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Understanding kids' special needs
Hospitals can be frightening for children. A hospital stay causes stress for a child simply due to the disruption in family routines - not to mention anxiety over whether procedures will hurt and whether everything will be OK.
How does communication with a child patient differ from communication with an adult patient?
It has to rely on things other than adult verbal communication. For children, particularly those younger than 10 to 12 years of age, the primary means of expression is not talk but play. You can't sit down with young children to explain why they are about to have a series of medical procedures in the same way that you can with adults. That's why at Mayo Eugenio Litta Children's Hospital, we have not only physicians and nurses on staff who are in tune to those differences in communication, we also have a full-time staff of child life specialists. Child life specialists understand the developmental stages of children and use the most effective means to communicate with each child - and usually that's through play or artwork.
Child life specialists use play and other means of expression such as drawing pictures to explain to children, in terms they understand, what will be happening while they are in the hospital. A child or teenager who knows what to expect will be much less fearful. Child life specialists also help children deal with their fears and frustrations through play. Having expert guidance to help express these concerns through play can greatly facilitate a child's comfort and ease with the hospital experience. Child life specialists also work with parents and others to get insights into a particular child's needs and help the family continue these beneficial play activities at home.
What's an example of how a child's experience in the hospital can be eased through play?
Let's say you have a 4-year-old child with an intestinal tract disease who needs to have a colostomy (a surgical procedure in which an opening in the colon is attached to the abdominal wall for the passage of stool). The are several issues here. One is that the child needs surgery, which in itself is a very frightening thing to a child. The child life specialist would use play, such as with a doll and a play operating table, to help the child understand what is going to happen. A 4-year-old has relatively recently completed toilet training, so control over bowel movements is a central issue in that child's life. After going through the developmental stage of achieving that control, the child is now in a situation where bowel control is no longer possible for a while. The staff is going to be sensitive to those issues and help the child understand why this is happening, and that he or she is not to blame for the loss of bowel control. Other activities will be emphasized to assure the child of his or her mastery of age-appropriate tasks.
Is it true that children often revert to earlier behaviors when they go to the hospital?
Yes, that's very common. Any kind of stress, whether it's physical stress from surgery or psychological stress, may cause a regression to behaviors previously outgrown. That's another concrete reason for the integration of a child life specialist early in a child's care.
How can the physical setting of a hospital be made less threatening for a child?
It's important to have the environment organized in ways that are sensitive to the developmental stages of children and adolescents. You need to have rooms that are welcoming to children. At Mayo Eugenio Litta Children's Hospital, we have a toddler play area, a preschool and school-age play area and a teen lounge, each equipped with age-appropriate toys and activities.
The presence of a parent or other family member is important in helping the child feel secure. A comfortable environment, with privacy for families, will facilitate their presence. We provide private rooms for all parents with an extra bed for a family member. We encourage parents or family members to sleep overnight in the child's room.
All medical procedures are performed in special treatment rooms, not the child's hospital room. That's because children can't necessarily separate cognitively when a nurse is coming in to draw blood from when a nurse is simply coming in to check on them. We want children to understand that their room is a safe and secure environment, which will not be used for unpleasant procedures and tests. That's the kind of thing that may not happen at an adult facility that is taking care of children.
What about differences in the procedures themselves?
For example, we routinely use EMLA cream (an anesthetic agent applied to the skin) before taking blood from a vein to ease the pain and discomfort of that procedure. We use sedation for many more procedures than would be true for adult patients. We use sedation for all procedures that are frightening, difficult or painful for children. You can do some of these procedures without sedating some children, but then the next time a procedure needs to be done, it may be very upsetting to them.
Besides child psychology issues, are there other reasons for specialized care for children?
Children have a different spectrum of diseases than adults. There are many conditions in childhood that cause not only physical manifestations, such as fever or joint swelling, but also may affect the child's cognitive development or the development of motor skills or growth. Those are issues you don't face with adult patients. It's important to have clinicians specially trained to understand the potential implications of diseases in children.
At a children's hospital, we're dealing on a routine basis with congenital or hereditary disorders, chromosomal disorders and other similar conditions. Certainly those exist in adults, but they tend to be in a different spectrum. In a children's hospital, we are much more involved with genetics, developmental specialties, neurological development, growth and puberty issues, et cetera. It's an advantage to have people who are trained in these problems and who deal with them every day.
Young bodies respond to medications differently from adults. Knowledge about which medications are safe and effective in infants and children, as well as proper doses, is essential. The nutritional needs of children are different from those of adults. These needs are met by physicians with special training and by pediatric dietitians.
Not only the physicians but also the nursing staff and other medical professionals are specially trained to work with children. For example, how do you give medication to a 3-year-old who doesn't want to take it? The nurses are skilled in techniques of engaging the child and being able to do that. Pharmacists are also key. Many drugs come in forms that only adults can take: big capsules, big tablets. We rely on pharmacists who have a whole set of ways of formulating medications so that we can administer them in proper doses to children.
What can parents and family members do to help when a child is in the hospital?
Maintain a calm, confident manner. Answer the child's questions honestly in terms appropriate to his or her age. Stay with the child as much as you can. The presence of a parent or close family member overnight as well as during the day provides security and comfort.
A children's hospital is very much geared to the family as well as the child. The staff needs to create an environment that includes the family as an integral part of the treatment process, rather than seeing them simply as visitors. They are not visitors - they are part of the team of people who are helping care for the child in the hospital.