CE

Continuing Education
2.5 HOURS

By Catherine Gray Deering, PhD, RN, CS, and Debra Jennings Cody, MS, RN

Communicating with
Children and Adolescents
‘Children are all foreigners,’ Ralph Waldo Emerson said; but
it need not always be the case. Here are some specific,
age-appropriate tips for understanding the language of children.

A child’s world can be a lonely one. Adults often think that

they understand what it’s like to be a child because they
were once children themselves, yet most lose sight of the
child’s perspective.
Communicating with children takes skill, thoughtful-
ness, and practice. Even a conscientious practitioner may
be taking this ability for granted. This article focuses on
communication techniques that work with children and
adolescents, according to age, behavior, and the context
of the interaction. Nurses can use the approaches
detailed here to refine their interactions with children
and to teach parents how to improve communication
within their families.

Catherine Deering is a professor of psychology in the School of Arts and Sciences at Clayton College &
State University, Morrow, GA, and has practiced as a psychiatric nurse with children and adults. Debra
Cody is an assistant professor of health care management in the School of Health Sciences at Clayton
College & State University and has practiced as a maternal–child nurse. The authors acknowledge the
assistance of research librarians Rhonda Boozer and Jonathan Jay in the preparation of this article.
Contact author: Catherine Deering, School of Arts and Sciences, Department of Baccalaureate Nursing,
Clayton College & State University, Morrow, GA 30260-0285; [email protected].

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INFANTS tions among public health nurses, mothers, and
Infants (birth to twelve months) first learn to com- infants during clinic visits in Finland showed that
municate through their senses, primarily touch, sight, nurses used entertainment and playful persuasion to
and hearing. Studies have shown that infants who gain the infants’ cooperation during developmental
don’t receive adequate amounts of touch fail to assessments.3 Playful interactions are most wel-
thrive, even if they’re sufficiently fed and otherwise comed when prompted by the infant’s reaching out
cared for.1 Yet many adults fear “spoiling” their or making sounds to engage the adult, or when the
infants if they hold or child is calm and respon-
caress them too much. sive to new stimulation.
Nurses can debunk this For example, after an
myth by teaching parents infant has studied the
about the importance of examiner’s face, he may
touch to an infant’s emo- try to grab her glasses—
tional, physical, and cog- a sign that he’s respon-
nitive development. sive and ready to play.
For example, a par- Watch for signs that the
ent’s touch can convey infant is becoming over-
love and safety. An in- stimulated; these include
fant’s use of touch to looking or rolling away,
explore himself and his beginning to move the
surroundings encourages arms and legs in a fran-
sensory and motor devel- tic manner, and becom-
opment and allows him ing irritable.
to develop a concept of Adults sometimes ini-
the self. Nurses can also tiate play to distract an
demonstrate the impor- infant who is in emo-
tance of touch by cud- tional or physical dis-
dling infants in their tress (afraid, hungry, or
parents’ presence. At uncomfortable). But in
about eight months of such a case, playful dis-
age, however, infants traction is usually both
become anxious around ineffective and inappro-
strangers and shouldn’t
be taken from the arms
It’s easy for adults to forget how priate. Ask yourself,
“What do I need when
of familiar adults unless I’m afraid or uncomfort-
necessary. large and powerful they appear able?” and the answer
When communicating will probably be some-
with infants, it’s helpful to an infant. thing along the lines of
to speak in a soft tone “Comfort and reassur-
and to maintain eye con- ance.” Infants need no
tact without staring or intruding. It’s easy for adults less. Holding, rocking, and softly talking or singing
to forget how large and powerful they appear to an to a distressed infant—after tending to immediate
infant; indeed, some adults become so excited physical needs, of course—will comfort better than
around infants that they overwhelm them by lean- play will. However, if an infant must be separated
ing over their faces, making prolonged eye contact, temporarily from a parent or guardian, a distraction
and talking in a forceful, pressured tone. Research may prove helpful, particularly when accompanied
has shown that, across cultures, infants respond by gentle holding and verbal reassurances.
best to high-pitched, gentle tones of voice and that Many researchers in child development describe
most adults automatically adjust their vocal pitch synchrony as a caregiver’s sensitivity and timely,
from low to high when talking to infants.2 appropriate response to an infant’s communica-
Communicating through play, as when making tions. Examples include mimicking an infant’s sur-
silly noises or faces, playing peekaboo, or rattling a prised facial expression and softening one’s voice to
small toy, can be effective as long as the child seems calm a frightened infant. One study revealed
receptive to it. A study of 1,554 videotaped interac- the two most common causes of asynchronous

