing open-ended wording can be more welcoming and hopeful. Let the child talk and find positive things. I always ask a child to tell me 3 good things happening.
Paul Graham Fisher, M.D.
Paul Graham Fisher is Professor of Neurology and Pediatrics, and by courtesy, Neurosurgery and Human Biology; the Beirne Family Professor of Pediatric Neuro-Oncology in the School of Medicine; and the Bing Director of the Program in Human Biology in the School of Humanities and Sciences at Stanford. He has been Division Chief of Child Neurology at Stanford University since 2008. His research focuses on epidemiology, therapy, and late effects of childhood brain tumors, and he has authored over 200 publications on brain tumors and other neurology and pediatrics topics. His epidemiologic work explores biologic underpinnings of childhood cancer, particularly medulloblastoma, ependymoma, and germ cell tumors. He is an Associate Editor for The Journal of Pediatrics, and is proud every day to take care of children and our world’s future.

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