Brittany Spah, CCLSCentraCare Health System

PPoowweerr 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 LifePsychological PreparationPost Operative SupportDevelopmental Stages

Fears and Reasons for Anxiety Interventions

Child Friendly InteractionsLittle Words…Big Impact

Child Life

What is a Child Life Specialist?Education and TrainingChild 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 levelIntroduce yourself and your roleOnly give choices where choices existDo not make promises you cannot keepAppearances 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 voiceSpeak clearly and be succinctUse play as a strategy for getting to know the

childListen to and observe the child at playBe 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, 2009. 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) 215-221