A Child Life Specialist at Disney Children's Hospital at Florida Hospital
Carlye A. Fields, CCLS

As an adult, being admitted to a hospital for medical treatment can be a very stressful time in your life. Try imagining going through that same experience as a child. Children, unlike adults, may lack the ability to understand why certain things are happening to their body and their fear can become a major factor in the success and outcome of their treatment. At Disney Children's Hospital at Florida Hospital, some of the major goals of the Child Life Team are to help children by establishing a trusting relationship, preparing them for tests or procedures, familiarizing patients and their parents with hospital surroundings and medical supplies, and creating a child friendly environment where children are encouraged to play.

Establishing a trusting relationship with a patient and their parents is a key factor in determining the success a Child Life Specialist will have during interventions. By walking into a room to introduce services and then encouraging a patient to engage in play allows our role to be defined differently than that of a nurse or physician. Many hospitalized children develop fears toward any staff that are in scrub clothing so our Child Life Team makes careful effort to differentiate ourselves even with the clothing we wear.

By establishing a trusting relationship in our initial encounter with a patient, we are then able to adequately prepare them for any test, procedure or surgery that they may face during their admission. Child Life Specialists will sometimes use different approaches to help appropriately prepare a patient according to their age and cognitive development. Some different techniques for teaching a pediatric patient include showing a child pictures in our procedural photo teaching book and letting them manipulate medical supplies that they will see and feel during their experience. These techniques can help them visualize their experience ahead of time and remove unknown factors. Using age appropriate sensory words to describe how things may feel to a child (“bright,” “warm,” “smelly,” “slimy,” “loud,” “bitter,” etc.) may aid a child in understanding what they will actually see, feel, smell, hear or taste. Tricks to help a child get through a more routine procedure such as an IV start or a blood draw can include positions of comfort where their parent/caregiver can hold them in a comforting way during the procedure, giving the child a job to concentrate on (holding their arm still, hugging mommy, counting to 3, etc.) and distraction items to help focus a child’s attention on something positive. Blowing bubbles, watching their favorite movie or hunting through an "I Spy" book can keep the child distracted leading up to and sometimes through a procedure which decreases their anxiety and increases the chances of the procedure being successful and less traumatic for the patient. A Child Life Specialist's most important job is to provide support during these procedures to maintain a trusting relationship.

Familiarizing a patient with hospital surroundings and medical supplies is not only helpful in preparing patient's for tests, procedures and surgeries but it can also be used to create an atmosphere for play. Using medical supplies to play doctor with a stuffed animal or doll not only allows a child to play (something very normal to them) but it encourages them to be educated and comfortable with supplies they may see regularly in the hospital. Through manipulation of different materials, patients are able to better understand the uses for commonly used medical supplies such as a tourniquet, syringe, etc. and therefore their anxiety can decrease making their hospital experience less traumatic. Medical play sessions allow our patients to learn about the hospital and medical equipment without feeling threatened. Play is the most important outlet for children experiencing anxiety and stress.

Even with no real objective, playing in either an individual or a group setting is an outlet for energy and expressing emotions, an opportunity to see other children who are going through some of the same experiences and allows for an escape from reality. At Disney Children’s Hospital at Florida Hospital, there are no medical procedures allowed in our playrooms. Even something like taking a child's temperature, which may seem minimally invasive to an adult, can be upsetting for some kids. Our playroom is a safe retreat for our patients and in that room they know that they can just be children and let go of their fears even if it’s just for a just for a short time.

Due to the fact that play is such a normal occurrence in a child's life, it is a key role in normalizing a child's environment. Through the Child Life Team, efforts are made to help keep children on a routine that is as normal and predictable as possible. For children who are younger or who have special needs, a personalized developmental sheet can be created to hang in the patient's room. A typical developmental sheet will provide valuable information of the patient's daily routine, the patient's likes/dislikes, how to comfort the patient, and physical/social capabilities. These personalized sheets are developed from information gathered in an interview between the Child Life Specialist and the patient's parent/caregiver in an effort to enhance the level of care provided by all staff members.

At Disney Children's Hospital at Florida Hospital, it’s the job of the physicians and nurses to look at the physical well-being of the child but it is the Child Life Specialists' jobs to look at their psychosocial and emotional needs. Through trust, preparation and play, we create an atraumatic environment for healing that will make a positive lasting impression.

Carlye A. Fields, CCLS