A visit to the emergency room can be scary for anyone, but it can be especially scary for a child. Like many top pediatric centers, team members in the Baystate Children’s Hospital Emergency Department use a child and family-friendly approach that has been shown to both improve care and the patient/family experience.
As the area’s only pediatric emergency department, it is critical for doctors, nurses, and staff to be adept at easing the nerves of young patients, while making sure that they treat patients in a timely and effective manner.
“We like to think about the experience of what it’s like to be a patient or a family member, and respect the developmental and situational needs of each,” said Dr. Joeli Hettler, chief of the Sadowsky Family Pediatric Emergency Department at Baystate Children’s Hospital.
Child Life Specialist on Duty
There are a number of physical and psychological techniques used to help children and families understand and participate in their medical care, making the overall experience better for everyone. In addition to pediatricians and pediatric-specific nurses, the pediatric emergency department has child life specialists who help kids and families understand and plan for any procedure that may be painful or frightening.
“Child life specialists work in many places within the Children’s Hospital. In the emergency department, our primary goal is to try to minimize pain and stress throughout the visit for the child and their family,” said Elizabeth Farrell, Emergency Department child life specialist at Baystate Children Hospital.
“We also do a lot of work preparing families for what they’re going to experience during their visit and try to make the environment a little less stressful," she said. "We do this by providing developmentally appropriate information about the procedure and by preparing them for steps and sensations they will experience, often letting children interact with medical equipment to familiarize these items.”
She continues, “Providing items to play with, such as movies, toys, or videos games further helps to distract them from the pain and anxiety they may experience during the procedure. Families know their children best. We work hard to solicit the family's ideas to create a plan for approaching the procedure that is individualized to their needs.”
The Right Tools for the Task
While there's no replacement for team members who are comfortable working with children, it also helps to have the right tools for the job.
“Since we work on some of the tiniest patients, our pediatric emergency department is equipped with smaller ‘child friendly’ equipment,” said Hettler. “In addition, we are often able to choose treatments that respect the fear a child may have of needles or shots. For instance, we have a narcotic pain medication that when delivered as a nasal spray is as effective as an injection of morphine.”
However, for times when needles may be required, the team stays one step ahead.
“If we anticipate the need for an IV placement or a blood test, our triage nurses apply a topical cream when the patient arrives,” said Hettler. “This provides reassurance to the child and family that the skin will be numb if the care requires a blood draw or IV.
"Similarly," she says, "we apply a different topical medication to lacerations as we prepare the child for wound care. Multiple applications of this topical medication, often with the patient’s help, desensitizes the child to a provider touching their wound with an instrument and sets the stage beautifully for any cleaning or repair that is required.”
“As a child life specialist, this special approach helps makes a great difference by allowing the child to trust in their caregivers and providing small moments to interact through play," said Farrell. "For example, our child sized oxygen masks are designed to look like a dragon. They not only fit better on tiny faces, but they also come in handy when we want to interact with the child and do things like have them pretend to breathe smoke or roar like a dragon.”
The Power of Words
Another important technique is paying attention to the way things are worded when addressing a child.
“From the beginning, we try to speak to them using words they understand,” said Hettler. “Also, we don’t expect the visit to go a certain way, so if the child is more comfortable in the parent's lap, we do the questioning and exam with them in their lap. If we need to get down on the floor and play with a toy that has the child’s interest to allow us to do our exam, we’ll do that as well. With older children, we let them decide if they will be the first to explain the reason for their visit, or if they’d like a family member to speak for them. Teenagers are given the option of privacy for certain types of visits.”
Child life specialists also play a big part in helping doctors and nurses approach each child at their developmental level.
“When a child needs to have sutures, we often don’t initially call them stitches because a lot of families have already told they child that they hope they don’t need stitches, so children look at stitches as a bad thing," said Hettler. “We often refer to them as string Band-Aids for the right age child. A simple word change and having them take part in the procedure makes a big difference and helps keep the child and family’s anxiety and stress down. This allows our team to gently introduce information, and then expand upon it or give appropriate terms as the child is ready for them."