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Childhood Is a Different Country

Vibha Krishnamurthy (vibha.krish@gmail.com) is a developmental paediatrician and the founder of Ummeed, a non-profit organisation in Mumbai for children with disabilities.

Some adults magically connect with young people, but others can acquire this skill.

The door of the playroom at the Massachusetts General Hospital in Boston had a sign saying “Adults not allowed, unless accompanied by a child.” I entered the playroom with Sheena. I had met Sheena a week before in the ward where I was a paediatric resident, two decades ago. She was four years old, with a long-standing kidney disease that required frequent admissions. Every day during my morning round, I had asked politely after her stuffed toy fish and the book she was looking at. After a few days of chatting, she had commanded me to “come play house” with her.

I showed up after the workday was over, a little bemused, wondering what I had signed up for. “Playing house” evolved into a variety of pretend games in the playroom, her sanctuary from needles and other invasions of her little body. I spend a magical hour with her, transforming in an instant from a fireman to a princess. It ended with her examining me with a stethoscope, whacking my knee with a toy knee hammer, and solemnly pronouncing me well enough to go home. As I walked home that evening, it struck me that for the first time I had really gotten to know one of my patients.

When I began my paediatric training in the United States in 1996, I was already a qualified paediatrician in India. I knew all about sick children and how to treat them. From diabetic coma to tubercular meningitis, I knew how to heal a child’s body. But apart from my little niece, I do not remember talking to children or getting to know them. I specialised in developmental paediatrics, a branch of paediatrics focused on child development and children with disabilities. As a developmental paediatrician it was critical for me to learn to talk to parents, but more important, to learn to listen to them. Asking open-ended questions became part of my tool kit of skills. I had to stop asking questions like, “How many words can she say? Can she make sentences?,” and instead, say, “Tell me about Mona. How does she express herself? How does she tell you what she wants?” The answers proved over and over again that parents, irrespective of how educated or poor or ill they may be, are experts on their children.

But no one had ever taught me how to talk to children! Even though it seems obvious, entry to medical school or admission into paediatric residency is not determined by the applicant’s ability to communicate with children. Yet some adults seem to magically connect with children, whom children trust and allow into their worlds. Priscilla, the paediatric physiotherapist at the hospital where I trained, taught me that it was possible to do a neurological examination of the fussiest baby—she would sing “The wheels of the bus” and examine the baby’s arms and legs, making them go “round and round.” My aunt had no children of her own but her genuine curiosity and interest in children drew them to her like a magnet. I would like to share with parents, professionals and anyone who wants to communicate with children the skills I have learnt from observing these masters over the years.

Starting Well

The first thing I learnt was to create a level-playing field. Getting down to a child’s level is important. I remember a nurse asking me to imagine how I would feel if I were sitting on the edge of a five-foot-high chair with my feet dangling—certainly not chatty. Using furniture that is appropriate for a child is important or just getting down on the floor with the child. Never let the gulf of a desk get in the way of making friends. Unless you are sharing it with the child, avoid swivel chairs. Who can focus on what that doctor is saying when there is a possibility of spinning and zipping across the floor?

Then, I like to meet children, at least the older ones, alone, if they are comfortable. I introduce myself and shake hands like I would with an adult, to let them know that they are important to me. I explain what is going to happen next as well as what is not going to happen—no injections, nothing painful. Then I wait for the child to get comfortable and explore the room by looking or moving around. If I am talking with the parent, I pause frequently, to check whether the child has a comment or a question.

Before I meet the child alone, I find out his or her interests. Antoine de Saint-Exupéry’s The Little Prince has a line summarising how we adults ask questions: “Grown-ups love figures. When you describe a new friend to them, they never ask you about the important things. They never say: What’s his voice like? What are his favourite games? Does he collect butterflies? Instead they demand: How old is he? How many brothers has he? How much does he weigh? How much does his father earn? Only then do they feel they know him.”

Questions such as “What did you learn at school?” will get you overt eye-rolling or at best a shrug and the response, “Stuff.” One six-year-old with autism responded to my naïve question “How is school going?” with the droll response: “On and on.” You will get farther if you begin the conversation by asking them what they think India’s chances are in the cricket match or who their favourite actor or dinosaur is.

Children love to teach, and I find it liberating not to be an expert and to be taught. No play-acting is involved. In her book The Memory Illusion, Julia Shaw talks about how we all tend to be overconfident in our ability to remember how our childhood was. No adult remembers precisely what it was like to be a child. But ask and ye shall receive. If you see a four-year-old sitting on the floor with what looks like a bridge of Lego blocks, extend an invitation to talk about it with, “Will you explain what this is to me?” You might get a response like, “It’s a conveyor belt that moves heavy things from a little boat onto a big ship that rescues people who…” Merely exclaiming, “Oh, what a nice bridge!” would never have let you into that story.

The Teenager

Then, there is the teenager. Forget any dreams you ever had about being a “cool adult.” Bow to their superior knowledge. Some people are born to technology, some achieve technology and some have technology thrust upon them. If you are like me and most other adults, then you are part of that last group. That teenager with attitude is part of the first and the sooner you acknowledge that, the more likely you are to make her or him your friend, and learn something. I have received kindly tutorials on topics ranging from “what rap is really all about” to “twenty shortcuts you need to know on a Mac.”

There is this whole myth that adolescents do not want to talk. The truth is that most adults do not want to listen. Most teenagers I have met desperately want to talk about family, the complexities of relationships, and the stress of juggling academics, adult expectations and peer pressure. What is more, many of them are making the best choices they can under the circumstances. Being allowed to be part of these important discussions is a privilege, and we need to honour that. There is a pact with children in my room about giving each other undivided attention. Our cell phones do not enter the room.

Children remind me to have a perspective on what is really important in life. One time, after a long conversation with a patient’s parents about school and how it needed have a more inclusive curriculum, offer special education support, etc, I asked my young patient, a seven-year-old girl with cerebral palsy, what she would like to have at her school that it did not then have. She answered thoughtfully, “The girls come down to recess in twos, holding hands. I want someone to hold my hand at recess.” It was an incisive reminder that for every child, having a friend and being socially included by peers are the most important aspects of being at school.

My patients refer other children to me, sometimes their siblings and often their friends. Occasionally, they listen to me and take my advice. When you make enough deposits in a child’s “trust account,” you can occasionally make a withdrawal and ask her to trust you. My favourite payoff was when the mother of an erudite seven-year-old patient narrated this story to me. On his way to an appointment to meet me, his grandmother asked him what kind of a doctor I was. He responded solemnly, “A doctor of comprehension.” She asked, “And what does she comprehend?” “Me,” he answered. “She comprehends me.” During moments of self-doubt, I hold that answer close to myself.

 

Updated On : 28th Jul, 2017

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