Increasing Comfort: Tools for assisting pediatric patients during medical procedures

Question 1

Child Life Services

Answer 1

Child life specialists – use play and therapeutic activities to help children and families during their hospitalizations/treatment in multiple ways

• Preparation
• Develop coping plans
• Provide social and emotional support
• Medical pay
• Developmental play opportunities
• Normalize through special events
• Daily play groups to promote normalization and positive coping

Question 2

Preparing the child and caregiving

Answer 2

Information should be developmentally appropriate

Explain everyone’s role, what sensations they may feel, smell, see, taste, etc.

Acknowledge any fears, misconceptions, uncertainty, anxiety, and tension

Question 3

Child-friendly medical language

Answer 3

Radiation – “flashlight”

Pulse Ox – “Band-Aid”, “flashlight finger”, “Glow toe”

Blood Pressure Cuff – “a wrap for your arm that will give it a ‘special hug’”

Question 4

What age range is infancy and toddlerhood?

Answer 4

Birth - 2 years

Question 5

Development Tasks: Infancy and Toddlerhood (Birth - 2 years)

Answer 5

Physical development

• sensory and motor control
• increase in muscle control

Cognitive/Language development

• cause and effect relationships emerge
• establishing routines, recognizes familiar environments

Question 6

Infancy and Toddlerhood (Birth - 2 years) [continued]

Answer 6

Social/emotional development

• attachment to caregivers
• separation anxiety, stranger anxiety develops

Issues related to hospitalization

• separation anxiety
• over stimulation
  
  • visual (bright light), auditory (excessive noise), tactile (poking, etc.)

Question 7

Interventions: Infancy and Toddlerhood (Birth - 2 years)

Answer 7

• Communicate
• Engaging/disengagement cues
• Return to self-regulating state after procedures
• Watch for over-stimulation in the environment
• Encourage parental interaction and involvement (could be debated)
• Encourage utilization of security objects for home
• Provide consistency as much as possible
• Diversionary items to use during procedures

Question 8

What age range are preschoolers?

Answer 8

Ages 3 - 6

Question 9

Development Tasks: Preschoolers (Ages 3-6)

Answer 9

Physical development

• gross and fine motor skills are more refined
• Sex identification

Cognitive/language development

• magical thinking

Question 10

Developmental Tasks: Preschoolers (Age 3-6)

Answer 10

Social/emotional development:

• Increased degree of independence
• modeling and imitation
• peer interaction and make-believe play common

Issues related to hospitalization

• physical development: loss of control and regression
• cognitive development: misconceptions, fantasy and magical thought, view treatment as a punishment
• Social/cognitive development: separation anxiety, loss of independence, and lack of consistency

Question 11

Interventions: Preschoolers (Ages 3-6)

Answer 11

• “Safe” areas
• encourage patient participation
• give explanations in concrete terms
• explain each step during process in sensory terms
• clarify misconceptions prior to procedure
• provide simple choices
• encourage parental participation
• allow parents to verbalize fears/concerns
• provide limits and structure
• provide positive reinforcement
• provide peer interactions when possible

Question 12

What age range are school-age children?

Answer 12

Ages 7 - 12

Question 13

Developmental Tasks: School-age children (Ages 7-12)

Answer 13

Physical development

• Variations in physique develop
• Gains in flexibility, balance, agility, and force

Cognitive/language development

• interest in acquiring knowledge
• advances in memory, attention, grammar, and mathematical and scientific concepts

Question 14

Development Tasks: School-age children (Ages 7-12) [continued]

Answer 14

Social/emotional development

• increased relationship with peers
• continuing development of self-esteem
• development of self-conscious emotions (guilt, pride)
• major advances in perspective taking
• strong desire for group belonging and acceptance among peers

Question 15

Development Tasks: School-age children (Ages 7-12) [continued]

Answer 15

Issues related to hospitalization

• Physical development
  
  • Loss of control
  • altered expectations
  • regression
• Cognitive development
  
  • fear of not being well again and body-altering or painful
• Social/emotional development
  
  • may become withdrawn
  • acting out
  • issues related to separation from peers and social settings

Question 16

Interventions: School age (ages 7-12)

Answer 16

• Allow child to help out in his or her care
• provide “safe” areas
• Incorporate familiar home routines
• Explain procedures in developmentally appropriate language
• Explain what and when you are doing something
• Suggest ways of coping
• Allow time for questions
• Encourage peer communication/support
• Allow for play opportunities when possible

Question 17

What age range are Adolescents?

Answer 17

Ages 13 - 18

Question 18

Developmental Tasks: Adolescents (ages 13-18)

Answer 18

• Physical development
  
  • sexual maturation
  • growth spurt
  • hormonal changes
• Cognitive/language development
  
  • capable of abstract thought
  • development of the imaginary audience and belief that they are invincible
• Social/emotional development
  
  • sense of moral self
  • sex role identity
  • increased autonomy from parents
  • importance of peer group membership

Question 19

Developmental Tasks: Adolescents (ages 13-18) [continued]

Answer 19

Issues related to hospitalization

• Physical development
  
  • lack of privacy
  • body image altered
• Cognitive development
  
  • missing school/classes and implications that follow
• Social/emotional development
  
  • decreased connection to their peer group
  • fears of being “different” compared to others
  • dependency upon parents/other adults when they are struggling for independence

Question 20

Interventions: Adolescence (ages 13-18)

Answer 20

• Respect their privacy
• Involve them in decision-making
• Access to same-sex medical staff (if wanted)
• Tutoring services if hospitalized
• Addressing body image concerns
• Encourage contact with peers
• Allowing discovery of their individual coping skills
• Explain procedures using developmentally appropriate and correct terminology (do not use “little kid” language)
• Be honest with explaining and answering questions

Question 21

Common misconception: Preschoolers

Answer 21

Illness and hospitalization are punishments

caregivers wont return

misconceptions regarding choice of words (ex: being put to sleep)

they will never return home

there will be a lot of pain/harm to their body

Question 22

Common misconceptions: School-age

Answer 22

bodily mutilation

misconception about what part of their body is being treated

loss of control from medicine/medicine will make them feel weird

expression of feelings/fears will label them as “bad”

they can manipulate or “talk their way out of” surgery

Question 23

Common misconceptions: Adolescents

Answer 23

bodily disfigurement

loss of control and independence

loss of peer acceptance

embarrassment

fear of death during surgery/procedure

they will be expected to understand all that is happening to them

Question 24

Common distraction techniques

Answer 24

Stroking, singing, or talking with the child (*Kamil singing the lion king to a child’s treatment)

Visual and interactive distractions (iPads, pop-up books, bubbles)

Be a calming presence (get on child’s level, meet them where they are at)

Validate their fears/feelings and help them to feel “safe”