Child Life team soothes young patients, helps them adapt to hospital

February 1, 2011


INDIANAPOLIS — When a doctor says,"We're going to use a camera to look at your insides," a child may picture a large lens and camera body and worry about how the doctor will get it inside her.

When a nurse says, "We're going to put you to sleep before surgery," a child may recall when the family pet was put to sleep, and assume that's what the nurse means.

The Child Life Services staff, a team of specialists at Peyton Manning Children's Hospital of Indianapolis, is trained to anticipate and defang these types of misperceptions. Team members work to see the hospital through a child's eyes and find ways to make the experience less scary.

Before and during a child's inpatient stay or outpatient procedure, Child Life staff members meet with the patient, their care team and their family. They assess the child's intellectual maturity and temperament and learn the procedures the child will undergo, so they can prepare the child for what comes next. They'll use a combination of play, education, conversation and other activities to help the child cope physically and emotionally with their condition and treatment.

Peyton Manning Children's is one of about 450 health care and service organizations worldwide with a Child Life program, according to figures from the Rockville, Md.-based Child Life Council. That nonprofit organization educates and credentials Child Life specialists. To be certified, specialists must have a bachelor's or master's degree in child development or a related field, complete a 480-hour internship and pass an exam.

Peyton Manning Children's started its Child Life program over a decade ago, with two specialists. It has been expanding since, and now has 10 Child Life specialists, an art therapist and a schoolteacher. Team members visit every child admitted to the hospital, plus many children receiving outpatient services. They cover every department of the children's hospital, which has 46 inpatient beds, 15 pediatric intensive care unit beds and 18 pediatric emergency department beds.

Peyton Manning Children's is part of St. Vincent Health, a member of Ascension Health.

Peyton Manning Children's sees newborns through 21-year-olds with a wide variety of conditions. Some of the most common are orthopedic, respiratory, and heart complications, and cancer. Some children stay just a day, others for weeks or months. Some return frequently, others don't. Most are on-track developmentally, others have delays.

Pediatric patients may function below their usual developmental level because of the strain of being sick or because of medications they are taking, said Stephanie Tooley, clinical director of the pediatrics, pediatric ICU, pediatric short stay and Child Life departments at Peyton Manning Children's. The Child Life specialists tailor their approach accordingly.

Older pediatric patients can use Child Life's video games, computers and iPods for fun and therapy, and they can host friends in the program's teen room.

Given the hospital's diverse patient mix and the diversity of patient needs, Child Life experts must be prepared for just about anything.

Acclimating the child
Relationship-building is at the heart of the Child Life specialist's role, explained Angie Shepler, a Peyton Manning Children's Child Life expert. The specialists are attentive to family dynamics and how families handle the strain of a child's illness. "We see how people are coping, we support the patients and their families in what they're going through, and we keep them informed."

Young children may not have the vocabulary or self awareness to express their experience of illness or pain. The Child Life specialists sometimes use games, stories or dolls to tease out what children are feeling. Patients of all ages tell the specialists they are afraid of the procedures, and they want to go home. Some small children think they must have done something wrong and are being punished by being kept at the hospital.

The specialists reassure the children and try to make the daily routine as normal as possible, breaking up the monotony or stress of tests and procedures with time for art, play and schoolwork.

Tooley said the team may use games to educate a patient about staying healthy with diabetes. They have toys designed to help physically impaired children meet developmental targets and they have books and movies for fun and learning, including titles in other languages for non-English speakers.

A focus, Tooley said, is on helping the child be a child.

Medical play
Child Life specialist Danielle Patterson conducts pre-surgery tours with her patients, showing each exactly where they will be going and explaining medical procedures. Particularly for small children, she demonstrates a syringe prick or how stitches are applied on a medical doll and then helps the child handle the needle. This gives them a sense of control, Patterson said. Little kids can drive a motorized car into the surgery room.

Art therapist Lisa Rainey helps children process their hospital experience through drawing, painting, collage making and sculpting.

Rainey tailors each project to the patient's recovery. If a child needs to stand, Rainey encourages her to work at an easel. "Often, the patient is so consumed with their art making that they forget that they are also attaining physical goals," Rainey said.

Some patients decorate a Styrofoam head with clippings that reflect their emotions, fears and fantasies about their condition. One oncology patient used the head to display her first wig. "The project seemed to be empowering for her, and it gave her a safe space to verbalize how she had felt while losing her hair," Rainey said.

Child Life Services' on-staff teacher, Sandy Smith, is a go-between for patients and their schools. She helps children stay as current as possible on assignments. She learns from the children's clinicians and from her own research how the patients' conditions and treatment affect their ability to do schoolwork. Children's self-image can suffer if they fall behind in school, said Smith.

Smith also visits patients' classrooms, upon the family's request, to explain to teachers and classmates why the child is out and what to expect when the student returns. If classmates aren't prepared, they might fear that they'll "catch" the patient's condition; or they may react inappropriately to an oncology patient's wig.

Shepler said some clinicians once considered the Child Life team just "play ladies." But, Tooley said, as the specialists have proved the value of their insights and support, they have gained clinician buy-in. This has convinced administrators to support and expand Child Life Services, Tooley said.

It's not a billable service, so backing from Peyton Manning Children's, its foundation, grants and donations are vital.

Family matters
The Child Life specialists include siblings in play exercises and speak with them about their feelings. They connect parents and others to support groups. And, should a child die, the specialists talk with family members and may point them to St. Vincent's spiritual care services.

Sharon Hobbs of Shelbyville, Ind., has had two children at Peyton Manning Children's, a son with leukemia and a daughter with asthma and other respiratory problems. Her son, who is now in remission, loved getting games, cards, books and magazines from the Child Life staff and enjoyed a birthday party they threw for him. Her daughter soaked up the arts and crafts projects they brought.

Hobbs said the Child Life services give kids "something to look forward to, so that they don't always have to concentrate on being sick and away from home."


Copyright © 2011 by the Catholic Health Association of the United States
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