Exam 2: Communicating w/ Children and Caregivers

Classification of pediatric patients:

Neonates:

Infants:

Children:

Adolescents:

Neonates: birth-28 days

Infants: 28 days to <12 months

Children: 1-12 yrs

Adolescents: 13-17 yrs

- Treat parent/caregiver (and child) with __________________

- Address parent/caregiver _________, _______________, and _________________

- Address caregivers by their _____________ vs. _______ or _______

- Inform caregivers that you will be talking with their _______________

- Provide guidance on level of child involvement with their ________________; encourage _____________, when applicable

- Interpersonal skills play a role in _____________________________ and can impact __________________________ on medical advice

- Be mindful of the __________________________ you provide and _________ as needed

- Written info. should be at the ____________ grade level. (most levels are at the _________ grade level)

- Determine who will be ___________________________ and direct instruction accordingly

- Provide adequate information to the school for _____________________________ during school hours

- respect

- fears, concerns, and questions

- name vs. "mom" or "dad" (or ask how they would like to be addressed)

- child/adolescent

- medicines; autonomy

- parent/caregiver satisfaction; parent/caregiver follow-through

- written information; clarify

- 5th-6th; 10th/11th

- giving the medication

- safe/appropriate administration

General considerations for pharmacist when counseling children (4)

- child developmental level

- child-caregiver interaction

- health literacy level

- culture

T/F: ALWAYS verify identity of the adult who is with the child/adolescent during the encounter

TRUE

- ___________________ provides pediatric-specific medication information handouts

- Parent-friendly medication information handouts are available and should be provided over _________________________ versions whenever possible

- Highlight _____________________ during counseling

- Lexi-Comp online (easy to read, specific to kids)

- non-pediatric specific versions

- relevant info (measuring dose, instructions, adverse effects, warning/precautions, reassurance regarding indications)

Community pharmacists report communicating with children directly about their meds _________% of the time

~20-30%

Children can provide/receive information during health care visits as early as _______________________

3 years of age

USP has developed a position statement outlining principles for teaching....

children/adolescents about medicines

(Other orgs providing info: FDA, safekids.org, national pharmacy orgs)

Ten Guiding Principles for Teaching Children and Adolescents About Medicines:

- Supports right of children/adolescents to receive ____________________ and _____________________ about medicines in a manner consistent with their _______________, _________________, and ___________

- appropriate info. and direct communication

- health status, capabilities and culture

Ten Guiding Principles for Teaching Children and Adolescents About Medicines:

- Intended to stimulate activities encouraging children to become _____________________________ in the appropriate use of _____________ (in anticipation of adulthood)

- active participants

- medicines

Once medicine leaves the pharmacy, who's responsibility is it?

responsibility of the parent to appropriately dose and administer

Studies and documented phone calls to poison control centers indicate many ______________________________ each year due to ___________ and ___________________ med errors

- unintentional overdoses

- OTC and prescription

Parents were asked to measure 1 tsp (5mL) of acetaminophen using dosing cup, dropper, dosing spoon, and oral syringe

- What did the dosing cup result in?

- Dosing errors with cups and dosing spoons were more common in....

- Dosing cup resulted in overdose for most measured doses.

- Dosing errors with cups and dosing spoons more common in parents with lower health literacy

- BE PROACTIVE PHARMACISTS

what is the most appropriate dosing device to provide a family for dosing pediatric liquid meds?

In what units?

- syringe

- mL

in what pediatric age group are 10-fold dosing errors most commonly seen?

5 years or less

Why does communication with children and caregivers matter?

Appropriate and comprehensive communication and counseling with pediatric patients and their caregivers can:

- DECREASE errors

- INCREASE adherence

- Have an overall positive impact on our pediatric patients’ health

Sensory motor stage

Age range:

Characteristics:

Medication counseling strategies:

Age range: 0-2 years

Characteristics: Explores the world through direct sensory/motor contact; Object permanence developed

Medication counseling strategies: Learning about medicines is not possible. Gain rapport early. Cannot deliver med education., but can ensure child is at ease

Sensory motor stage (0-2 years), how to ensure child is at ease? (4)

• Do not lean over child

• Do not remove child from caregiver's arms

• Do not force play

• Allow parents time to comfort the child if anxious/distressed

Preoperational stage

Age range:

Characteristics:

Medication counseling strategies:

Age range: 2-7 years

Characteristics: Use of symbols/images to represent objects; Classifies object by single feature; Does not reason logically; Egocentric thinking; ability to pretend

Medication counseling strategies: Hands-on activities are most effective. Important to include taste of medication in counseling

For the preoperational stage (ages 2-7) remember: (3)

- Be patient; allow them time to think and communicate (they're developing new skills, learning new words, how to formulate sentences)

- Use distraction and play to re-direct attention

- they do not have a good concept of time; Communicate in simple, concrete terms; Avoid asking for prolonged recall of information

Concrete operational stage

Age range:

Characteristics:

Medication counseling strategies:

Age range: 7-11 years

Characteristics: Child can think logically about concrete objects (adds/subtracts); Time, space, quantity are understood; Classifies objects by several features and can place in order

Medication counseling strategies: Give them time to ask questions; include discussion about adverse effects that should be reported to parents

For concrete operational stage (ages 7-11 years) remember.. (6)

• Open-ended questions

• Can provide more accurate recall of info. (symptoms, activities)

• Greater need to know information

• Greater need to express concerns & ask questions

• Can begin contributing to decision-making regarding treatment plan

• Responsive to visual displays

Formal operational stage

Age range:

Characteristics:

Medication counseling strategies:

Age range: 12 years + (adolescents)

Characteristics: Can reason abstractly; Strategy and planning become possible; Theoretical, hypothetical thinking

Medication counseling strategies: Able to receive info. at the same level as an adult, but keep in mind they can be more embarrassed about topics

For formal operational stage (12+ years, adolescents):

• Can hesitate to _______________; ____________ to provide information

• Refrain from starting conversations with ________________

• Increased eye contact = ___________________________

• Adolescent should be _________________________________

• Learn to _______________ for their health and __________________ their needs

• Providers should remain _______ and _____________ while listening

• Critical to include adolescents in ______________________

• Give opportunity to talk in ___________________

- trust adults; unwilling

- your agenda

- increased trust in provider (can improve over time)

- primary provider of information (caregiver can confirm)

- advocate; communicate

- calm and nonjudgmental

- decision-making

- private (i.e., no parents or caregivers present)

Tips for establishing rapport with children and adolescents

- be respectful

- sit at or below eye level

- remain nonjudgmental

- interesting talking points (toy, book, games, etc.)

- make them feel validated

- calm, open, present

- speak in terms of daily activities

- DO NOT allow parents to speak poorly of child in ur presence

Instead of using "mom" and "dad", address caregivers by......

their name or ask them what they prefer

If child is shy, frightened, or embarrassed...

provider can allow time for play, and allow as much privacy as possible

When communicating with parents and caregivers you must determine who will be....

giving/administering the medication