Children Who See TR/Child Life Specialists Cope Better, Spend Less Time in Hospital

from The Children's Hospital (TCH) News, November 2003

Therapeutic Recreation/Child Life specialist Jen

Liska prepares Tanner Osborn, 9, for surgery.

Children who see a child life specialist in the hospital before and during their hospital stays cope and adjust more effectively, understand their procedures, are less distressed and spend less time in the hospital than children who don’t, studies show.

And nowhere is this more true than at The Children’s Hospital, child life specialists here say.

"Our biggest reward is knowing that kids do better as a result of what we’re doing here," said Tommi Joseph, child life specialist.

And what they do at Children’s is a lot.

The 12 — soon to be 13 — Therapeutic Recreation/Child Life specialists strive every day to make sure patients and their families are prepared for their procedures and the children are adjusted to the hospitalization stay.

Not all patients see a TR/CL specialist: some are referred, some ask to see a specialist, and some are a priority because of their ages, intrusiveness of the procedure, length of stay or a procedure’s high level of pain.

But for patients who do see a TR/CL specialist, the experience sometimes begins with a tour of the hospital before a child is admitted. Once a child is settled, the TR/Child Life specialist will come back and talk the family through whatever procedure the child is facing.

"We talk about things they may encounter, such as medical equipment," Joseph said. The goal is to help the patients and their families understand what the procedure or surgery will entail and how to cope.

The process differs depending on the patients’ age. Children 6 months old to 6 years are "more vulnerable to the effects of the hospital," Joseph said. "They may have difficulty comprehending all that is going on with them."

To help younger children cope during a procedure such as a shot, the TR/CL specialist might have them blow bubbles or blow on a pinwheel — which has the double whammy of relaxing their muscles, making the shot that much easier. Distracting toys work too.

Children 13 and up have other issues, such as self-esteem, said Therapeutic Recreation Specialist Kristine Jansen. They are also encouraged to determine their own coping style to help them relax within the hospital environment.

Teen patients are encouraged to relax by chatting, taking deep breaths or listening to music.

Getting the patient to conjure an image of their favorite place or the place where they’re happiest works for many patients.

Medical play is another strategy TR/CL specialists may use. If a child thinks needles are scary, the specialist might initiate medical play as a way for a child to express feelings, fears and/or misconceptions about "getting a needle" or to rehearse ways to cope for the next time they "get a needle" in the safe context of play, said Karen Konvolinka, MS, CCLS.

"We find out what they’re most afraid of," Joseph said. "It’s play with a purpose."

Specialists also have many other responsibilities, including supporting patients who don’t have a parent available for support, helping a patient’s siblings understand their brother or sister’s illness or hospitalization and helping with end-of-life issues.

"People truly understand the impact of what we do," Joseph said. "We’re the safe people in the hospital. We don’t ask intrusive questions. We don’t do intrusive procedures. We normalize the experience for kids and adapt it to their level."