Module 4: Promoting Mental Health in Early Childhood

Doctor Entertaining ToddlerOffice Practices to Promote Family Partnership


  • Ensure that the waiting and exam rooms provide opportunities for children to explore safely; consider typical waiting behavior (provide children with space to move around in and toys and books to play with; place dangerous objects out of reach).
  • Train office staff to observe and note parents’ discipline practices and to model appropriate expectations for behavior in early childhood.
  • Encourage office staff to verbally acknowledge and offer rewards for any self-control children exhibit while undergoing medical procedures and in coping with the stress of the visit. Emphasize that shaming is never appropriate. Encourage staff to praise children for verbally expressing their pain or fear.
  • Place toys and books in the waiting and exam rooms to facilitate observation of interactions between the parents and the child, the child and siblings, and the child and other children. Comment on the interactions or play you see as a way of eliciting parent perceptions of the child (“I noticed that your child was playing with another child in the waiting room. How do you think he gets along with other children?”).


  • Ensure that your office restroom is set up to facilitate independent self-care, such as providing stools for the toilet and sink, easy-to-use faucet handles, accessible towels and soap, and child-friendly reminders to flush the toilet and wash hands.
  • Be sensitive and responsive to regressions in behavior and to the difficulty in separating from parents, which many children exhibit under the stress of medical appointments. Techniques include:
    • Approaching children slowly
    • Greeting them and complimenting their clothes or possessions
    • Suggesting that parents stay with, hold, and reassure frightened children
    • Conducting the exam slowly while describing each step and how it will feel
  • To help children who have trouble dealing with office visits:
    • Invite them back for social visits so that they can play in the waiting room
    • Give children stickers or treats
    • Provide toy doctor bags and doll “patients” to get “shots”
    • Stretch exams and needle sticks across visits when possible
    • Do only what children can handle in a first visit
    • Affirm children’s mastery of the experience
    • Schedule return visits as necessary
  • Ensure that office staff respect the cultural diversity of families. Show respect for cultural differences by asking about each family’s background and approaches to childrearing and by incorporating their preferences into care plans.
  • Incorporate cultural diversity in the artwork displayed in the office.
  • Encourage families to get to know other families and children with similar cultural backgrounds, disabilities, or health conditions. Place a community bulletin board in the office, or offer the waiting room for group meetings. Keep a list of resources, such as parent support groups and organized play groups, on the bulletin board.


  • Treat siblings as individuals. Offer privacy for interviewing and examining each child even if the family came together.
  • Provide resources regarding sibling relationships including catalogs of noncompetitive games, instructions for special time, and books about sibling relationships.

School Readiness

  • Learn about the policies of local schools on screening, transition classes, retention, and acceleration.
  • Set up a Reach Out and Read program in your office. Contact Reach Out and Read, 29 Mystic Avenue, Somerville, MA 02145. Phone: (617) 629-8042. Website:
  • Set up a network (bulletin board, parent group) for exchange of information on local preschools and child care providers.
  • Have access to the Web site of the local library to locate children’s books and resources on specific topics for parents.

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