April 2025 - Teaching optometry and ophthalmic dispensing learners how to communicate with children

Greater awareness of the importance of early eye health checks may mean that optometrists are seeing more paediatric patients. It is widely recognised that communicating with children and their families can be challenging for healthcare professionals. Optometry and ophthalmic dispensing learners must be able to adapt their approach and style according to specific individual needs (O1.1, O2.1) and in a manner that is supportive of achieving desired outcomes. This includes written and verbal communication, as well as recognising non-verbal cues (O2.2).

Why is communicating with children different from adult patients?

We are all unique and each patient requires a personalised approach to their eye health care based on their individual needs. In particular, the way in which paediatric patients are cared for requires a different approach to that of adults. This is primarily because children may struggle to convey and describe their visual symptoms. As a result, reading body language and obtaining their health history from their parent or carer is crucial. It is therefore important that the child is accompanied during the examination by an adult who knows their history and symptoms, and who can help the child feel comfortable and settled. ^[1]

Infants and children may be apprehensive about the appointment and this in turn may unsettle their parents and carers. Respecting the child's fears and concerns and putting them at ease is essential to set the tone for the consultation and gives confidence about the validity of the results of the examination.

The College of Optometrists Guidance for Examining Younger children gives specific advice on key information to gather and tests to carry out.

Learners should be encouraged to warmly welcome children to their consulting room and introduce themselves at the start.
Learners can build a rapport with children through dialogue and a range of open and closed questions - asking their name, age and interests will help to put them at ease. Dr Cathy Hamer explains that open questions are best used in getting to know a child and family without needing to make presumptions. Closed questions give the respondent restricted number of options, so response choices are limited e.g. do you prefer this frame or that one? Having limited options to choose from means patients aren’t overthinking their responses and can make their choice more easily. Closed questions are also easier to understand, as they’re usually worded in simpler terms.^[2] Learners can then ask if the child has any concerns and help to allay their fears through clear explanations of what tests will be performed. This will avoid any surprises and the child, and their accompanying adult are likely to feel more comfortable when they know what is going to happen.
Learners need to be patient. Children may find it harder to explain their symptoms and can be easily distracted. Encourage learners to give the child time to explain how they feel and if necessary, engage with their parents or accompanying adult to help build a clear picture of the symptoms and reason for the consultation. On the other hand, there may be situations where learners need to be assertive to ensure the consultation and any testing are completed successfully to ensure positive patient outcomes.
Emphasise the importance of body language when treating infants and children. Learners should sit so that they are at the same level as their patient to avoid appearing overbearing or intimidating.
Make it fun:
- Learners can gamify the examination - setting the child challenges and making it fun or including the use of toys and visual aids. It is also worth remembering that the appeal of stickers at the end of a consultation can never be underestimated.
- Children are often curious. They may want to play with the equipment or show an interest in it so encourage learners to involve them in the process by explaining what each machine does as they go along, and how it will be used with them. Perhaps even let them press a button!
- Learners should be encouraged to try to engage in an activity which the child is likely to enjoy, e.g. giving them a fidget toy, blowing bubbles, or making a paper aeroplane, before attempting the dispensing process. However, if all else fails, offer another appointment but consider what day, time of day etc. the child is most likely to co-operate. ^[3]
- Encourage learners to make use of visual aids such as fun diagrams and pictures to help explain tests and procedures.
- After an eye examination, picking frames is often the most enjoyable part for children, so optometrists and dispensing opticians should try and make the experience fun. MCOptom optometrist Michelle Beach has a dedicated children's area at her practice in Nottingham with brightly coloured cabinets to house the children’s cases, and a kids’ club with cartoon animals wearing glasses and lens cloths. ^[4]
- As Professor Bruce Evans says, "have fun yourself. I love a day of seeing children – it’s so much fun, and so many of them have a huge sense of humour. If the practitioner is enjoying it, the child will too, and then you’re going to get really good results.”
Scenario-based teaching of clinical communication skills can be a useful way to develop necessary skills. Similarly, role-play scenarios where learners practice handling uncooperative or anxious children.
As the NICE Guidelines state, learners must be encouraged to include children in any decision when there is a choice of options, including where there is no impact on health or treatment outcomes.
Remind learners that children can be unpredictable and may say unexpected things but this should not be taken personally. Building resilience can help with this. December 2023's Topic of the month has tips on building resilience.
Be aware that children with disabilities or whose preferred language is not English may have additional communication needs. In these circumstances, it is even more important to adapt your approach and work with their parent or carer to ensure the best possible care. Recommendations | Babies, children and young people's experience of healthcare | Guidance | NICE

Parents and carers

Ensure the accompanying adult is present in the consulting room throughout the examination. This helps ensure that the adult is fully informed and protects you and the child. They can also help the optometrist to explain instructions. Examining younger children - College of Optometrists
Learners must ensure that the accompanying adult has accurate information about the outcomes of the eye examination.
Model behaviour - show how to reassure parents and caregivers, as their involvement is key to the child’s comfort and cooperation.

Dr Cathy Hamer ^[5]advises that the dispensing optician should seek to explore and understand the reasons behind this. Parents generally want the best for their child and encouraging them to see that improved vision would be beneficial for their child’s learning and other aspects of development can be a strong motivator. Students could explain that early intervention can help address potential issues before they affect a child’s learning and development. However, if they are adamant in their refusal then you might suggest they go away, think about it and take time to observe how their child sees things and whether this is causing any difficulties. Giving specific examples of what they might experience could be helpful, for example:

SPOKE: Sector Partnership for Optical Knowledge and Education