Communicate with the Family

Assess and treat the child in the context of his or her family, avoiding separation whenever possible. Emergency department policy should encourage parental accompaniment of children to the clinical area. It is optimal to consider that there are two patients, child and parent(s), each with expectations that must be addressed. Caregivers have essential historical information and, in the case of infants and toddlers, are physically necessary to the performance of a meaningful physical assessment. At all ages, children watch their parents for cues with respect to how to respond to the medical staff. Parents who understand and accept the sequence of events involved in emergency care become allies in enlisting their child's cooperation. Whenever possible, parents should be encouraged to remain present during procedures, maintaining visual and physical contact from a sitting position. Appropriate exceptions include parental discomfort and critical illness. Finally, because parents are intimately familiar with their child's range of verbal and nonverbal behavior, the examiner must take the phrase "this is not my child" as parental concern for abnormal level of consciousness. This reliance on parental knowledge is particularly applicable to the assessment of a child with developmental delay.

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