Establishing rapport in paediatrics

On paeds prac at a child development centre I see a wide variety of outpatients with tort/plag and gross motor skill delay. When referred for PT these children have already been screened by a by paediatrican for any neurological involvement. Children often attend their appointments with parents. When seeing these patients especially the infants and toddlers it is important to establish rapport with the parents but inparticular the child.

During my first few treatment sessions I found establishing rapport with parent's really easy as they were obviously adult. A challenge for me was to establish a relationship with the child. I found it especially difficult due to my limited exposure to infants and toddlers previously and did not know where to begin.

I have now seen children for the past fortnight and have developed a few strategies to establish rapport which i would like to share. In outpatient setting such as these often the child will be seen in a block of treatments. At inital treatment sessions I think its important just to let the child play in their new surroundings and just observe their play. This allows them to familiarise themselves with the environment and develop trust in you the therapist. There is no point trying to force the child to do a tone or other assessment at inital assessment as in some children they become very distressed and cling to their parent the whole session.

Another strategy that has worked well is positioning both of the therapist as well as the parents. Although the child may be playing with you, its important to position the parent in the child's view so that they always feel safe. This may mean positioning toys near the parent or encouraging crusing with a toy towards their parent. Often if a child is total un-cooperative with the therapist I encourage the parent to modify their play with the child so I can observe their behaviour.

Through this prac it has really developed my skills treating and communicating with younger patients. I now use these strategies when I encouter a difficult child who is un-cooperative or in distress at PT. This makes for a more trusting relationship between you and the child, making the physio session more productive and enjoyable for the child. Wasting an entire session forcing the child to do something they do not want to do will only decrease productivity of the session and make them less co-operative with future PT.