Developmental and Age Considerations

A person’s age needs to be considered when conducting the client interview. Most importantly, you need to consider a client’s developmental stage. Developmental stage does not always align with a client’s chronological age. With regard to communication, a focus on developmental stage includes attention to areas such as language and cognitive and socio-emotional development. At times, you may need to modify your communication so that you are appropriately engaging with the client at a level they understand.

There are many ways to construct chronological age categories. Broadly, children are considered anyone under 18 and adults are considered anyone 18 and older. More specifically, you could consider the categories used in this resource:

• Newborns and neonates: newborns are birth to a few hours old and neonate is up to 28 day.
• Young children: clients who are 5 years and younger, including infants (28 days to 1 year), toddlers (1–2 years), and preschoolers (3–5 years).
• Older children and adolescents: clients who are 6–17 years, including older children/school-age children (6–12 years) and adolescents (13–17 years).
• Adults and older adults: clients who are 18 years and older, including adults (18 years and older) and older adults (65 years and older).

See Film Clip below of an expert pediatric nurse speaking about how communication varies between children and adults.

Film Clip: Interview with an expert pediatric nurse.

Young Children

You should use a combination of verbal and non-verbal communication with infants. Be constantly aware and adapt your use and choice of communication strategies based on the infant’s response.

Figure: Young children

Most infants enjoy hearing the human voice, and this is how they learn and make sense of language. You should talk to them in a relaxed and pleasant tone of voice even though they cannot verbally respond. It’s also okay to use baby talk with infants as it can help with language development: baby talk is a type of speaking where you use enhanced vocal intonation and hyper-articulation of sounds such as vowels and consonants.

In terms of non-verbal communication, you should have a relaxed body posture, smile, use appropriate eye contact, and gestures with your hands; these techniques are important with all children because non-verbal language can facilitate their sense of safety.

With children, you should adapt your communication to their developmental stage. Tailor your language to a level that children will understand, avoiding long complex sentences and instead using short sentences with simple words. Although you may use baby talk with infants, you should use a different approach with toddlers, who often want to be included in the conversation. As children get older, they enjoy receiving compliments and encouragement to connect with them (e.g., “look how much you have grown” or “great job!”).

Because care partners (typically parents) are usually present with young children, it’s important to involve them so that the child feels safe. Here are some points to consider with care partners:

• While communicating with a parent, the infant or toddler may sit on their parent’s lap and/or play with a toy. This introductory communication can help the child get familiar and comfortable with you, particularly at the first meeting.
• Children may behave differently because they are afraid or not feeling well. For example, they may hide behind the care partner or refuse care from the healthcare provider or cry or scream. These behaviours can create stress for the care partners, so it’s important to be patient and demonstrate unconditional positive regard.
• Some or all the client interviews will be conducted with the care partner when the child is unable to speak or fully articulate. Because care partners are considered a secondary source of data, you should ask them to clarify and elaborate how they know what they are sharing with you. For example, if they say that their baby is in pain, ask how they know this.
• At times during the care episode, it may be appropriate to interview the parent without the child present, particularly when talking about sensitive topics.

Older Children and Adolescents

Older children and adolescents are usually at a stage where they can participate in the care episode in a more active way and articulate their experiences, emotions, and needs. Thus, it is important to address them as the client first, as opposed to the care partner. Care partners are often still involved, but you should offer the child/adolescent the opportunity to speak with you privately at times. For example, you might say to the client: “At this age, I often like to provide time to speak with you alone. Are you okay if I ask your mom or your dad to step out for a few minutes?”

You should continue to use a combination of non-verbal and verbal language and communication strategies. In terms of non-verbal communication, use eye contact with a relaxed and open posture that demonstrates interest in what they are saying. Smiling may be appropriate depending on the topic. You should also facilitate the interview using strategies such as nodding and statements that encourage the client to continue sharing (e.g., “uh huh” and “tell me more”). Be aware of your facial expression and vocal intonation to ensure you are conveying empathy, acceptance, and a non-judgmental attitude. You may want to include fun objects or games, or include the child in the assessment process (e.g., “would you like to try tapping on your own knee with this reflex hammer?”).

Adolescents are in a transitional stage where they are still children but are moving closer to adulthood. It is important to recognize and respect their self-determination. Additionally, emotional and cognitive capacity will vary from adolescent to adolescent and from situation to situation. Therefore, your communication strategies will need to shift based on the adolescent and the situation. Overall, you should convey acceptance, honesty, and respect. Avoid talking to them as a child, as this is often interpreted as demeaning. Some adolescents are old enough to make their own decisions regarding some aspects of their health care: in many jurisdictions, this capacity to consent, which includes being able to understand and weigh risks and benefits, is determined by maturity level rather than by age.

When discussing sensitive and intimate topics, it is important to recognize that adolescents often feel self-conscious, embarrassed, and have a fear of being judged. Your communication strategies should convey acceptance and understanding of what they are experiencing. You should have an open and non-judgmental attitude so that you can cultivate a trusting relationship with the client. Permission statements can be particularly useful as they can help normalize what an adolescent may be experiencing.

Adults and Older Adults

Adulthood is a large age category including everyone 18 years and older, but there is great diversity within this group. Some adults will have had minimal encounters with MRTs and others will have had extensive encounters. Younger adults in their late teenage years and early twenties may share characteristics with adolescents, so you may use many of the same communication strategies. You should also examine and acknowledge your own biases and tendencies to stereotype older adults and constantly re-assess your own assumptions so that they do not negatively affect your communication.

With older adults, it is important to give them time to process and answer questions, as they may have a slower response time. Avoid making assumptions about their hearing or vision or cognitive capacity. Rather, speak in a clear voice and face them while you speak as you would with all clients. It can be helpful to write down instructions or educational information for older adults, as they are often dealing with substantial quantities of health information.

Some older adults may have a care partner present with them because they are managing multiple illnesses and may have cognitive or physical impairments that cause disabilities. When a care partner is present, you should engage in an inclusive communication approach. After engaging in the introductory phase with the client, ask about who the person with the client is. If appropriate, you should consider the client and care partner as a dyad in which both are recipients of care, but the client should be your main focus during your assessment. Avoid assuming that care partners can better answer questions for older clients. For example, direct your questions to the client even though the care partner may help answer some of the questions.