Jennifer Jewell, M.D., FAAP, has a photo on her bookcase that captures one of her chronically ill patient’s last Christmases. A group of nurses, pediatricians, family members and a child life specialist cheerfully surround the 11-year-old. The image reminds Dr. Jewell of the importance of child life specialists and the care they give their patients.
“When I think back to when he would come into the hospital, the first people he would ask about were the child life specialists because they provided him some sort of safety and individuality that the other people in the photograph couldn’t provide him,” said Dr. Jewell, former chair of the AAP Committee on Hospital Care.
The importance of child life services is highlighted in an updated policy statement from the Committee on Hospital Care and the Association of Child Life Professionals. The policy Child Life Services is available at https://doi.org/10.1542/peds.2020-040261 and will be published in the January issue of Pediatrics.
Improving education, well-being
Child life professionals prepare children and their families for medical procedures by providing coping strategies and focusing on the patient’s emotional well-being. They collaborate with the interdisciplinary team to improve the health care experience and limit stress.
The specialists use therapeutic play, teach distraction techniques and provide a supportive relationship with patients and their families as they adjust to their child’s medical experience. Among the tools they might use to engage the patient are bubbles, light-up toys, breathing techniques, music, video games, art, puppets, dolls or pretend medical equipment.
An essential function of child life services is normalizing the patient’s medical experience, said Dr. Jewell, a lead author of the policy.
“When you start talking about a child’s lifelong experience, it’s very short compared to an adult,” Dr. Jewell said. “For that reason, it’s so much more important to normalize experiences for them. An important function of the child life specialist is to make sure that they … help the patient and family understand how this will be a part of their life both inside and outside the hospital.”
Barbara Romito, M.A., a certified child life specialist and lead author of the statement, agreed.
“What we find with children is the more we treat them like a normal, healthy child, the better,” said Romito, child life program director at Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital in New Brunswick, N.J. “One of the roles of the child life specialist is to make sure we keep the focus on the child and to instill within the whole team that this is a child first and that we need to make this child’s life as normal as we can.”
Creating normalcy and using coping and therapeutic strategies also improve the patients’ medical experience. With an estimated 50% to 75% of children developing significant fear before surgery, child life specialists can alleviate some of this anxiety and help provide a better overall experience.
The policy cites research that shows children who were psychologically prepared for surgery have decreased post-traumatic stress, lower levels of fear and anxiety, and better long-term coping skills than children who did not receive this preparation.
Preparing children for medical procedures and providing coping techniques also can increase compliance, reduce the need for analgesics and decrease the need for sedation in procedures like MRI and radiation therapy. Support provided by child life specialists also increases patient satisfaction, family engagement and is cost-effective.
Programs evolve
Child life programs started in the late 1950s when health care professionals realized that most children discharged from hospitals were medically healthy but were having severe psychosocial and emotional aftereffects.
Now, there are more than 430 child life programs across North America, mainly in children’s hospitals. Child life services also can be utilized in other settings such as private practices, outpatient units, dentists’ offices and funeral homes.
According to Dr. Jewell, the policy statement aims to inform pediatricians practicing outside of hospitals of the multiple benefits of child life specialists and their commitment to the child’s well-being.
“Child life specialists can look at any situation and guide the rest of the medical team to turn their full attention to what is best for the patient and families,” Dr. Jewell said. “Child life specialists act as an advocate for the patient.”
Recommendations
The statement provides guidance to advance the child life profession, including the following:
- Child life services’ collaboration with the interdisciplinary team is essential in meeting the child’s health care needs.
- Child life services, provided by a certified child life specialist, are recommended for pediatric inpatient units, emergency departments, chronic care centers and other diagnostic/treatment areas.
- Child life services staffing should be individualized to address the specific needs of pediatric inpatient and outpatient areas.
- Child life services should be included in operating budgets and cannot rely solely on contingency or philanthropic funding.
