THE DOCTOR-CHILD RELATIONSHIP

NEW YORK TIMES COLUMN: FAMILIES TODAY:
THE DOCTOR-CHILD RELATIONSHIP
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Routine visits are opportunities for me to develop a relationship with the child and the parents right from the start.

I never expect a baby between the ages of 9 months and 3 years to leave her mother’s lap for an examination. When I recognize the child’s need to be close to a parent, the child knows I respect her.

I never look the child directly in the face or ask for her to accept me. In this period, I gradually approach her, using a doll or teddy and her parent to show what I am about to do – like using the stethoscope.

I make a big effort to get a slightly older child to want to come to my office – loading it with toys, a fish tank, a climbing gym, a flexible cloth tunnel to crawl through, and a rock collection, and I offer stickers and plastic rings (for children old enough not to swallow them) that they can show off as tokens of their bravery.

As the child comes into my office, I watch to see how comfortable she is. If she’s frightened about me, I know that. Giving her time to get used to me is respectful. The time is well worth it. She’ll be far easier to examine. Her parents will be less hesitant to warn me of potentially serious problems – early – once they’ve seen this demonstration of my concern for their child’s comfort.

As I examine the child in her parent’s lap, I urge her to listen to my chest. We’re sharing the experience and she knows it. She also knows that I respect her privacy and her natural anxiety about being examined. We’re setting the stage now for a long future relationship.

I comment on the child’s temperament and mode of play. She knows I understand her. She listens. Anything her parents and I need to discuss is talked about in front of her, and I try to put it in her terms. I want her to understand what we are talking about. No secrets! I prepare her for a shot, honestly, and urge her to cry and to protect herself. After it’s over, I congratulate her on her success.

As a child gets older, at 4 or 5, I may even urge her to ask her own questions and to call me on the phone. She won’t yet. But by 6 or 7, she will.

We can discuss her illness between us, though of course I won’t leave the parents out. In later years, when she’ll let me see her alone, we can share confidences without its being a triangle – though she, her parents and I all know that I will help her to tell them what she needs to.

I believe in sharing all I know about each illness with the children themselves. My goal is to help them take an active role in conquering their own diseases. If they can call or talk with me, and carry out my advice, this lesson will stay with them. When they recover, I can congratulate them: “Look how you knew what to do – and it worked!”

When children must go to the hospital, it becomes even more critical that a physician explain the reasons and the procedures in front of the child. We have found that preparation for acute or chronic hospitalization cuts down on the child’s anxiety in the hospital, shortens the child’s recovery time and reduces the symptoms of anxiety afterward.

In my office practice, the best reward for me at the end of a busy day always came when I heard a child’s chortle of delight as she rushed in to see me and my familiar toys. Then I knew we were off to a good start.

Sharing Responsibilities

  1. Seek to establish a trusting, respectful relationship between your child and her doctor. You must do your part as well. It’s is no help to enter the office saying, “He’s going to cry” or “She hates coming to see the doctor.”
  2. Prepare the child ahead of time, truthfully, and with reassurance about what is likely to happen.
  3. Remind her that you’ll be there, and that it’s her own doctor who wants to be her friend. The doctor knows how to help her when she’s well and when she’s not. It’s surprising to me how much it helps a child’s self-esteem to learn to trust her physician. Working with a pediatrician is a mutual job of learning what you can – and can’t – get from each other. You must demonstrate respect, and you deserve respect in return. Both of you have the same goal – a healthy, competent, confident child!

(This article is adapted from “Touchpoints: Birth to Three,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.