Non-compliance in paeds

On my paeds/rural placement I’ve discovered that gaining compliance with children for Ax/Rx is somewhat more difficult than with adults who understand that physio may help them and are willing and able to follow instructions..

It seems that many children get upset/anxious/scared when they feel they have lost control – whether it be not being able to control their movement or control the situation.

To gain trust and compliance we need to provide children with this feeling of control and autonomy, yet in order to achieve our treatment goals the therapist must obviously stay in control of the session! I’ve encountered children who refuse to do anything or do everything other than what you’d like them to do and also the difficult teenager who is just way too cool for physio! But I’ve learnt (from the great team of PT/OT/Speechies) that offering the children a choice is a really easy way to provide the kids with that longing to feel in control and ultimately gain their compliance. It’s much more difficult to ignore/avoid someone who is offering two options than one who is trying to make you do what they want. So, ask them whether they’d like to throw a basketball or soccer ball; find out if they’d prefer to do frog jumps or bunny hops; ask them whether they would prefer to use the stairs at the front or those inside; give the child your about to serial cast the really important decision of picking which colour plaster they should have etc etc. I’ve been amazed by how well this simple ‘trick’ works across the different ages of children on my placement. Even babies like control – let them pick the toy you’ll use for motivation and when they become irritable because your supported sitting has become too hard, make sure they get some comfort from mum before trying a new position.

There are so many examples and I think it is finally starting to become second nature for me to ask a child if they want to sit on the blue chair or the red chair instead of simply asking them to sit. And it is really paying off! My sessions have become much more productive by guiding the children to complete the activities I want them to do, simply by allowing them a choice which is inconsequential to my treatment goals.