1. Additional Resources
• Calgary Family Assessment Model
• Canadian Association of Pediatric
Nurses
• Canadian Association of Child Life
Leaders
• Pediatric Nursing Canada
Fig. 5
References
Articles:
Drendel, A. L., Kelly, B. T., & Ali, S. (2011). Pain
assessment for children: overcoming challenges and
optimizing care. Pediatric emergency care, 27(8),
773-781.
Koller, D., & Goldman, R. D. (2012). Distraction
techniques for children undergoing procedures: a
critical review of pediatric research. Journal of
pediatric nursing, 27(6), 652-681.
McCarthy, A. M., Kleiber, C., Hanrahan, K.,
Zimmerman, M. B., Westhus, N., & Allen, S. (2010).
Impact of parent-provided distraction on child
responses to an IV insertion. Children's Health Care,
39(2), 125-141.
Stock, A., Hill, A., & Babl, F. E. (2012). Practical
communication guide for paediatric procedures.
Emergency Medicine Australasia, 24(6), 641-646.
References Continued
Textbooks:
Hockenberry, M. J., & Wilson, D. (2013). Wong's
Nursing Care of Infants and Children Multimedia
Enhanced Version. Elsevier Health Sciences.
Pillitteri, A. (2010). Maternal & child health nursing:
care of the childbearing & childrearing family.
Lippincott Williams & Wilkins.
Ward, S. L., & Hisley, S. M. (2011). Maternal-Child
Nursing Care Enhanced, Revised Reprint with the
Women's Health Companion: Optimizing Outcomes
for Mothers, Children and Families. FA Davis.
Images:
Fig. 1: Nurse and girl with bear. [Photograph]. (n.d.).
Retrieved from: http://www.cadencehealth.org/what-
we-offer/specialized-care/pediatric-specialty/pediatric-
picu
Fig. 2: Pediatric nurse play set. [Photograph]. (n.d.).
Retrieved from: http://www.toysrus.com/buy/play-
doctor-kits/pediatric-nurse-play-set-8519-53972266
Fig. 3: Girl using nurse play set. [Photograph]. (n.d.).
Retrieved from: http://www.henrybear.com/buy/md-
8519/pediatric-nurse-role-play-set
Fig. 4: Child and nurse with needle. [Photograph].
(n.d.). Retrieved from: https://www.aap.org/en-
us/Pages/Default.aspx
Fig. 5: Nurse and boy. [Photograph]. (n.d.). Retrieved
from: http://www.accesshealthcareservices.com/home
-care/pediatric-care-management/
Rachel S. Hommersen
RPN to BScN Student
McMaster University
THE
PEDIATRIC
CLIENT
Communication Skills
in the Acute Care
Setting with the
12-36 month old client
Fig. 1
• Therapeutic Relationship
• Assessment
• Intervention
Rachel S. Hommersen
RPN to BScN Student
McMaster University

2. Purpose
• Unintentional childhood injury is leading
cause of hospitalization and death for
the toddler (age 12-36 months).
• Toddlers do not have the vocabulary to
describe symptoms.
• A crying, whining preschooler who is
“just not herself” probably has a
symptom she cannot describe.
• Toddlers have fears that adults do not
experience such as the fear of the dark,
separation, the unknown, intrusive
procedures, and mutilation of body parts.
• Preparation for children of this age,
therefore, should clearly aim at
alleviating these fears.
Therapeutic Relationship
• The relationship needs to be established
with caregivers first; once child feels
comfortable with nurse present, child
more likely to engage.
• Eye-level interaction should be in line
with both caregiver and child.
• A favorite toy or personal item such as a
blanket can help provide security.
• Consider introducing role playing tools
early on when establishing relationship.
• Allowing toddler to play with medical
equipment by touch which can reduce
anxiety.
Fig. 2
Assessment
Head to Toe Body System Assessments
• Describe purpose of assessment to
caregiver.
• Use play to demonstrate procedure to
toddler.
• Encourage toddler to demonstrate and
practice with a doll or teddy bear or on
caregiver.
• Perform assessment on toddler using
affirmative language; for example:
“instead of ‘don’t tense your arm’,
affirmative language would be ‘keep
your arm nice and relaxed”.
Fig. 3
Pain
• The skill of the nurse lies in helping the
child to convey the kind and intensity of
the pain he is experiencing and then
determining the best way to manage
pain.
• FLACC Pain Scale
Intervention
Preparing a Toddler for a Procedure
• Describe procedure to caregiver; explain
what happens and how long it will take.
• Explain that kicking and screaming
during a procedure is a common
response because of loss of their
mobility and not because of pain or bad
behaviour.
• Use play to demonstrate procedure;
encourage toddler to demonstrate and
practice with a doll or teddy bear.
• Use simple, concrete language to
describe to toddler and how it might feel.
• Limit prep to 5–10 minutes.
• Identify what restraints may be used and
give an explanation as to why.
• Allow caregiver to decide if they would
like to be present for procedure. (Some
prefer to leave room and return right
after to comfort child.) Allow caregiver to
stroke their child or speak soothingly to
their child if they remain in the room.
• If a procedure will involve pain,
encourage caregiver presence, provide
guidance and if possible, comfort/cuddle
toddler during procedure.
• Use distraction: Pacifier, swaddling,
rocking, eye contact, music, singing,
picture books.
• Consider pharmacologic pain reducing
interventions when available.
Fig. 4