Treatment outcomes are invariably less favourable in adolescents when we fail to create effective two-way communication. We need to prioritise giving children a voice in the therapeutic environment to help them making decisions that are right for them and that they can understand and commit to. Taking the time in the initial appointment is pivotal to successful outcomes and should not be underestimated.
Children will expect you to ask about their pain, but many need a little time to feel confident with you before discussing their pain. Reluctance to talk about their pain may stem from the repetition of telling clinicians about their pain, or fear that they might be told it could get worse or limit their activities further. Maybe start with asking them about their favourite activities and interests and what they are missing most and why. This can give real insight into the impact symptoms are having on them and help therapists know what lies ahead in terms of return to play.
Some children may take longer to process auditory information and need to be given time to consider answers before replying. Reassure them it is ok not to know the answers to questions you might ask and that they can refer to their parents if they choose, but that you will give them time to answer so they don’t need to feel rushed. This may help in encouraging parents not to jump in with answers as soon as the child pauses for thought, but it not an easy skill to slow down to their pace when clinics are busy. If we try to speed up the process and force answers from a child who is not ready or trusting of the setting the therapeutic relationship may encounter a setback. Taking time to understand what matters to kids especially when pain is long standing is pivotal in building a positive therapeutic relationship.
Priorities:
- Two-Way Communication: Effective two-way communication is essential in adolescent treatment to ensure they feel heard, understand their options, and can commit to their care plans.
- Tailored Communication: Communication should prioritise the recipient’s understanding, ensuring that the information makes sense to them, not just to the practitioner.
- Initial Appointments: Building rapport from the first appointment through active listening, clear communication, and a supportive environment is crucial for successful outcomes.
- Accommodating Needs: Consider the individual needs of children, particularly neurodiverse ones, by providing clear instructions, managing clinic environments, and minimising stress.
- Inclusive Dialogue: Address children by their preferred names, balance conversations with parents, and avoid overwhelming them with multiple or complex questions.
- Exploring Fears: Identify fears or misconceptions about pain or treatment in both adolescents and parents to ensure accurate understanding and adherence to treatment plans.
- Vocabulary: Children don’t have the extensive past experiences and vocabulary to describe pain. In neurodiverse children this is amplified, with many exhibiting alexithymia which is a broad term that means difficulty identifying or describing feelings. Autistic often describe their pain as fatigue which can cause confusion. Replicate their words and not use your words in future conversations. It reduces confusion but also show you are listening and understanding their story.
- Let them draw a dynamic visual pain story to help them recognise triggers for their pain and help explore their experiences along the treatment continuum. Give verbal and nonverbal feedback and thank them for great information.
- Consistency in Care: Seeing the same healthcare professional across visits fosters trust, reduces repetitive explanations, and strengthens therapeutic relationships.
- Validating Experiences: Reflecting on and affirming patients’ experiences helps build trust, empathy, and a sense of validation for both the child and their parents.
- Simplified Explanations: Use simple, credible explanations for pain to reduce confusion and help adolescents and parents align their beliefs and understand the condition.
- Empowering Self-Management: Educating adolescents and parents about their conditions promotes autonomy, reduces fear, and supports adherence to treatment plans for better outcomes.
The Kids Back 2 Sport website is for teachers, parents and young athletes to learn more about how to reduce their injury risk, boost their capacity and explain their injury in a language they can understand, so please do promote the site and if you are treat children, then please get in touch to join the directory so parents can find people who understand the significant differences between adults and children and access the right diagnosis and treatment from the outset.
