Communication and interview techniques differ depending on patient demographics and situation. Obtaining a history from an adult would require different approaches than obtaining the history of a toddler Communication and interview techniques vary depending on patient demographics and situation. Obtaining a history from an adult would require different methods than obtaining the history of a toddler. As Dandekar et al. discussed, “unlike other disciplines, pediatric residents interact with parents of patients at nearly every clinical encounter” (2018). In this interview, the clinician should communicate with both the patient and grandmother as appropriate. The young patient may be more comfortable sitting on the grandmother’s lap than on the exam table. As young pediatric patients may be hesitant to participate in the clinical interview, the clinician may need to incorporate fun into the examination and allow the patient to play with medical equipment.
According to the World Health Organization, the social determinants of health (SDOHs) are “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” (2021). There has been a more significant occurrence of health-related social risks in recent times, such as parental incarceration, exposure to violence, and pediatric behavioral health needs. These risks increase clinicians’ pressure to address psychosocial concerns and social determinants of health in well-child visits. When obtaining a health history for this patient, questions regarding their home environment should be explored. The interview should involve the grandmother and patient, with attention to the family dynamic and non-verbal communications. Simple descriptions should be used, with questions directed towards the child, but clarification gathered from the grandmother if needed.
Depending on the subjective and objective information gathered early in the interview process, screening the patient for malnutrition may be necessary. There are various “screening tools in pediatrics to facilitate the identification of children at risk for malnutrition who need further assessment and possible nutritional intervention” (Hulst et al., 2020). Additionally, due to the non-traditional family dynamic, other questions regarding the child’s environment may need to be explored. Does their housing complex provide adequate safety, heat, and water? What conditions led to the child living with their grandmother? Is there parental involvement, and to what extent? How much does the grandmother know of the parents’ social and medical history? Does the grandmother stay home with the child or work? What is the childcare situation? Each of these questions will help determine the next steps in this patient’s care.
Since the child lives with his grandmother, there might be a need to explore past psychosocial trauma. If others are involved in his care, what is their level of involvement, and are they reliable caretakers? Caregiver depression and developmental and behavioral problems in young children are essential areas for screening. Additionally, as a biracial child, there may be opposing cultural practices influencing the child’s upbringing. Specific childhood health problems such as behavior problems, asthma, and food insecurity are more prevalent among children living in poverty. They can have long-lasting effects on child health and well-being (Francis et al., 2018). Multiple risks can be associated with living in a high-density housing complex. Milligan et al. stated that “indoor air pollutant exposures are also disproportionately experienced by children in poverty” (2016). Screening for carbon monoxide, secondhand smoke exposure, lead, and mold is necessary as they are all associated with asthma exacerbations and upper respiratory infections.
Clinicians can assess the stress of food insecurity in individual families by incorporating a screening tool into their practice. The USDA’s 18-item tool provides a measure to evaluate food insecurity with the Household Food Security Scale (Coleman-Jensen et al., 2014). More simply, the 2-item screen designed by Hager et al. uses a subset of 2 questions from the Household Food Security Scale (2010).
Five targeted questions I would ask my patient and his grandmother to assess his health risks and begin building a health history are as follows:
Where was the patient born, and did he have adequate prenatal and infant care? What is his familial history? What is the patient’s medical history so far? Has he had any significant illnesses?
What are the patient’s current living conditions? Are there economic needs? Is there heat, water, and safety?
What is the patient’s previous medical access? What is the insurance and medication coverage? Has he received the recommended childhood vaccinations?
What is his diet? Are there food access problems? Is he a picky eater?
How would you describe his development for his age? Is he in pre-school? Is he behaving and developing similarly to other children his age?
References
Coleman-Jensen, A., Gregory, C., & Singh, A. (2014). Household food security in the united states in 2013. SSRN Electronic Journal. Published. https://doi.org/10.2139/ssrn.2504067
Dandekar, A., Weintraub, M. L. R., McFeely, E. D., & Chasnovitz, R. (2018). Parent involvement in the pediatric resident applicant interview. Academic Pediatrics, 18(6), 605608. https://doi.org/10.1016/j.acap.2018.02.017
Francis, L., DePriest, K., Wilson, M., & Gross, D. (2018). Child poverty, toxic stress, and social determinants of health: Screening and care coordination. OJIN: The Online Journal of Issues in Nursing, 23(3). https://doi.org/10.3912/ojin.vol23no03man02
Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., de Cuba, S. A. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers, A. F., & Frank, D. A. (2010). Development and validity of a 2-Item screen to identify families at risk for food insecurity. PEDIATRICS, 126(1), e26e32. https://doi.org/10.1542/peds.2009-3146
Hulst, J. M., Huysentruyt, K., & Joosten, K. F. (2020). Pediatric screening tools for malnutrition: An update. Current Opinion in Clinical Nutrition & Metabolic Care, 23(3), 203209. https://doi.org/10.1097/mco.0000000000000644
Milligan, K. L., Matsui, E., & Sharma, H. (2016). Asthma in urban children: Epidemiology, environmental risk factors, and the public health domain. Current Allergy and Asthma Reports, 16(4). https://doi.org/10.1007/s11882-016-0609-6
WHO. (2021). About us. Https://Www.Who.Int/. Retrieved November 30, 2021, from https://www.who.int/teams/social-determinants-of-health/about
