Improving the Child’s Experience

Alinda Shelley BS, CCLS

Certified Child Life Specialist

Development

Infant • Fear separation from parents or caregiver

• Infants need a safe, secure, nurturing environment

Toddler/Preschool• Perceive pain and hospitalization as punishment

• Give them the opportunity to assert themselves and the freedom to attempt new skills

DevelopmentSchool Age

• Fear bodily injury and loss of control

• Wants everyone to adhere to rules

• Create an environment where they can succeed

Adolescent• Worries about body image, change in appearance,

and separation from peers

• Wants to be treated as an adult

• Wants privacy

Common Changes• Increased demand for attention

• Regression

• Hyper vigilance

• Greater fear of strangers

• Changes in eating

• Anger

• Greater concern about the body

• Increased crying and clinging

Building Rapport• Introduce yourself and your role

• Get down on eye level

• Engage in play

• Carry bubbles or other small toys

• Lanyard toy

• Smile

• Respect expression of emotions

Don’t• Talk down (including baby voice and nicknames)

• Say “Be a big kid” or “Be brave”

• Make promises

• Tell them info they won’t experience

• Exaggerate the experience (over or under)

• Compare patients

• Talk about children as if they aren’t present

Preparation• Imagine how a child would view the experience

• Describe using senses and steps

• Give clear, concrete, simple information

• Watch a child’s affect to perceive whether it’s too much or too little information

• Utilize choices

• “You can choose what you’d like to do while you have your shot. You can’t choose whether you have one.”

• Give the child and parent a job

IV Prep• Describe using senses and purpose behind it

• 1st- Tourniquet (most of the time called a rubber band)—it is going to feel tight and helps to see and feel the vein (blue line)

• 2nd- Cleaning—it will feel cold and wet and removes germs

• 3rd- Poke—some kids say it feels like a poke or pinch. Your job is to hold your arm still and take deep breaths. Purpose dependent upon situation.

Be Honest• NEVER make a promise you can’t keep

• If you lie about ANYTHING that happens during their experience, they will become distrustful of medical personnel

Language

“The King Who Rained” by Fred Gwynne

Coping Plan• It is okay to cry/ express feelings

• Engage in conversation

• Use electronic devices

• Utilize toys/ books

• Guided imagery

• Deep breathing

• Give each person a role

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NY: Avon Books. Kiely, A.B. (1992). Volunteers in Child Health: Management, Selection, Training, and

Supervision. Bethesda, MD: Association for the Care of Children's Health. Merck Manual. (2003). Illness in Children: Social Issues Affecting Children and Their

Families [Internet]. Available from: http://www.merck.com/mmhe/print/sec23/ch287/ch287c.html [Accessed April 2, 2007].

Northam, E. (1997). Psychosocial impact of chronic illness in children. Journal of Paediatric & Children’s Health, 33, 369-372.

Pediatric Education Services, Primary Children’s Medical Center. (2006). Let’s Talk About. . . Your child’s emotional responses to illness, injury and health care.

Pinnick, N. (1984). The work of chronically ill children on a hospital unit. Children’s Health Care, 12, (3), 113-117.

Sheldon, L. (1997). Hospitalising children: a review of the effects. Nursing Standard, 12, (1), 44-47.

Wright, M.C. (1995). Behavioural effects of hospitalization in children. Journal of Paediatric and Children’s Health, 31, 165-167.