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 adult–infant communication: ignoring an infant’s encourage a child to elaborate as they convey confi-
invitation to interact and overstimulating an infant dence and interest.
who needs to withdraw and rest.4 One common mistake adults make is to discuss
serious problems (such as a spouse’s drug
abuse or concerns about their own health)
with one another in the presence of young
children, assuming that they either don’t
understand or aren’t listening. Because
young children are completely dependent on
the adults around them for their care and
safety, they remain remarkably attuned to
adults’ moods and reactions to events. They
soak up information even when seemingly
preoccupied with play. Nurses should take
care not to discuss frightening or serious
matters with parents and other adults in
front of children, who aren’t able either to
fully comprehend or to tolerate the adults’
reactions. If parents initiate discussion,
nurses must be prepared to gently interrupt
and suggest that the children play in the
waiting area or stay with another adult.
Communicating with toddlers and pre-
schoolers often involves setting limits. Some
It’s unwise to offer assistance to a toddler who’s nurses may find this unpleasant or believe it stifles
a child’s spontaneity and creativity. But in our expe-
rience, limits help young children to feel safe; and
trying to do something independently; this nurses can demonstrate limit setting to parents in
a constructive, nonpunishing manner. A young
child’s defiance can be countered by offering
structured choices and distracting or directing him
will only increase the child’s frustration. toward an alternate behavior. For example,
suppose that, while you’re trying to assess a tod-
dler’s breath sounds, he repeatedly grabs at your
stethoscope. Rather than saying, “Don’t touch
my stethoscope!” you might hand the child a toy or
TODDLERS AND PRESCHOOLERS playfully engage him in the assessment (“Now take
The toddler and preschool years (ages one through a breath and let it out really slowly, like a choo-
two and ages three through five, respectively) are a choo train!”). Another technique, known as posi-
time of amazingly rapid language acquisition. tive reframing, involves stating specifically what
Toddlers, whose vocabularies tend to contain fewer you’d like the child to do, rather than criticizing
than 50 words, learn to attach meaning to sounds what he has done.6 For example, instead of saying,
(words) and to construct simple two-word sen- “You’re going to spread germs by coughing like
tences (such as “Want juice!”). Preschoolers build that,” you could say, “Remember to cover your
vocabularies at the astonishing rate of 10 to 20 new mouth when you cough.”
words per day; by the time a child reaches age six, During the toddler years, the development of a
his vocabulary will have grown to as many as sense of self brings with it a strong need to assert
10,000 words.5 In fact, a preschooler’s ability to independence, to have control, and to be possessive.
conceive language often surpasses motor develop- Offering choices—asking, “Do you want a green or
ment, sometimes causing temporary stuttering—the an orange Band-Aid?” for example—is an impor-
mind works faster than the mouth. Toddlers and tant aspect of communicating with children in this
preschoolers need time to complete their thoughts age group. It’s unwise to offer assistance to a toddler
without interruption by adults. This requires who’s trying to do something independently; this
patience, as the child’s thoughts often don’t seem will only increase the child’s frustration. Instead,
logical. If adults become impatient or abrupt (“I give him time and encouragement to keep trying for
can’t understand what you’re saying!”), the child success (such as gentle hinting). If the toddler is
may feel frustrated or ashamed. By sitting down and holding a toy, any request to see it or share it will
gently repeating what the child says, adults can likely be met with protests of “That’s mine!” In

