Jabbed with a sharp needle, confined in a noisy MRI machine, covered with an anesthesia mask before surgery. Hospital experiences are unpleasant enough for adults. For children, they can be especially stressful and frightening.
More children are facing painful and invasive procedures, as medical advances have made survival possible for more premature infants and children with diagnoses including cancer, cerebral palsy, cystic fibrosis and congenital heart defects. Some three million children are considered “medically complex” at present, and their ranks are growing by about 5% a year, according to the National Association of Children’s Hospitals and Related Institutions. Ongoing health problems have made many of these children frequent fliers in the hospital system. More than just temporary discomforts, fear and pain can lead to long-term trauma for children, studies show.
Many hospitals have adopted innovative ways to help kids through the experience. “Making a procedure less scary and more relaxing for a child can lead to better outcomes,” such as better accuracy in magnetic resonance imaging and less need for sedation, says Susan DeVore, chief executive of hospital purchasing alliance Premier Inc., which leads quality-improvement programs. “But it is really about being the right thing to do,” she says.
At some hospitals, child-life specialists use puppets and dolls to engage kids in “medical play,” which helps them learn to cope by acting out stories of illness and recovery. Hospitals take children on pre-surgery tours of operating rooms so they know what to expect. Some use special devices so IVs can be inserted painlessly. Some hospitals are experimenting with distractions during tests, such as iPads or special goggles that kids can wear to watch a movie while undergoing an MRI.
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Up to 80% of pediatric patients and their families report some traumatic stress after illness, injury, hospitalization or painful medical procedure, according to the federally funded National Child Traumatic Stress Network, which provides tips, checklists and screening tools. Untreated traumatic stress can negatively affect treatment and recovery.
Mission Children’s Hospital, an Asheville, N.C., unit of nonprofit Mission Health, recently spent $60,000 with help from two foundations to buy and install a digital video system with special goggles, which kids can wear to watch movies during MRIs. Bret Sleight, director of pediatric radiology, says the goggles eliminate the need for sedation—which is costly, time-consuming and carries some health risks—for children who might physically resist an MRI scan or fidget while inside. Sedation also can leave children groggy and nauseated. Kids watching a movie are more likely to complete the test without moving, making costly repeat tests less likely, Dr. Sleight says.
Joanna Arthur, 5 years old, was born with spina bifida, a condition in which the bones of the spine don’t form properly around the spinal cord. She has had to undergo several MRIs to monitor shunts implanted in her brain to relieve fluid buildup that can result from the condition. When she was sedated before a test, it would take a full day for her to recover, her mother, Joy Arthur, says.
At Mission, child-life specialist Amy Anne Waters met the Arthurs ahead of time and showed Joanna a puppet going into a pretend MRI machine. She showed her how the goggles fit over the head and help prevent feelings of claustrophobia with an image that appears as if on a screen 5 feet away.
Watching “Cloudy With a Chance of Meatballs” during a recent MRI, Joanna was so quiet that her mother wondered if she was asleep. After the test, when Joanna had to take the goggles off, her main concern, Ms. Arthur recalls, was, “I didn’t get to see the end of it.”
At Cardon Children’s Medical Center in Mesa, Ariz., part of the nonprofit Banner Health system, children’s rooms are designated as “safety zones,” and procedures that might cause fear or pain are performed elsewhere. When procedures or tests are over, kids go to a toy closet to pick out something to comfort them. When inserting an intravenous tube, staffers use a device called a J-Tip, which uses pressurized gas to send numbing medication into the tissue beneath the skin so the IV needle can be inserted into the vein painlessly. Children can go into the operating room ahead of time with an anesthesiologist and try on the mask that will be used to sedate them.
“We want to make sure they are well prepared, well distracted and that their pain is controlled completely,” says Cardon Chief Executive Rhonda Anderson.
Medical play helps prepare children for the trauma of treatment, studies show. Often they create stories about characters who overcome illness and pain. In a recent study, children benefited from expressing and releasing their feelings playing with toy stethoscopes, doctors bags and casts, said Laura Nabors, associate professor at the University of Cincinnati and lead author of the study. Sometimes they replayed negative experiences but generally their characters became healthy again.
Child-life specialist Courtney Kissel is working with 3-year-old Hector Guerrero, as he undergoes chemotherapy for leukemia at Cardon. He speaks little English but quickly learned the phrase “toy closet,” she said, and loves to wrap his doll with medical tape. “We can use play as a universal language for teaching kids about medical procedures.”
Mindy Mesneak, another child-life specialist at Cardon, leads medical play sessions using cloth dolls made by residents of a local retirement home. She says children’s stories offer insight into how they are coping and help them feel better about what they have been through. “When a child has one negative experience, it can ruin the trust in medical facilities and staff for a long time, even into adulthood,” she says.
MacKenzie Tobin, age 4, had surgery at Cardon in August to repair a skull deformity. While her parents were present, she had an IV needle, which was removed and reinserted without numbing medication, her mother, Kelly Tobin, recalls. “It was incredibly traumatic for all three of us,” Ms. Tobin says. Two weeks later, her parents took her to the emergency room with an infection, but this time a J-Tip was used to prevent pain. While MacKenzie was in pediatric intensive care, her mother says, a specialist used medical play to make her weeklong stay easier. MacKenzie used Band-Aids, a toy blood-pressure cuff and a toy IV set to help a doll.
Date: Nov. 11, 2013