I undertook a Peadiatric Placement first off this year, and came across a few challenging situations. The extent to which we study Peadiatric topics is no where near as much as our core units, and although we cover a lot of important topics, there is no real mention of behavioural problems or how to deal with kids in pain. This sort of thing really only comes from experience. I guess it would make an interesting unit “how to deal with a 5 y/o who has behavioural issues and is in pain” and although a long-winded title, I’m sure it would be an interesting unit!
I had been on prac for a few days and was in the orthopaedic area. Up until this day, all the kids I had come into contact with were fairly well behaved and compliant to physio treatment. I also realised later that all the previous patients I had seen, had all been over the age of about 10.
The first day I was allocated to treat this particular patient, I actually heard her before I saw her. I was entering the ward, and heard this incredible high-pitched screaming coming from a room. Little did I know at the time this was to be my patient…
I read her notes; she was a 5 y/o aboriginal girl from up north who had a diagnosis of septic arthritis of her L ankle. She had undergone a ‘wash out’ in surgery the previous night and was due for physio treatment today to encourage movement of her ankle.
I entered her room with my supervisor and was surprised to see this little girl now squealing with laughter as she was playing a game with her mum. After introductions and explanations of why we were there, we started to head off to the physio treatment area. To give an overall idea of how this girl behaved, there was approx 10 distinct changes between screaming, sulking and laughing in the time it took to get to the physio area (about 1 ½ mins)
She was eager to show me how she could walk using the K walker, which she did keeping her L hip and Knee fully flexed so her foot was very far off the ground. When I attempted to show her that she could relax her hip and knee and still just keep her foot off, she refused and screamed that it hurt. So we changed activities; I began by distracting her and hitting a balloon around, so get the focus off her foot. Once she had settled down and was happy again, we tried to get her to move her foot by making patterns in talcum powder that was on the floor. She refused at first, then began by moving her hip and knee to move her foot instead of her ankle, when we tried to correct the technique she screamed and said it hurt.
I then used the balloon again and she started laughing and playing, and then attempted the ankle movements with the same result. I wasn’t sure how much I should continue persisting with the ankle ROM exercises or just do general activities. And I wasn’t sure how much her ankle truly hurt or if she was using it to get her own way. After about 20 mins of treatment, this little girl had not done anything I had asked and had continued to be demanding and scream if she didn’t get what she wanted.
I came out of this treatment session feeling like I had not achieved anything, as I hadn’t done what was asked to do, which was get her ankle moving. I told this to my supervisor, who said I had attempted to do what was asked, but she had behavioural issues, which made it difficult. She said I had done really well in building rapport with this little girl, but that I needed to know when to change tact in terms of exercises.
As the placement went on, my aim was to have multiple exercise ideas lined up, so that if I was faced with a similar situation again, I could quickly change tact and attempt another. I still think it is probably something that you just get better at with experience!
A major learning experience I took away from doing this placement is that you have to be extremely creative with kids. There is no way you can use adult tactics and ask them to ‘move their ankle,’ because they wont! If anyone has any thoughts or ideas on how to know when to change tact or keep persisting with exercises, please feel free to respond!
1 comment:
I think it makes perfect sense from the child's point of view, she knew using her ankle hurt so she didn't want to use it. What she wont understand is why she has to use it, so you trying asking her with distraction and encouragement. After that I think the only way to go is to find a reward that the child wants and make it clear what needs to be done to get the reward. That way the child is motivated to perform the task and tolerate the pain.
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