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Managing the Frightened Child

Krauss BA, Krauss BS, Ann Emerg Med. 2019 Jan 12. pii: S0196-0644(18)31560-9. doi: 10.1016/j.annemergmed.2018.12.011


Medical encounters are often frightening for children and stressful for their families. When children are afraid, they resist cooperating and responding to verbal reasoning, inhibiting assessment and treatment.234 For children to cooperate with physical examination and minor procedures, clinicians must first establish a trusting relationship with them.56 Although establishing trust is fundamental to effective interactions with children, there is no systematic approach to teaching this skill. This article describes and demonstrates a practical approach to rapidly establishing trust with children in the emergency department. We deconstruct the elements of clinician-child interactions and elucidate the underlying principles and methods of an approach to establishing trust. Our objective is to place a framework and a set of tools around what emergency physicians are doing intuitively, to enhance effectiveness in their interactions with children. Although what is described below is based on established child development and nonverbal communication research, we have developed much of the practical format and nomenclature presented.

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