Priority Topic: In Children

Key Feature 5: In assessing and treating children, use age-appropriate language. 
Skill: Communication, Patient Centered
Phase: Treatment, History

Key Feature 6: In assessing and treating children, obtain and share information with them directly (i.e., don’t just talk to the parents). 
Skill: Communication, Patient Centered
Phase: History, Treatment

A 6 year old male came into the office today with his mom after sustaining blunt trauma to his right eye. More specifically, another kid accidentally busted open his umbrella right next to him during recess and whacked his eye - classic Vancouver recess risks. Although he was little, I was able to get this story from him, and only him, and I didn't have to have his mom tell me the story. After he explained what happened, I summarised it (as above) and asked if I had the story straight. He confirmed that I did, and then I looked at his mom for some sort of collateral agreement, and she nodded her head in affirmation. He then propped up on the examining table for me, where I examined his eye and reassured myself that it truly was an uncomplicated umbrella whack. I told him how super lucky he was to have such fast eyelid reflexes that shut at lightning speed to protect his eyeball! He let out a major heart-warming smile. I then told him to avoid scratching at his eye, especially if it gets a little itchy from a crusty scab, and that if his eye pain started to get worse, or if clumpy gunky stuff starting coming out of his eye, or if he just started to feel any worse in the next little bit for any reason, to let his parents or a teacher know. He said "Okay" as he nodded his head, and I high-fived him for being so tough. I then reiterated my advice to Mom: "If it seems like his eye pain is getting worse at all or he develops discharge during the day (not just first thing in the morning), difficulty seeing, or any surrounding skin changes such as swelling or rash, to not hesitate to return to clinic for followup assessment. She agreed and thanked me for the care. The boy had such knockout yellow rain boots on too that I just had to share with him how awesome I thought they were as he confidently strolled out of the examining room in front of his mom. His appointment was done, he had been cooperative, and he was ready to get back to playing or whatever other important things he had on his to do list for today.

​Something I should add here is that this patient's mom was not necessarily the prototype; many parents jump in and start sharing their take on the situation. This tends to shift the focus away from the child, and I think makes them feel as though it's not as important for them to tell the story of what brought them in as much because their parent will. When this happens, I acknowledge what the parent is saying, and then try to confirm this with the child (if old enough) or adolescent, to bring the focus back on them. At least until it feels like I'm getting nowhere fast (not uncommon with a younger adolescent). Once they know I think they're the ones who I'm most interested in, they seem to be more engaged in sharing information, which is at the very least as important as the parent's second-hand perspective, and they seem to also be more cooperative with the physical examination that follows. But more than clinical manipulation, focusing on the child is for me an act of respect, demonstrating my commitment to serving them first as they self-determine what is in their best interests. Even if it is just to get back to some very important playtime.