Is your non-verbal child unable to communicate what is hurting them when sick? Is your child verbal, but has impaired comprehension, which makes it hard for them to tell you what’s wrong? Good afternoon, everyone. Speech-language pathologist/momma here. Today’s topic is about how to help your child communicate their ailments when sickness or injuries arise, specifically if your child is non-verbal and/or has comprehension issues. Sure, you know when they are sick because their behavior changes or you can physically see the symptoms of the ailment, but you can help your child more if you have a general idea as to WHAT/WHERE the pain/discomfort is.
Oftentimes, our first question is, “Where does it hurt?” or “Where’s your boo boo?” while all the while placing your hands on their forehead, looking in their eyes, and touching their belly. Maybe they replied by pointing to their head or saying, “Ouch, I have boo boo.”
OK, THEY ANSWERED YOU. BUT, DID THEY REALLY?
Here’s where it can get confusing.
Scenario 1 (child exhibits echolalia, which is where they repeat what they hear)
Parent: “Where does it hurt?”
Parent: “Yes, I know, it hurts. WHERE does it hurt? Where’s your boo boo?”
Child: “Boo boo.”
Scenario 2 (child exhibits comprehension difficulties and very short speaking patterns)
Parent: touching child’s belly “Does your belly hurt?”
Parent: touching child’s head “Does your head hurt too?”
Parent: In order to confirm….“So your belly hurts?”
Parent: “Does your belly HURT? Is your boo boo in your belly?”
Scenario 3 (child has large vocabulary and is very verbal, but has comprehension difficulties)
Child has large bruise on knee
Parent: “What happened?! How did you get this boo boo on your knee?!”
Child: “That’s my knee. My knee is a joint. It helps me to bend my leg.”
Parent: “Did you fall at recess today?”
Child. “We go outside for recess when it’s not rainy or too cold. They’re giving rain tomorrow. Will the rain come after recess? I want to have recess tomorrow.”
Scenario 4 would be where your child does not respond at all, but is very obviously in a state of distress.
In all these scenarios, we have yet to know what the source of pain or injury to your child is. If you take your child to the doctor, the same scenario plays out, which results in extensive tests in order to locate the source and cause of discomfort.
Before I go on, I want to specify that this post is not intended to eliminate doctor or ER visits. As always, follow your gut instinct.
Here’s where VISUALS come in. Talking specifically about helping your child communicate what is wrong when sick or hurt, it does not take a lot of visuals. If you would like to go in more depth to see how to help your non-verbal child and/or child with comprehension difficulties communicate while performing everyday activities, please see How to Teach Your Nonverbal Child to Communicate Without Using Words. Using visuals appropriately does require some comprehension, BUT comprehension often improves with visuals.
How to Teach Your Child to Use Visuals When Sick or Hurt
#1) First, determine their starting point for comprehension or what they already know. VERY IMPORTANT STEP because they can not tell you or show you something if they do not already know the words/objects/pictures that go with it. “Test” the following items:
1. Body part recognition
-Can they point to all the body parts that you name?
-Can they name the body parts themselves?
2. Ability to answer yes/no questions
-Can they correctly answer if you say, for example, “Is this a dog?” “Is this your head?” (if they can normally point to that body part when asked) Is my name “Tom?” “Is your name Tom?”
3. Ability to answer “what” questions?
-What is this?
-What am I doing? What are you doing? What is the boy/girl in the picture doing?
4. Ability to answer “where” questions and/or identify familiar places?
-Where are we/you right now?
-(Show them a picture of a familiar place, such as daycare, school, etc.) What is this place?
#2) Ask yourself: What symptoms resulting from illnesses and injuries does my child most commonly get and what are they most susceptible to? Find and/or make pictures that represent those common and potential symptoms and injuries. Examples are having a picture of your child (clothed, of course, sorry I had to specify that) facing the camera with their arms held out slightly to the side. Make sure you can see from the top of their head to their toes. Eliminate as much background stimuli as possible. Another example is as follows: if your child is frequently becoming injured, take pictures of your home, their school (make sure no people are in the photos), park, gym, any places that your child frequently goes. That way, you can better find out where they got hurt so you can help your child avoid that location/cause in the future. I would love to recommend some websites featuring free PECS cards that are specifically related to helping your child communicate their ailments/injuries, but was unable to find any that suited my fancy. Make the pictures accessible and durable. Punch some holes in the ends if you like and put them on a key ring or clip so you can take them wherever you go. For the full body picture, however, I would keep that a standard paper size and laminate it. I personally recommend having actual pictures they can physically touch or pick up as opposed to keeping them stored on your phone, for example. Your child may become distracted by the phone and just point to any picture in order to get the questioning process over and get to the fun.
The Actual Teaching Part…
Quick tip: In the beginning, familiarize your child with the visuals and practice using the visuals when they are feeling well.
If your child had difficulty naming or pointing to basic body parts or answering simple questions, please read Part 1 of The Basic Language Concepts Your Child Needs and How to Teach Them at Home to improve your child’s identification of basic body parts and please read How to Improve Your Child’s Ability to Answer and Ask Questions to improve your child’s ability to answer questions.
#3) Touch their arm, for example, and say, “What is this?” Place your hand over their hand and guide their hand to touch the arm on the picture. Repeat this with other body parts that are common sites of injury. Repeat this process until your child can INDEPENDENTLY POINT TO the right body part on the picture. So if you say, “Where is the arm?,” you want them to be able to point to the arm on the picture. This is not intended to TEACH them their body parts, but to TEACH them basic use of the visual system. Do Step #3 with all the pictures. For example, where is the daycare? Where is school?
#4) Read books or watch videos involving children that fall and get hurt or feel sick. Stop reading the book or pause the video as soon as it is obvious what is hurting the character, get the pictures, and ask your child, “What hurts on _______?” or “Where was ____________ when he/she got hurt?”
Quick Note About Step #4 and HOW You Ask Your Child Questions: Word the question the same way every time when practicing and use that same wording when using the pictures during moments of injury/ailment. If you want to say, “Where does it hurt?”, ask it that way EVERY. SINGLE. TIME. Communicate that phrase to any other caregivers, teachers, etc. When your child is sick or hurt, they need to know WHAT you are asking them. Because if they feel like their head is about to burst or their arm is about to snap in two, their comprehension is going to be MUCH worse. Familiarity and predictability will improve their comprehension.
#5) Use the visuals when they are actually sick or hurt, even if they haven’t mastered #3 and #4. Most people learn by doing. I’m not saying to drill them and make them point to a picture over and over while they are miserable, but if YOU KNOW FOR SURE where the site of injury is or where it happened, ask them the question, and point to and/or pick up the picture that correlates with it.
Most importantly, be consistent and patient with the process. Teaching the use of visuals to aid communication takes time, no matter if it is a parent of their own child doing the teaching, or a licensed speech-language pathologist. It takes time, but giving your child more control of their own environment is so worth it!
I hope everyone finds something in here that is helpful. If you do not see something that relates to your child, please leave a comment below or email me at firstname.lastname@example.org and I will do my best to create a post, no names mentioned of course, that will hopefully help your child.
This article was written by a speech-language pathologist, but is not meant to replace a speech-language evaluation or speech-language therapy. If your child is already receiving speech-language therapy at this time, please continue to work on improving your child’s communication at home. Therapy is so much more effective when we all work together with the same goal in mind!