Lecture 23: Communicating with Children

Question 1

What are the guiding principles for medication use? (4)

Answer 1

1. Children want to know. Pharmacists should communicate directly with children about medicines.
2. Children’s interests should be encouraged and they should be taught how to ask questions of healthcare providers, parents, and other caregivers about medicines.
3. Children, their parents and their health care providers should negotiate the gradual transfer of responsibility for medication use in ways that respect
   parental responsibilities and the health status and capabilities of the child
4. Children’s Medicine education should take into account what children want to know about medicines, as well as what Healthcare professionals think children should know

Question 2

List the 5 questions for children to ask about my medicine:

Answer 2

1. Why do I need this medicine?
2. When do I take it?
3. How long do I take it?
4. How could it make me feel?
5. When do I see my health team again?

Question 3

Tips for Taking with Children (5):

Answer 3

• Introduce yourself to the parent and child
• Find out how the parent and children want to learn
• Use child centred small talk
• Share questions other kids have asked before asking your question.
• Try to assess the child’s ability to understand / developmental level

Question 4

Tips for working with parent:

Answer 4

• Please remember to listen to what parents. They notice the small details.
• Sometimes parents need reassurance that something is normal and they are doing the right things. Particularly new parents.

Question 5

Slide 8 !

Answer 5

Look at this table!

Question 6

Piaget Theory of Cognitive Development

How many stages and what are they?

Answer 6

sensorimotor
preoperational
concrete operational
formal operational

Question 7

Piaget Theory of Cognitive Development:

Sensorimotor stage:
what age range?
describe

Answer 7

from birth to 2 years

• identifies object performance, the object still exists when out of sight
• recognition of ability to control object and acts intentionally

Question 8

Piaget Theory of Cognitive Development:

Preoperational stage:
what age range?
describe

Answer 8

2 to 7 years

• Begins to use language
• Egocentric thinking difficulty seeing thins from other viewpoints
• Classified objects by single features i.e. color

Question 9

Piaget Theory of Cognitive Development:

Concrete Operational stage:
what age range?
describe

Answer 9

7 to 11 years

• Logical thinking
• Recognizes conservation of numbers, mass and weight
• Classifies object by several features and can place them in order

Question 10

Piaget Theory of Cognitive Development:

Formal Operational stage:
what age range?
describe

Answer 10

11 years and onward

• Logical thinking about abstract propositions
• Concerned with the hypothetical and the future
• Create hypotheses and test

Question 11

How to Communication with Preschoolers?

Answer 11

• Enthusiastic greeting
• Briefly ask about toy or clothing
• Consider using toys or interesting objects as distractors
• Sticker charts are useful
• Do not tell children that medicine is candy
• Storage is important –> Medicine is the leading cause of poisoning in Canada

Question 12

“Put medicines and vitamins up and away - out of reach and out of sight.”

List 5 Ways to protect children from medicines and vitamins:

Answer 12

1. Pick a place your children cannot reach
2. Put medicines and vitamins away after each use
3. Teach your children about medicine safety
4. Tell guests about medicine safety
5. Hear the click to make sure the safety cap is locked

Question 13

List 3 tips about Medication Safety for Preteens and teenagers:

Answer 13

1. Keep cleaning products in their original containers
2. Throw away old medicines and other potential poisons
3. Speak with older kids about the dangers of inhalants and abusing prescription medicines

Question 14

Slide 18 ???

Answer 14

Not sure if this is needed?

Question 15

Can I fill a sixteen year old’s prescription without

telling their parents?

Answer 15

• Yes, if you believe the child has capacity to made decisions.
• Parents still have rights to access health information (and may even be alerted by drug insurance when medications are filled).

Question 16

List ways (9) in helping children take medicine for parents:

Answer 16

1. Explain how medicine helps children get well
2. Make the medicine taste better or easier to swallow
3. Give your child choices when possible
4. Give medications at the same time and place
5. Use play
6. Avoid physical struggles
7. Numb the taste buds by sucking on a Popsicle or ice chips before giving the medicine
8. Chase down the medicine with a drink afterwards. White grape juice works well for masking bitter tastes
9. Coat the tongue by giving your child a peanut butter and maple syrup mixture before giving them the medicine

Question 17

List tips (4) for taking crushed or powdered medicine:

Answer 17

1. Crush pills and mix with foods that do not require chewing such as apple sauce, yogurt, ice cream, pudding, etc.
2. Crush pill, dissolve with water ans cherry syrup to mask the taste
3. Crush pill and mix with frozen raspberry juicy concentrate. The cold temperature and the strong raspberry flavour may mask the taste
4. Remember that the child must take ALL of the mixture (keep the mixture small)

Question 18

Swallowing Pills ???

Answer 18

Look at slide 24

Question 19

List 4 Comfort Promise ways to reduce needle poke pain:

Answer 19

1. Comforting position
2. Distraction
3. Sucrose
4. Numbing

Question 20

List 10 comfort positions to help children get through challenging procedures:

Answer 20

1. Bear Hug
2. Back Snuggle
3. Sing Along
4. Bubble Blower
5. Tech Savvy
6. Eye Spy
7. Poke Whisperer
8. Burrito Wrap
9. I’m a Real Looker
10. Deep Breather

Question 21

ONE VOICE for children during medical procedures:

What does ONE VOICE acronym stands for?