36 AJN ▼ March 2002 ▼ Vol. 102, No. 3 http://www.nursingcenter.com

 Tips for Establishing Rapport with Kids
stressful situations such as initial meetings or in unfa-
miliar surroundings, young children shouldn’t be
forced to share possessions until they’re ready. The
capacity for giving and taking comes later, during
the preschool years. To establish rapport with a tod- 1. Sit or otherwise lower yourself so that you’re at the child’s eye
dler, try admiring the toy, commenting on his activ- level. Don’t tower over the child.
ities, or encouraging him to try something new (for 2. Look for clues about what captures the child’s interest or imag-
example, “Would you like to climb up on the scale ination (such as particular books, toys, and characters on T-
all by yourself?”). Toddlers also respond well to shirts) and ask the child about it.
parallel play, in which the adult engages in an activ- 3. Share your thoughts and observations with the child as a way
ity that the toddler imitates, or vice versa, and to of leveling the playing field (“I don’t like shots either,” for
active play that involves toys and hands. example), but avoid going into elaborate detail or shifting the
focus to yourself.
During the preschool years, imagination domi-
nates the child’s mind. Although this makes interac- 4. Avoid making trite comments that can make children self-
tion with preschoolers a delight, it also fuels the conscious (such as “You’ve gotten so big!” “You have such
nice red hair!” “Are you shy today?”).
development of fears and can lead to misinterpreta-
tion of language and events. Words that sound iden- 5. Use a normal tone of voice, and adjust your vocabulary
tical or very similar but mean different things can be enough to be understood, taking care not to “talk down” to
the child.
especially confusing to a preschooler, who might hear
die instead of dye and chicken pox pie instead of 6. Maintain a calm, gentle, unhurried, and open demeanor
chicken pot pie. Care should be taken to use vocabu- rather than a forceful, energetic one, especially with children
who seem hesitant.
lary that isn’t likely to be misunderstood and to con-
firm the child’s understanding of what’s been said. 7. Link information to activities of daily living rather than to
Preschoolers have limited memory of recent abstract concepts (“Your mother will be back after lunch,” for
example, instead of “Your mother will be here later”).1
events and in response to questions often use
preestablished “scripts” describing what usually 8. Don’t jump to conclusions about or devalue an adolescent’s
happens, even when the script isn’t accurate.7 For perspective of a concern; even if you don’t agree, it’s impor-
tant to allow all opinions to be expressed.
example, when asked what he ate for breakfast one
morning, a child might say, “For breakfast, I eat 9. Practice attentive listening; don’t be busy doing other
cereal and orange juice,” even when he actually ate things, especially when adolescents are trying to communi-
cate with you.
yogurt. Further, one recent study showed that young
children typically don’t tell everything they know to 10. Don’t allow parents to speak unfavorably about their children
interviewers, especially when asked broad questions in your presence. This sets a poor example, embarrasses the
children, and undermines their trust in you.
(such as, “What did you do today?”).8 They are
much more likely to give accurate information when
REFERENCE
asked specific questions that stimulate their memo-
1. Boggs K. Communicating with children. In: Arnold E, Boggs KU, editors.
ries (such as, “Did you go outside today?” or “Did Interpersonal relationships: professional communication skills for nurses. 3rd ed.
you eat anything that tasted funny today?”). Philadelphia: Saunders; 1999. p. 405-29.
Preschoolers ask simple questions that sometimes
have complex answers. But children in this age
group have both a limited ability to process audi- feelings, allowing a window into their world.
tory information and a short attention span.9 Drawing offers a similar opportunity: a preschool
Therefore, the simplest response is usually the best. child will often draw whatever is on his mind, espe-
Be brief and truthful without giving the child more cially if given a simple prompt such as, “Draw a pic-
information than is needed or asked for. For exam- ture of what’s happening today” or “Draw a picture
ple, if the child asks, “Why is my mother sick?” you of your family.” This medium has been used exten-
might answer, “Everybody gets sick sometimes; sively with children who have serious illnesses.
we’re helping your mother get better.” Similarly, if Clinicians di Gallo and Netzer-Stein found that
the child asks, “Why are you giving me drugs to drawing allows children with cancer to express their
take when they told us not to take drugs at school?” fears; it can also be used in assessing a child’s ability
you might say, “These drugs are safe drugs that will to cope.10
help you get better.” It’s important to allow the
child time to ask more questions if he wants to. SCHOOL-AGE CHILDREN
Because preschoolers tend to have heightened fears, School-age children (ages six through 12) are at a
they usually want reassurance from adults when stage of cognitive development marked by a height-
asking questions. ened ability to use logic and to understand events.
Puppets and other forms of dramatic, imagina- They can grasp the seriousness of events around
tive play allow preschoolers to act out thoughts and them and comprehend the impact of various stres-

