Preparing Your Child for Their Own, or a Relative's, Hospitalization

Take a moment to reflect back on the very first health care experience you can remember. You may even close your eyes and bring it to life in your mind's eye: What was the environment like, how did it smell, did you taste anything, do you remember any sounds there, who was with you and how did the provider explain everything -- or not? Let yourself really go back into that memory, and stay there for a minute. And now, how do you feel?

My very first memory is around age 5, going with my father to the doctor. The room was cold and brightly lit, with lots of metal and glass containers with unfamiliar objects in them. I sat in a chair off to the side while my father was in the exam chair. I had no idea why we were there. The doctor pulled over the biggest machine I had ever seen and took a tube and placed it in my father's ear. He flicked a switch and a startling loud, gurgling sound began as unknown substances passed through the tubing. I was convinced he was sucking the insides out of my father's head. It was gross and scary, and I felt alone wondering if I was next. He was actually just removing some wax from his ears.

Moving ahead to my teen years, I have many memories of my own health care experiences while in treatment for a serious medical condition. The memories that stand out most for me are things like doctors telling my mother to please step out of the room because I would probably get very upset when they began, and it would be hard for her to watch. There were times when information was left out, and I had an unexpected outcome that left me feeling distrustful and scared. Then I have some other memories of a smiling orderly telling me everything would be OK, a nervous resident screaming for help when I coded and me lashing out at nurses when I couldn't make my needs known.

These memories were created decades ago, when the field of "child life" was not as well incorporated into health care as it is today. There was no child life specialist helping me through my experiences. Imagine, if you can, how different these health care experiences would be if a trained professional was there to use developmentally appropriate tools to explain everything to me. Imagine, if my parents had been afforded the information about how to best support their child during health care experiences?

A child life program recognizes the unique emotional and developmental needs of children and their families throughout their health care experience. The role of the child life specialist is to help children successfully cope with illness, injury and treatment so they may continue to live normal lives during their health care experience. Child life specialists are professionals trained at a bachelor's or master's level who have completed a clinical internship and passed a certification exam to become credentialed to provide services to patients that range from newborns to young adults and their families to minimize stress and trauma during medical events.

A health care experience can be an especially challenging time for children and their families. In addition to the initial distress of illness and injury, unfamiliar faces, sounds, smells and surroundings may leave children feeling anxious, isolated and uncomfortable. These same feelings arise when a child is visiting a family member in the hospital, with an additional layer of worry and confusion over what's happening to their routine.

Many hospitals have child life programs staffed by child life specialists and other related professionals, that help to create a comfortable and familiar hospital environment for children and families and educate children and their families, often through medical play where the children get hands-on experience learning about medical equipment and procedures. Child life specialists use puppets, dolls and medical tools to help children begin to understand and cope with their fears during their hospitalization. This technique also helps to prepare children and their families for tests, procedures and surgeries.

Child life specialists address common fears and misunderstandings; they provide emotional support and teach vital coping techniques for managing pain and anxiety.

Play is an important part of every child's life; it's essential to his or her growth and development. Play is also a tool for learning and can promote healing and a sense of mastery and coping through challenging situations. Recognizing this, child life specialists supply children with age-appropriate recreational activities, both in the playroom and at bedsides, and provide programming including art, games, dramatic play and medical play -- which fosters creative expression and facilitates healing on many levels. Additionally, licensed creative arts therapists work with patients and families individually and in small groups to encourage healthy coping skills during hospitalization, using modalities such as art, music, dance and more.

A vital role of the Child Life team is to recognize that many professionals and clinicians will see patients and families during their hospital stay, and all will work together to create the best experience possible. However, the most important players shouldn't be overlooked: the patient and family members! Patients and family members need to have a strong voice in developing a patient and family-centered care plan. Think about it: Who would know better what will help support their experience?

Through involving the patient and family in the treatment care plan, whether it's a quick visit to the pediatrician for a well checkup or a hospitalization, each experience is important to the development of a trusting relationship between patient, family and providers.

Here are some tips for caregivers to encourage successful experiences:

Give the child choices whenever possible. "Do you like to watch what the doctor is doing, or would you rather look away?" "Which arm do you want the doctor to check first before they place the needle?"

Be honest. "We're going to the doctor today so they can figure out why you're not feeling well, and make a plan to help you feel better."

Don't make promises you can't uphold. Don't promise it's the last time the doctor will do something; rather, reassure your child: "They're going to try and place this needle in the best vein they can find. They will try to get it on the first try, and if they can't, we'll take a short break before they try again."

Reinforce all cooperative behaviors and validate their expression of emotions. Avoid making them responsible for the success of the procedure -- for example, "If you would just hold still, the doctor could finish the exam." Instead, try saying, "It's OK if you need to cry now, and if you can hold still, we can be finished even more quickly!"

Use concrete language, and choose your words carefully. You can avoid increasing the anxiety of anticipation with your language. Anxiety is heightened by the use of words such as "yucky, hurt, burn, sting." Try saying things like "this medicine may have a taste that is different for you." If possible, offer a favorite drink to wash it down. For injections or blood draws, reassure your child, "You will feel the doctor pressing on your arm as the medicine goes in/blood comes out, and when they're finished, you'll feel more comfortable."

Offer comfort. Patients can use transitional comfort items such as teddy bears and blankets to soothe themselves. Parental/caregiver involvement may provide comfort; offer lap sitting or hugging as needed. Use soothing tones and touch to calm the patient. Provide distraction with favorite stories, music or games.

When patients, families and health care providers work together as a team, the experience will enhance coping, build trust and improve the overall outcome. If your child is being hospitalized, inquire about child life services. Many hospitals have a pre-op tour program that patients can visit in advance of their hospitalization to learn what to expect.

For more information on the child life profession, visit www.childlife.org. For more information on The Phoebe H. Stein Child life Program at The Children's Hospital at Montefiore, visit http://www.cham.org/programs/childlife/.