Answer 21

• One voice should be heard during procedure
• Need parental involvement
• Educate patient before the procedure about what is going to happen
• Validate child with words
• Offer the most comfortable, non-threatening position
• Individualize your game plan
• Choose appropriate distraction to be used
• Eliminate unnecessary people not actively involved with the procedure

Question 22

What is pharmacists’ role in Child Abuse?

Answer 22

• Observing and Reporting
• By engaging in a process of learning to recognize the signs of abuse and neglect and knowing what to do, we can find the courage to act -both in the moment and how to report.

Question 23

List types of Abuse (4):

Answer 23

• Child Neglect
• Physical Abuse
• Emotional Abuse
• Sexual Abuse

Question 24

Child Neglect

Pharmacy staff observes a child who is dirty, appears listless, has a history of frequent respiratory infections, and is inappropriately dressed.

What would be possible conversations?

Answer 24

Always focus on the child when talking to a caregiver. This reduces the likelihood the caregiver will feel defensive.

“She seems to be really struggling. I can help refer
you if you need help with housing or food or other
supports.”

“We are here to help. Please feel free to let us know
any time if we can help with more than just
medications.”

Question 25

Physical Abuse

Pharmacy staff observes a child with multiple bruises on arms and legs. The bruises range from purple to yellow to barely visible This is a sign of multiple injuries as bruises fade and change colour over time.

What would be possible conversations?

Answer 25

Always focus on the child when talking to a caregiver. This reduces the likelihood the caregiver will feel defensive.

“That’s a lot of bruises. What have you been up to?”

If the caregiver cuts off the conversation, pay attention There is no reason a child would not answer this question If the child says. “I fell out of a tree” follow up with:

“Looks to me like some of those bruises are old. What
happened there?”

It is the reaction you are watching for and consistency of the story.

Question 26

Emotional Abuse

Pharmacy staff observes a young child who is being screamed at to “shut up” and “stop being such a f..ing pain in the ass.”

What would be possible conversations?

Answer 26

Other than making a report, there is little pharmacy staff can do besides letting the adult know his/her behaviour is not anonymous.

Possible conversation directed to the child:
“Sounds like you guys are having a tough day. How
about you stand over here and watch what I am
doing to fill the prescriptions.”

Question 27

Sexual Abuse

Pharmacy staff observes a girl around 13-15 years of age trying to pick out a pregnancy test.

What would be possible conversations?

Answer 27

Use “courageous conversation:”

“Do you think you might be pregnant? I have been
doing this a long time and I know someone your age
might be in a difficult situation.”

“Are you in a safe situation? Is there anything I can do
to help? Can I help you find someone to talk to?”

You might get shut down and told to mind your own business. Or you might learn that this is a victim of incest, rape, or sexual trafficking.

Question 28

What is Grooming Process?

Answer 28

Grooming is the process of developing a relationship with a child to make it easier to sexually abuse the child. Understanding and recognizing grooming behaviours are key to stopping child sexual abuse.

Question 29

Describe the Grooming Process:

Answer 29

1. Identifying and targeting the victim
2. Gaining trust and access by providing special attention, understanding, friendship, gifts,and special treats
3. Playing a role in the child’s life (and family too)
4. Making the child feel special (e.g. attention and gifts) 5. Isolating the child- taking the child out of his or her surroundings so that others cannot witness the grooming and abuse
5. Creating secrecy around the relationship
6. Initiating touch and sexual contact
7. Controlling the relationship to ensure that the child won’t disclose the abuse

Question 30

Child Abuse:

Patterns to look for:

Answer 30

Trust your Gut Feelings!

1. How a child is being treated while in your presence
2. Patterns of injuries or abusive behaviour
3. A child who looks severely neglected
4. Flirtatious, inappropriate interactions between a child and an adult

Remember, most people feel anonymous when they are in a public place. They do not expect you to be paying attention. It is this circumstance that gives you the opportunity to observe and act to protect a child.

Question 31

Child Abuse

What to do if a child discloses….

Answer 31

1. stay calm and react without shock, disbelief, anger, judgement or fear
2. let the youth tell you what happened in their own words no interruption
3. listen carefully without asking questions
4. reassure them that it is right to tell and it is not their fault
5. acknowledge how they are feeling (scared, angry, embarrassed, hurt, sad)
6. help them feel comforted and supported by saying things like:
   * I believe you and I will support you
   * it is okay to feel scared, angry and hurt
   * I will try to help you figure what happens next
   * you are brave for talking about this and it is right to
   tell someone

Question 32

Child Abuse

What to do after a child discloses….

Answer 32

Soon after the child or youth tells you what is happening, find a private place. Write down what you heard and saw. Be sure to:
- use the same words the child used
- describe the way the child looked, how they behaved
and other things you noticed
- keep your notes private and secure

You role is to report what you observed. You should NOT “investigate”.

Call 911 if you or the person are reporting is in immediate danger.

Call Child Abuse Hotline: 1-800-387-5437 (KIDS)