The unsung heroes of sick kids

Chances are that if you have kids, you’ve had at least one unplanned visit to the hospital. Taking care of children in the emergency department (ED) is a special challenge for many reasons including the fact that the child’s parents don’t choose to see me specifically, they are usually meeting me for the first time, and they’re meeting me under very stressful circumstances.

When I started practicing medicine 20 years ago, thinking about how we could make visits to the ED less traumatic were of peripheral concern at best. It’s not that we didn’t care, but more that we were taught that “brutane” (i.e., holding a child down) was the proper way of safely performing a scary or painful procedure on a child. Anyone remember the papoose? (cringe)

Pioneers of child life specialists in the 1920s were already thinking about how we could make visits to the hospital less traumatic for children by providing play, preparation, and educational programs. Despite the early recognition of the stress hospitalization puts on children, widespread adoption of these tools didn’t become formalized until the 1980s.  Since then, we have learned that visits to the hospital aren’t simply unpleasant for kids, but they can be downright traumatic. We are now painfully aware that kids and adults can develop post-traumatic stress disorder (PTSD) from their hospital visits or medical treatments. On an anecdotal level, I’ve seen kids (and sometimes parents) who arrive in a panic because of prior traumatic experiences from doctor visits.

Child life specialists elevate the level of quality care we provide to children and families in health care. Despite this, the role of these professionals is frequently misunderstood. I asked some child life specialists I know a few questions about their profession and advice they have for the rest of us trying to do our best to take care of kids.

What are the most common misunderstandings about child life?

One of the most basic misunderstandings about being a child life specialist that they are not volunteers simply bringing toys to or blowing bubbles for the kids. Being a child life specialist is also not a stepping stone to nursing or medical school. It encompasses a graduate education in child development, family-centered care, bereavement, stress, and coping. Child life specialists take a national certification exam after completing at least two clinical rotations for real-world experience and participate in continuing education for recertification.

Many people on the medical team also think that child life specialists are there to make the child stop crying. Providing distraction, toys, blowing bubbles or showing movies are used to help the child feel that the hospital is a more normal environment and less scary. Sometimes crying is cathartic for children and completely normal. The goal is not to prevent the child from crying, but to help normalize the experience, make it less frightening and to help the child cope with the stress productively.

What are the most common mistakes you see people make when caring for kids in the medical arena?

One of the biggest mistakes adults make in preparing children for medical treatments or procedures is lying to them. This comes out of a genuine desire for the child to not be afraid or to lessen the stress on this child, but it creates a sense of distrust. Child life specialists encourage parents and providers to be honest with kids about what to expect. This should be presented to the child in a developmentally-appropriate way.  For example, if a child will need a blood draw, telling her that it won’t hurt only for her to discover that it did hurt not only doesn’t allow the child to prepare mentally, but also tells her that what we tell her may not be true. The unknown is often more anxiety-provoking than the actual procedure.

Not every child responds to the same way to stress or the uncertainty related to being in the hospital or doctor’s office. Some children have a lot of pre-procedural anxiety and perseverate on things that are about to happen. In this situation, it may be best to prepare him for what’s to come just before starting the procedure. Medical staff often want the child life specialist to block the child’s view of the procedure, but some children can become very anxious if they can’t see what is going on.  Others want to pretend you’re not even in the room, in which case blocking their view and distracting them with a book or movie works better. We rely on the child’s parent or guardian to give us an idea of how their child copes best.

The last most common mistake is one I see a lot when people work with elders and children: not speaking directly to the patient.  Regardless of the child’s age or developmental stage, they are taking in everything happening around them, including your body language, tone of voice, and facial expressions. Younger children can comprehend much more language than they can speak. It helps to take a moment to connect with the child.  If she is a younger child, show her a toy or blow bubbles. Talk to older children about their favorite sport or food. Talk them through your examination and explain what you’re doing as you’re doing it.

What is the best advice you’ve received about how to comfort children when they are receiving medical care?

Presenting yourself to the child with a calm presence by facial expression, tone of voice, softness of the eyes allows for the child to find a person who provides a sense of comfort during a stressful situation.  One child life specialist remembers a patient telling her that during the numerous wound dressing changes she endured after a severe burn injury, she would always look for the staff person with the kindest eyes because everyone would enter her room covered with medical gowns and masks. This gave her someone of comfort to focus on during a painful medical procedure.

A frightened child is looking for comfort in the people around her, but from no one more so than her caregiver. Sometimes when a child is distressed, everyone in the room will try to comfort the child by offering soothing words. It can be better to allow the child’s caregiver to provide the comfort, because this is the voice that she genuinely wants to hear. The comfort of touch from a caregiver cannot be understated as well. Having the child in a parent’s lap or holding the child’s hand where the child can see him or her also helps reduce fear and anxiety in a stressful situation.

Finally, making the environment calm by reducing noise, turning down harsh lighting or even using soft music from a smartphone or toy can reduce the overall feelings of stress in the room.

The next time your child needs medical attention, keep in mind some of these tips from the experts. If you are lucky enough to have a child life specialist involved in your child’s care, take a moment to appreciate the quality of care they provide and thank them for their service. I wouldn’t want to practice medicine without them!

Irene Tien is an emergency physician and can be reached at My Doctor Friend.

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