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 sors on themselves and others.11 For example, they parents or older siblings in crises. Although this can
understand that a sick person may die and that be touching to witness, it’s important to consider
“bad people” might intentionally hurt them. that the school-age child may be reluctant to com-
As do younger children, school-age children care- municate his own needs. Nurses should be alert to
fully observe their parents and other adults for cues such role reversals and ready to reassess the child’s
about how to interpret events. They may try to fit perceptions and needs.
parts of an overheard adult conversation together, School-age children respond well to third-person
conversation prompts, such as “Some kids
don’t like being compared to their brothers
and sisters,” and “I knew a kid who was
afraid to get an X-ray because the machine
looked so big.” They may reply by admit-
ting their own fears or by asking about the
“other kid” to learn the answers to their
own questions. Another good technique,
asking a school-age child what he’d wish for
if granted three wishes, can reveal much
about the child’s feelings. For instance, a
child who says, “I wish I was smarter,” may
be feeling pressured to perform better acad-
emically.
When communicating with school-age
children, it’s important to know how they
perceive a situation before explaining it or
beginning any teaching. Whaley recently
reviewed the research on strategies for
explaining illness to children.13 He noted
Especially around school-age children, adults should that, in clinical situations, a simple question
such as “Why do you think you are here in the hos-
pital?” often reveals surprising misconceptions that
monitor their own emotional reactions to an event the school-age child has been reluctant to share
(“Because I did something wrong” is not an unusual
answer). Often, adults forget to address them
and explain it without exaggerating its impact or directly when explaining events, underestimating
their ability or their need to understand what’s hap-
pening. In a recent study, Stivers analyzed 291
using unnecessarily frightening language. videotaped clinic interactions between pediatricians
and their patients ages two to 14,14 and found that
children were rarely given the opportunity to state
the nature of the problems that had brought them to
often forming an incorrect conclusion.12 Especially the clinic. But when the physician first addressed a
around school-age children, adults should monitor child directly and then asked specific questions
their own emotional reactions to an event and (such as “Where does it hurt?”), the child was usu-
explain it without exaggerating its impact or using ally both eager and able to respond.14 A similar
unnecessarily frightening language. Therefore, study of videotaped interactions between physicians
when telling children that a family member is ill or and children revealed that, on average, a child con-
must undergo a procedure, a simple, straightfor- tributed only 4% of the utterances during a clinic
ward approach is best. Avoid a grim or overly con- visit.15 Further, the physicians directed 75% of their
cerned tone. For example, to a child whose father is statements to parents; only 25% were directed to
having back surgery, instead of saying, “Your dad the children.
is having an operation to take a bone out of his Both studies also underscored the importance of
back, and he won’t be able to walk for a while,” it’s providers’ communications with parents, finding
preferable to say, “Your dad is having an operation them both informative and instructive. A third
that will help his back, and he’ll need to rest for a study examined experienced nurses’ communica-
few days while it heals.” tions with mothers of young children and found
Whereas younger children are naturally egocen- that these communications performed crucial func-
tric, school-age children are more capable of empa- tions, allowing the nurses to offer support, confirm
thy. As a result, they may try to care for their a mother’s impressions and decisions, boost her self-

