Brittany Spah, CCLS CentraCare Health System Power Power to the Pediatric Patient

Young Patients Making Big Statements “You know, that takes a lot of bravery.” -Kathryn, age 7 “I really don’t feel good, and to make it worse, I’m so, so scared to be here!” -Max, age 6 No one talks to me or even looks at me…it’s my body but they only talk to my mom and dad.” -Daniel, age 16 “But it does hurt…there is no such thing as a little poke.” -Grace, age 8

Topics of Discussion Child Life Psychological Preparation Post Operative Support Developmental Stages  Fears and Reasons for Anxiety  Interventions Child Friendly Interactions Little Words…Big Impact

Child Life What is a Child Life Specialist? Education and Training Child Life Availability at CentraCare  Consults  Pre-Surgical Tours – Contact Child Life to arrange tour

Psychological Preparation Communication of accurate, developmentally appropriate information in advance of an experience Includes:  Reason for the surgery  Anticipated sequence of events  Sensations that accompany the experiences

Psychological Preparation Patients who are prepared prior to surgery:  Experience lower levels of fear and anxiety  Display positive long term coping skills and adjustment to future medical needs  Express significantly greater satisfaction with their experience Benefits for provider and child:  Predictability decreases stress and anxiety  Expected stress is less upsetting than unexpected stress  Promotes trusting relationships  Increases accuracy of the patient and family expectations  Identifies potential stress points and allows for rehearsal of coping strategies  Increases confidence and cooperation

Post Operative Support Coping Plans  Caregivers who are present with the child  Pertinent special healthcare needs  Comfort items  Favorite toys or activities  Other information Family presence

Infants (0-12 months) Fears/At Risk For:  Separation from caregiver  Stranger anxiety  Basic needs feeling unmet Interventions to support infant’s coping:  Maximize parental involvement and information  Minimize unfamiliar caregivers  Promote and encourage normal routine  Provide appropriate stimulation and comfort

Toddlers (1-3 years) Fears/At Risk For:  Separation from caregiver  Heightened stranger anxiety  Loss of control  Pain  Disruptions in routines  Waiting times Interventions to support toddler’s coping:  Offer opportunities for medical play  Maximize parental involvement and information  Minimize unfamiliar caregivers  Encourage exploration of environment and movement activities  Promote and encourage normal routine

Preschoolers (3-6 years) Fears/At Risk For:  Separation from caregiver  Stranger anxiety  Loss of control  The dark  May view surgery as punishment for “bad” behavior  Regression Interventions to support preschooler’s coping:  Maximize parental involvement and information  Provide concrete explanations  Promote procedural preparation and identify coping methods  Offer opportunities for medical play  Offer choices and control

School-age Children (6-12 years) Fears/At Risk For:  Separation from friends, school, and routines  Loss of control  Regression Interventions to support school-age children’s coping:  Maximize parental involvement and information  Preparation  Procedural support  Medical play  Offer choices and control

Adolescents (12-18 years) Fears/At Risk For:  Change in appearance or body image  Increased dependence on caregivers Interventions to support adolescent’s coping:  Provide and respect privacy  Respect independence  Offer choices and control  Provide preparation  Involve patient in care and decisions

Special Healthcare Needs Changes in routines and environment may be even more stressful Primary caregivers are the best source of information  Nonverbal cues  Specific stressors/comfort techniques

Child Friendly Interactions Bring yourself down to the child’s level Introduce yourself and your role Only give choices where choices exist Do not make promises you cannot keep Appearances can be deceiving – make no assumptions!  Chronological vs. developmental age  Boy vs. girl (especially in infants) Pre-op phone calls

Child Friendly Interactions Use a calm, unhurried and confident voice Speak clearly and be succinct Use play as a strategy for getting to know the child Listen to and observe the child at play Be honest “Will it hurt?” is the most common question asked by children

Child Friendly Interactions Avoid phrases that might be misinterpreted or might have multiple meanings Substitute words that may be interpreted as threatening State directions in a positive way

References Thompson, Richard H. The Handbook of Child Life: A Guide for Pediatric Psychosocial Care. Springfield, IL: Charles C. Thomas, Print. Drake, J., Johnson, N., Stoneck, A.V., Martinez, D.M., Massey, M. (2012). Evaluation of a Coping Kit for Children With Challenging Behaviors in a Pediatric Hospital. Pediatric Nursing, July-August 2010;38(4)