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Brandt's Rants

Brandt's Rants

Pediatric Patient? Check Your Maturity at the Door

Brandt, Robert MD

Author Information
doi: 10.1097/01.EEM.0000547698.80860.0e
    pediatrics, communication
    pediatrics, communication:
    pediatrics, communication

    I read through several emergency medicine magazines recently searching for a life-changing topic I could write about. After an hour, I realized not a single article had the USDA-required allotment of pun-based ridiculousness. Let's take a serious look at why it is so important not to be serious sometimes. This reminds me of when I entered a pun contest. I entered 10 puns, but none of them won. Sigh. No pun in-ten-did.


    I won the best kids resident award in residency. This should come as no surprise to those who know me because I have the maturity level of an 8-year-old. Have I matured since then? Meh, I am certain that fart jokes will remain funny till the day I die. Quite often, one of the most overlooked (and undertaught) skills is the ability to put patients at ease. We focus so fervently on the right diagnosis and meeting arbitrary time-stamps and unimpactful tests (I'm looking at you, blood cultures for pneumonia) that we forget the importance of treating the patient as a person. This is especially important in our pediatric population, so here are a few tricks for the next time you treat a kid, teen, youngling, ankle biter, whippersnapper, brat, bambino, urchin, squirt, or teenybopper.

    First, don't open with anything medical. Trust me, I took two years of improv courses at Second City; the opening is key. The first thing you do on stage is vital to how the audience (or your patients) see you. Transfer this to your pediatric population. The doctor is terrifying, especially for kids in the ED. Your first 15 seconds are paramount. I usually peek just my face around the door, lock eyes with the child, make a face, and then disappear behind the door again. I do this about five times until the kid is smiling. Childish? Duh, of course, but you and your pride are not the priority here, putting the patient at ease is the point. Also, you are greeting the child first, letting him know that he matters. You can talk to the parents in a minute.

    Second, find something in common. Stay at their level, in height and language. I ask most children about their favorite cartoon. This is easier if you have kids. Paw Patrol, Mickey Mouse Clubhouse, My Little Pony, and the most recent Pixar movie are all usually gold. You'll form an instant connection of trust if you say “Rainbow Dash is my favorite pony.” For the record, my favorite pony is Twilight Sparkle. Be a little silly. Simply saying you love Patrick from SpongeBob will often break down walls for many children.

    Third, leave the kids where they are. Kid in mom's lap? Work around it. Kid playing on an iPad? Work around it. Kid hanging upside-down from the ceiling? He is a vampire; work around it. If the child is happy, don't mess with him. Oh, and save the ear exam for last! Occasionally, you might have a child who does not start screaming when you look in his ears, but that is the exception.

    Toys, Blippi, Dad Jokes

    Fourth, distract and redirect. If and when a procedure must be performed, get out the distractions. By the way, “procedure” includes starting an IV, looking at a laceration, or sometimes even using a stethoscope. Our ED has a vastly underutilized toy box. Bubbles, stickers, coloring books, whatever, take all of them into the room and give the child options. Use your phone, go to YouTube, and put on some Blippi (he is gold for the little ones).

    Finally, if all else fails, go for the horrible corny joke, the dad joke. For those of you not in the dad joke secret society, allow me to introduce you. Dad jokes are jokes that are mildly amusing, usually pun-based, and, as a dad, you find them way funnier than anyone else. Well, you and any child younger than 7.

    Memorize these to try the next time you treat a 6-year-old:

    • How does the penguin build houses? Igloos them together.
    • Cashier: Would you like the milk in a bag? Dad: No, just leave it in the carton.
    • What's brown and sticky? A stick.

    And remember, just because these tricks are for kids does not mean that they will not also work for your older patients. I came up with this little gem for your next patient with a heart rate of 167 bpm. What is a pirate's favorite cardiac rhythm? Atrial fibrillation with Arrr V Aaaaarrrrrr!

    Thanks, folks. I'm here all week.

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