38 AJN ▼ March 2002 ▼ Vol. 102, No. 3 http://www.nursingcenter.com

confidence, and gently negotiate changes in her which may be useful in initiating effective commu-
approach to communicating with her children.3 nication with adolescents.16 Noting the prevalence
of eating disorders in this population, Roye subse-
ADOLESCENTS quently adapted the instrument to include weight
Adolescence (ages 13 through 18) is marked by (W), resulting in the HEADSS(W) assessment tool.17
intense feelings and a tendency to perceive
people and events in extreme terms. Adults
are likely to be seen as either “cool” and car-
ing or “clueless” and insensitive. Adolescents
often have difficulty trusting that adults will
treat them with respect and consider their
viewpoints. When they feel misunderstood,
they may withdraw or become hostile.
Taking the time to build rapport is vital to
communicating effectively with adolescents.
One particularly important principle is to lis-
ten more than you talk, especially at the
beginning of a conversation, and to convey
an attitude that is not judgmental (such as by
using neutral phrasing, tone, and body lan-
guage when asking questions), even if you’re
actually startled or disturbed by what they
are saying.
Start by using a straightforward approach:
explain the purpose of the interaction. Then
elicit the adolescent’s participation in the dis-
cussion. For instance, to engage him on the
topic of school, you could say, “Tell me about
your favorite subjects.” It may be helpful to
reassure the adolescent that he isn’t required
to talk about or reveal anything until he’s
ready to do so; this lets him feel in control of
the interaction while he gradually learns to
trust you. Explain the limits of confidential-
ity: anything that affects the adolescent’s
immediate safety (such as suicidal thoughts or
behavior) must be related to a parent or guardian. It may be helpful to reassure the
Laws regarding confidentiality and a teenager’s dis-
closures about sexual activity and related issues
(such as birth control and abortion) vary from state adolescent that he isn’t required to
to state. Use your judgment regarding a disclosure
of substance use; it should be revealed to a parent or
guardian if the child is in immediate danger (as from talk about or reveal anything until
intravenous drug use or addiction).
Always give adolescents the opportunity to talk
with you privately; also, be sure that when parents
are present, both the adolescent and the parents have
he’s ready to do so.
a chance to talk and ask questions. For example, if
you must ask a parent a question, you should then
turn to the adolescent and ask the same question. As the name indicates, nurses can use the tool to
(Sometimes nurses ask parents questions first to assess an adolescent’s home life, education, activi-
avoid putting the teenager on the spot.) This ties, substance use, sexual behavior, suicidal
achieves two goals: it lets you collect additional thoughts and depression, and weight and body
data, and it communicates respect for the teenager’s image. Because it’s a structured instrument, it allows
perspective. assessment in a manner that appears routine and
Cohen and colleagues developed the Home, that’s unlikely to make the teen feel singled out. The
Education/employment, Activities, Drugs, Sexuality, tool begins with the least personal questions, giving
Suicide/depression (HEADSS) assessment tool, the nurse a chance to establish rapport before ask-

[email protected] AJN ▼ March 2002 ▼ Vol. 102, No. 3 39

 ing more personal ones; it progresses toward a thor-
ough assessment of the principal areas of high-risk
behavior among teenagers.
Active listening skills, especially when com-
R E L AT E D R E S E A R C H bined with a calm, nonreactive stance, can help
you communicate with children in this age group.

Children and Providers:

Adolescents sometimes test adults during discus-
sion of difficult topics to see if they will “freak
out” or resort to lecturing, moralizing, or other-

How Well Do They Communicate? wise condescending. For example, if a teenager

says, “I got drunk last night,” a calm response
might be, “Tell me more about that and what led
According to one study, the answer is CLEAR. up to it.” Tolerating silence without prompting
or idly chatting is also important, giving adoles-

