1. Improving the Child’s Experience Alinda Shelley BS, CCLS Certified Child Life Specialist

2. Development Infant Fear separation from parents or caregiver Infants need a safe, secure, nurturing environment Toddler/Preschool Perceive pain and hospitalization as punishment Give them the opportunity to assert themselves and the freedom to attempt new skills

3. Development School Age Fear bodily injury and loss of control Wants everyone to adhere to rules Create an environment where they can succeed Adolescent Worries about body image, change in appearance, and separation from peers Wants to be treated as an adult Wants privacy

4. Common Changes Increased demand for attention Regression Hyper vigilance Greater fear of strangers Changes in eating Anger Greater concern about the body Increased crying and clinging

5. Building Rapport Introduce yourself and your role Get down on eye level Engage in play Carry bubbles or other small toys Lanyard toy Smile Respect expression of emotions

7. Don’t Talk down (including baby voice and nicknames) Say “Be a big kid” or “Be brave” Make promises Tell them info they won’t experience Exaggerate the experience (over or under) Compare patients Talk about children as if they aren’t present

8. Preparation Imagine how a child would view the experience Describe using senses and steps Give clear, concrete, simple information Watch a child’s affect to perceive whether it’s too much or too little information Utilize choices “You can choose what you’d like to do while you have your shot. You can’t choose whether you have one.” Give the child and parent a job

9. IV Prep Describe using senses and purpose behind it 1 st - Tourniquet (most of the time called a rubber band)—it is going to feel tight and helps to see and feel the vein (blue line) 2 nd - Cleaning—it will feel cold and wet and removes germs 3 rd - Poke—some kids say it feels like a poke or pinch. Your job is to hold your arm still and take deep breaths. Purpose dependent upon situation.

10. Be Honest NEVER make a promise you can’t keep If you lie about ANYTHING that happens during their experience, they will become distrustful of medical personnel

11. Language “The King Who Rained” by Fred Gwynne

13. Coping Plan It is okay to cry/ express feelings Engage in conversation Use electronic devices Utilize toys/ books Guided imagery Deep breathing Give each person a role

14. Bibliography Faber, A. & Mazlish, E. (1980). How to talk so kids will listen & listen so kids will talk. NY: Avon Books. Kiely, A.B. (1992). Volunteers in Child Health: Management, Selection, Training, and Supervision. Bethesda, MD: Association for the Care of Children's Health. Merck Manual. (2003). Illness in Children: Social Issues Affecting Children and Their Families [Internet]. Available from: http://www.merck.com/mmhe/print/sec23/ch287/ch287c.html [Accessed April 2, 2007]. http://www.merck.com/mmhe/print/sec23/ch287/ch287c.html Northam, E. (1997). Psychosocial impact of chronic illness in children. Journal of Paediatric & Children’s Health, 33, 369-372. Pediatric Education Services, Primary Children’s Medical Center. (2006). Let’s Talk About... Your child’s emotional responses to illness, injury and health care. Pinnick, N. (1984). The work of chronically ill children on a hospital unit. Children’s Health Care, 12, (3), 113-117. Sheldon, L. (1997). Hospitalising children: a review of the effects. Nursing Standard, 12, (1), 44-47. Wright, M.C. (1995). Behavioural effects of hospitalization in children. Journal of Paediatric and Children’s Health, 31, 165-167.