Talk to Strangers

I have four kids who are now in high school and out of the house. When my two oldest were very young, I read some books by Gavin de Becker. The first was called The Gift of Fear, and it changed the way I think about what I teach my kids.

Very early on, we taught them to talk to strangers—it’s the opposite of the advice I grew up with. I encourage you to check out the books, but one of the main points is that we model talking to strangers all the time. So it’s better to teach your kids which strangers are okay to talk to rather than have them grow up unable to talk to anyone—especially including someone when they actually need to ask for help.

When it comes to the ER, teach your kids to talk to me. I’m not the bad guy. The nurse is not the bad guy. Don’t threaten your kids with shots or IVs or painful procedures if they don’t behave. Frankly, that’s a stupid parenting technique anyway. But please don’t put me or other medical providers in the middle of your bad parenting.

Kids obviously have less understanding of medical things than adults, but they should be able to have a conversation with me about what symptoms they are having. (Obviously, this is age-appropriate—your infant is not going to be able to offer anything useful. On the other hand, your teenager certainly should be able to have a conversation with me and answer some simple questions.)

As an example, even young medical students are taught to ask these questions about any particular symptom. You will find that most providers, including me, ask some version of these questions depending on the complaint. OPQRST stands for: Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Timing. Regardless of how old your child is, some of this will depend on you as the parent to help figure out the answers. But you and your child answering “I don’t know” doesn’t help me narrow in on what is really going on.

• Onset: When did this start? Was it sudden or gradual?
• Provocation/Palliation: What makes it better or worse? Does it seem to be related to anything you do? What have you tried at home?
• Quality: What does the pain feel like? Is it burning, stabbing, sharp, dull, etc.?
• Region/Radiation: Where is the pain? Does it seem to move anywhere?
• Severity: How bad is the pain?
• Timing: Is the pain constant, or does it come and go?

Helping kids learn to speak as precisely and concisely as possible will serve them well in the ER—and it will serve them well in all of life. I’ve had very difficult interactions with teenagers who either answer “I don’t know” to pretty much all of my questions or give very conflicting answers that don’t make any sense.

For example, a child with abdominal pain for a week that has been coming and going—sometimes related to certain foods, sometimes related to having a bowel movement—moves around their abdomen, comes and goes in waves, but with a normal appetite, no nausea, and no fever generally doesn’t concern me. Something like that is most likely constipation. It probably doesn’t need labs and a CT scan.

On the other hand, one to two days of central abdominal pain that has been getting progressively worse, is now quite severe, and is now located in the right lower abdomen—associated with some nausea, a fever, and lack of appetite—might very well need labs and a CT scan to look for appendicitis. But between the child and the parent, if they are not able to tell me the details—or if the details are exaggerated—it’s likely going to push me to do more than is necessary because I can’t be sure about a diagnosis. And doing a CT scan for your child’s constipation is not in anyone’s best interest.

So, encourage your child—as they are able—to talk about what’s going on and help them clarify exactly what they mean as it relates to their symptoms. Prep them for a conversation with me. It’s part of life. Virtually everyone will go to the doctor at some point, so the better the communication, the better the care.