"Children understand better what they will face through drawings."

BarcelonaJust over two months ago, families visiting the emergency room or pediatric clinics at Hospital del Mar discovered how healthcare staff use pictograms when treating them. They are able to identify the symptoms that most illnesses present. From headaches, neck pain, stomach pain, or back pain, fever, runny nose, cough, rashes, vomiting, diarrhea, or dizziness, plaques, etc. And the possible treatments, from the simplest, such as a syrup, a pill, or a bandage, to the more complex, such as intubation, insertion of an IV, or insertion of a urinary or nasogastric tube (TEA), or with a language barrier, in the case of newly arrived families.

More relaxed atmosphere

It's 10 a.m. on Tuesday, and Verónica goes to the emergency room with her five-year-old son, Joel, who has ASD. While they wait for their turn, the boy appears calm, attentive to his mother, holding her hand when pediatric nurse Yasmina Ros and pediatric emergency room assistant Mónica Fernández call for him. Before entering the examination room, Ros and Fernández pause for a moment at the door to show him the pictogram that tells him what they're going to do. Once in the room, they ask the boy, a fan of cars and Lego constructions, if his neck hurts or if he has a runny nose, using the corresponding pictograms. The little boy says no, but Ros tells him, using the pictograms to help him, that the doctor will be back soon and will examine his neck. If his neck is irritated, she continues, they will recommend a syrup—which they show him with another pictogram. While waiting for the doctor, they take the opportunity to take his temperature, but not before showing him the pictogram depicting the thermometer and getting him to agree to it. Since Joel shows so much interest in the pictograms, Ros and Fernández continue showing him others showing children with back pain or arm slings.

Ros points out that the pictograms have been very well received by families, and especially by the children. "The children better understand what they're going to face through the drawings and they allow themselves to be better taught the techniques; there's better collaboration," she notes. "In fact," she recalls, "recently, there was a boy whose mouth we had to swab and, seeing the drawing, he wanted to do it himself." Fernández, in turn, emphasizes how, through the pictograms, "a more relaxed atmosphere and a more dynamic visit are achieved." "You don't go as fast as exploring because you're more entertained by the explanations and drawings, but the children and families appreciate that too; it's all like a game and much less traumatic," she adds.

Promote communication and trust

During the visit, Joel appears attentive at all times to the explanations of the nurses who are caring for him. He also seems very calm and cooperative. For him, the use of pictograms is not new either, since the family used them to help the little one begin to speak and communicate. "I think it's a very good resource for children who have these types of communication difficulties," says Verónica, his mother, who also acknowledges that, compared to other medical visits, her son "has seemed calmer and more confident with the nurses who have cared for him."

In the words of Montse Fàbregas, head of the pediatrics and neonatology nursing department at Hospital del Mar, said the ultimate goal of the pictograms is to "ensure everyone can communicate as effectively as possible." It's a very useful tool for children to use in schools, especially those offering special education. Those who ultimately chose the hospital, in addition to being very neutral and suitable for younger and older children, "are very comprehensive in terms of health and nutrition," explains Fàbregas. These are drawings, he continues, "that make everything more visual and understandable, which reassures children and families and makes the child's visit to the emergency room or doctor's office less traumatic." When this understanding exists, the intervention of healthcare personnel is also easier. "Everything flows more than when there's resistance or fear," notes Fàbregas, who cites another benefit of the pictogram system: "There's the advantage that children can also use them to communicate with us, since sometimes they don't know how to tell us something and they use the drawings we make available to them."