H ealth care researchers Sydnor-Greenberg and Dokken inter-

viewed children ages four to 17 with both acute and chronic
conditions to explore their previous experiences and
cents time to collect their thoughts, reflect on
their feelings, and decide how much they’re will-
ing to share.
preferences in communicating with health care providers; their When setting limits, offering alternatives and
mothers were interviewed as well. They asked the children to
allowing for compromise gives adolescents a feeling
identify instances in which communication had gone well and in
which it had not, and they solicited specific suggestions for of control. For example, asking, “Which would you
improvement therein. Although the children were less talkative like to do first?” or “Do you want to tell your par-
than were their mothers and appeared unaccustomed to being ents or would you rather I explained it to them?”
asked about their views, they were quite articulate about their are questions that permit choices. A statement that
preferences. The researchers categorized the children’s responses offers compromise might be, “Since you’re finding
into five components—context, listening, empowerment, advice, it hard to tell your parents, let’s tell them together;
and reassurance—and developed what they call the CLEAR com- I’ll help you to explain.” It’s important to show
munication framework. respect for teenagers’ perspectives by explaining the
Context involved seeing the child as more than someone with need for any restrictions. Teenagers may perceive
just a medical issue. The children in the study said they wished
limits as a rejection or punishment instead of pro-
their pediatricians would ask them about their school, friends, and
activities. Surprisingly, even older adolescents suggested that tection, especially if they’re set in a heavy-handed
providers ask more “personal questions.” One teenager with way and without discussion.
mononucleosis expressed gratitude that her provider asked about Adolescents tend to view themselves as actors in
her social activities; she was delighted when the provider an intense drama, one in which they occupy center
arranged for her to attend her prom for a few hours. stage and events take on heightened importance.
Listening meant allowing them to speak without being inter- Adults must be careful not to minimize the magni-
rupted and not making comments that conveyed disapproval or tude of teenagers’ thoughts and feelings, no matter
surprise. They were concerned about their fears being trivialized how exaggerated they seem. A calm approach, and
and reported instances in which they were made to feel foolish a sense of humor, can counterbalance the urgency
for crying or getting angry during a painful procedure. The study
they feel. ▼
noted several instances in which a provider’s careful listening to a
child made possible the correct diagnosis of a recurrent, compli-
cated problem.
Empowerment entailed fostering an active role for the child— REFERENCES
for example, by explaining in developmentally appropriate terms 1. Polan HJ, Ward MJ. Role of the mother’s touch in failure to
what is being done and why. Children said they wanted to be thrive: a preliminary investigation. J Am Acad Child Adolesc
told if they had to “get a shot.” One 14-year-old girl’s advice to Psychiatry 1994;33(8):1098-105.
other hospitalized children was, “Know what they’re going to do, 2. Cooper RO. The effect of prosody on young infants’ speech
and stick up for yourself!” Several children complained about perception. In: Lipsitt LP, Rovee-Collier CK, editors.
providers talking to their parents about them as if they weren’t Advances in infancy research. Norwood (NJ): Ablex;
1993. vol. 8. p. 137-67.
there. Children with chronic conditions, in particular, wanted
3. Vehvilainen-Julkunen K. Client-public health nurse
information conveyed directly to them. relationships in child health care: a grounded theory study.
Advice and reassurance, although less important to this group J Adv Nurs 1992;17(8):896-904.
of children than the other three components, were still significant 4. Isabella RA, Belsky J. Interactional synchrony and the origins
to them. Advice refers to the children’s need for providers to coun- of infant-mother attachment: a replication study. Child Dev
sel them in how to manage their particular illnesses. They also 1991;62(2):373-84.
wanted reassurance that they were healthy and that they were 5. Anglin JM. Vocabulary development: a morphological
doing a good job managing their symptoms. analysis. Monogr Soc Res Child Dev 1993;58(10[238]):
v-165.
Source: Sydnor-Greenberg N, Dokken DL. Communication in healthcare: thoughts on
6. Deering CG. Giving and taking criticism. Am J Nurs
the child’s perspective. J Child Fam Nurs 2001;4(3):225-30.
1993;93(12):56-62.

