A registrar survival guide - Consultations with children

By Dr Karen Snowdon on the 9 June 2011

Children make up a large proportion of general practice consultations, with the majority of these being acute presentations of illness.

Therefore, being able to consult effectively with children and their parents is an essential skill.

Communication

Assessment of the child begins when they arrive, with body language giving many clues. Look for signs of pain, anxiety and shyness. Establish a rapport from the beginning, both with the child and the adult attending with them.
If the child is old enough ask them to contribute when gathering the history, using appropriate language.

Child-friendly environment

A box of toys and books can be fun and offer distraction, putting the child at ease and allowing the adult to speak more freely.
Consider safety issues, such as where the sharps bin is located.
Children are inquisitive and seek these things out if they are in easy reach.

Examination

Assess the child's level of comfort while in the room. Smaller children are usually more content when examined on the lap of a parent.
Sit at the child's level, give lots of eye contact and give praise throughout.
Role play, such as listening to teddy's chest, may help with co-operation. Leave potentially upsetting parts of the examination until the end, such as ears and throat.

Management plan

Discuss the management and be specific about review dates if the problem is not improving.
Provide information as to what to do if the condition changes significantly, including out-of- hours.
Registrars may not know the family so speaking with other GPs, the health visitor or school nurses can be useful.
If unsure clinically, speak with your trainer or ring the on-call paediatrician, they are often very helpful and supportive.

Adolescents

Consulting with adolescents may involve dealing with sensitive matters, such as contraception, STIs and acne.
Patients may also worry about confidentiality issues. If they attend with a parent, the option of consulting with or without the parent should be suggested.

Guidance

The GMC guidance 0-18 years: guidance for all doctors gives useful information on consulting with children of all ages.

Essentials checklist
A good rapport with both the child and any adults involved. A child-friendly environment. A gentle approach to examination. An ability to listen to the child's views. A confidential approach when dealing with adolescents' sensitive issues.