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 is 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 and family experience.
As the area’s only pediatric emergency department, it is critical for doctors, nurses, and staff to be able to ease 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 on the premises.
“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.”
The Right Tools for the Task
Along with child life specialists being present, another technique is making sure you 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. “We also try to avoid needles if they aren’t necessary. Instead, we have a narcotic pain medication that sprays in the nose. This is tolerated much better and works just as well as a shot 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, we have a topical cream that we can place on the skin that numbs it before the procedure is done,” said Hettler. “Many times, we even have the child help apply the cream. That way it won’t hurt during the procedure and the child gets desensitized to the doctor touching their cut.”
“This special approach makes a great difference,” said Farrell. “We also have special equipment that help to create these opportunities. 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.”
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 in a language that 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 parents lap, we do the questioning and exam with them in their lap, or if a teenager is more comfortable if their parent left the room we respect those wishes, too.”
“When a child needs to have sutures, we often don’t initially call them stitches. 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 Farrell. “Instead, we might call them 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.”