Supporting Children with Challenging Behaviors Clinical Pathway — Primary Care

Behavior Safety Alert

If the parent/caregiver indicates any behavioral concerns before an appointment or behavioral needs are identified during the appointment, please review or complete a Behavior Safety Alert within the Visit Navigator. The alert will be added within the encounter under the Rooming or Review tabs.

If the alert has already been added, it will appear within the BestPractice Advisories header (orange banner on the sidebar of the child’s chart).

Behavioral History
Child's Behavioral History	None Elopement Physical aggression Verbal aggression Self-injury Other
Are there developmental issues on the child's problem list?	None Developmental delay Autism spectrum disorder Other
How does the child communicate?	None Verbal Non-verbal iPad/tablet Communication on board Sign language Foreign language Other
What behaviors does the child display when they are upset/agitated?	None Kicking Screaming Thrashing Hitting Punching Cursing Eloping Biting Spitting Property destruction Other
Are there any triggers or sensory considerations that we should be aware of (things that make him/her upset, angry, agitated)?	None Shots Vitals taken Lights Noise Specific words Times of transitions Unfamiliar places Too many people in the room Waiting rooms Too many demands Caregiver Other
What can we do to de-escalate the child?	None Distraction Family member Staff member Music Toys Breaks in care Review procedures before Offer choices One person speaks at a time Limit number of people Other
Environmental Considerations	Move medical equipment after use Remove extra furniture Items with wires should not be left in room Remind parent to take belongings with them and out of touch from the child Other
What is the best way to approach the child?	None Age appropriate, child-like friendly approach Helpful phrases Explaining care clearly Neutral tone Make eye contact Introduce self and what you are doing Other

Consider any needed referrals — Social Work, Child Life, Healthy Minds Healthy Kids, Psychology, or Sedation.

If more information is needed, RN or provider should follow up with parent/caregiver to plan for future appointment. Recommend Child Life consult for future planning, as appropriate.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.