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 7. Bauer P, Mandler JM. Remembering what happened next:

2.5
Very young children’s recall of event sequences. In: Fivush R,
Hudson JA, editors. Knowing and remembering in young
children. Cambridge: Cambridge University Press; 1990.
p. 9-29.
8. MacDonald S, Hayne H. Child-initiated conversations about
CE
Continuing Education
HOURS

the past and memory performance by preschoolers. Cogn

Dev 1996;11(3):421-42. GENERAL PURPOSE: To present registered professional
9. Boggs K. Communicating with children. In: Arnold E, Boggs nurses with effective strategies for communicating with
KU, editors. Interpersonal relationships : professional com- children and helping them cope with public disasters.
munication skills for nurses. 3rd ed. Philadelphia: Saunders;
1999. p. 405-29. LEARNING OBJECTIVES: After reading this article and
10. Di Gallo A. Drawing as a means of communication at the the one entitled “Helping Children Cope with Public
initial interview with children with cancer. J Child Disasters” and taking the test on the next page, you
Psychother 2001;27(2):197-210. will be able to:
11. Deering CG. A cognitive developmental approach to under- • Discuss factors vital to understanding how children
standing how children cope with disasters. J Child Adolesc react to public disasters and to helping them cope
Psychiatr Nurs 2000;13(1):7-16. with their reactions.
12. Sieh A, Brentin LK. The nurse communicates. Philadelphia: • Outline the phenomenon of posttraumatic stress dis-
Saunders; 1997. order, including diagnostic criteria and age-specific
13. Whaley BB, editor. Explaining illness: research, theory, and symptoms.
strategies. Mahwah (NJ): Lawrence Erlbaum; 2000. • Discuss strategies for communicating with infants,
14. Stivers T. Negotiating who presents the problem: Next toddlers, and preschoolers.
speaker selection in pediatric encounters. J Commun • Discuss strategies for communicating with children
2001;51(2):252-82. of school age through adolescence.
15. van Dulmen AM. Children’s contributions to pediatric out-
To earn continuing education (CE) credit, follow these
patient encounters. Pediatrics 1998;102(3 Pt 1):563-8.
instructions:
16. Cohen E, et al. HEADSS, a psychosocial risk assessment
instrument: implications for designing effective intervention 1. After reading this article, darken the appropriate boxes
programs for runaway youth. J Adolesc Health (numbers 1–19) on the answer card between pages 56
1991;12(7):539-44. and 57 (or a photocopy). Each question has only one
17. Roye CF. Breaking through to the adolescent patient. correct answer.
Am J Nurs 1995;95(12):18-24. 2. Complete the registration information (Box A) and help
us evaluate this offering (Box C).*
3. Send the card with your registration fee to: Continuing
Education Department, Lippincott Williams & Wilkins, 345
Hudson Street, New York, NY 10014.
4. Your registration fee for this offering is $16.95. If you take
two or more tests in any nursing journal published by Lippin-
cott Williams & Wilkins and send in your answers to all tests
together, you may deduct $0.75 from the price of each test.
Within six weeks after Lippincott Williams & Wilkins
receives your answer card, you’ll be notified of your test
results. A passing score for this test is 14 correct answers
(74%). If you pass, Lippincott Williams & Wilkins will
send you a CE certificate indicating the number of
contact hours you’ve earned. If you fail, Lippincott
Williams & Wilkins gives you the option of taking the
test again at no additional cost. All answer cards for
this test on Helping Children Cope with Public Disasters and
Communicating with Children and Adolescents must be
received by March 31, 2004.
This continuing education activity for 2.5 contact hours
is provided by Lippincott Williams & Wilkins, which is
accredited as a provider of continuing nursing education
(CNE) by the American Nurses Credentialing Center’s
Commission on Accreditation and by the American
Association of Critical-Care Nurses (AACN 9722, cate-
gory O). This activity is also provider approved by the
California Board of Registered Nursing, provider number
CEP11749 for 2.5 contact hours. Lippincott Williams &
Wilkins is also an approved provider of CNE in Alabama,
Florida, and Iowa, and holds the following provider num-
bers: AL #ABNP0114, FL #FBN2454, IA #75. All of its
home study activities are classified for Texas nursing con-
tinuing education requirements as Type 1.
*In accordance with Iowa Board of Nursing administrative
rules governing grievances, a copy of your evaluation of this
CNE offering may be submitted to the Iowa Board of Nursing.

[email protected] AJN ▼ March 2002 ▼ Vol. 102, No. 3 41