A guide to building quick therapeutic relationships in Paediatrics

Much research has been done into the importance of developing a therapeutic relationship when working with any client. In fact, a strong therapeutic relationship is often identified as the most significant factor associated with successful treatment.

When you are a child or young person faced with a medical encounter, it can evoke many emotions that you are not familiar with. Fear, worry and anxiety can all creep up before, during or even after a medical experience.

As Child Life Therapists, our role in establishing a safe and secure environment for children and young people is paramount. To do this we must build (often quite quickly), a sense of mutual trust, respect and care.

In medical environments, children can be surrounded by many unfamiliar sights, smells and expectations. Strange adults poke and probe and ask lots of questions. As medical professionals, there are many opportunities to quickly begin the process of establishing therapeutic relationships. In doing so, we are working towards creating a safe space that will help children feel more comfortable, confident and secure to engage in their medical encounter.

Introduce yourself and your role

While we may have a name and role clearly identified on a tag or badge, children are very unlikely to either read, focus or understand what this means and, more specifically, what this means to them. Getting down to the child’s eye level and introducing yourself and what you do is incredibly important. You are making an initial connection and showing them that they matter in this environment.

Find a connection

After introducing yourself, you can extend the connection by making an observation that could be relevant to the child. Are they wearing a t-shirt with a character like Bluey or a dinosaur? Are they carrying a toy? Are they watching something on an iPad or phone with a parent? Use these prompts to start a conversation that may help the child feel more comfortable and continue to build on your connection. Infants, children and young people are also incredibly perceptive! Try and find ways to make your interactions genuine. If the patient is not engaging, that is ok. We have to be ready to meet them wherever they are. This might mean that the interactions need to be with the parents and parallel conversations that make the child feel more at ease.

Resources

Having some resources up your sleeves when working in paediatrics is also incredibly helpful! Bubbles are amazing, small sensory toys, stickers, anything that lights up. They are a fabulous talking point, way to engage and a good source of distraction when required. You don’t need many things, but a couple of options go a long way!

Explain, explain, explain!

One of the scariest parts of being in a medical situation is fear of the unknown. It is important that procedures are explained to children of all ages. There are many amazing resources available such the Royal Children’s Hospital – ‘A Child’s Guide to Hospital’, that explain a range of procedures in video format from the child’s perspective.

RCH TV : A child's guide to hospital

Providing an understanding of what to expect in their health care encounter will offer the patient an increased sense of control. To build a trusting relationship, you need to be honest and explain things in a developmentally appropriate way. Remember that while this may take extra time, you are shaping not only their current experience, but all further health care encounters.

Research has shown us that infants as young as 6 months benefit from completing procedures in an upright position. Be aware that there are many comfort positions available for infants, children and young people and that unless it is completely necessary, lying flat is a position of vulnerability that can cause increased distress. Where possible, offer the child options for their positioning for procedures and alternatives for distraction.

RCH TV : Comfort Holds

Developing therapeutic relationships do take time, however, making small changes to our practice can help set the scene for the beginning of more positive health care encounters for paediatric patients.