Child Life Specialists

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By: Adina (Levitan) Rabinowitz

Q: My son is going in for surgery next month and someone mentioned that I should ask for the child life specialist at the hospital to come help us through the process. What is a child life specialist and how could he/she help us?

 

A: Imagine you get the phone call that is every parent’s worst nightmare… “Your child fell at school and broke his arm…” or “Your child was playing at home and fell on the concrete and has a huge cut…”

Or maybe less frightening… “Your child snores at night and needs his tonsils taken out…”

For any of these calls, chances are you will be making a visit to the hospital to get the best care for your child. While you are navigating the different doctors, nurses, and specialties, your child has never been exposed to this environment and becomes fearful and afraid. Or maybe he has been to the doctor’s office recently and remembers what it felt like to get a vaccination shot. Your child becomes upset, refuses to allow anyone near him, and treatment cannot proceed. Enter the child life specialist. As you are reading this, I can already hear the question forming in your head. “What is a child life specialist?” For those of you who have met child life specialists, you can testify how their presence was beneficial for your child when he needed stitches, an arm casting, or surgery, usually because you met us during a particularly stressful time, and we were there to help. For those of you who haven’t met a child life specialist, allow me to explain.

Certified child life specialists are healthcare professionals trained to understand the developmental needs of children and how traumatic experiences can impact a child’s development. We have educational backgrounds in a variety of disciplines, such as early childhood development and psychology; all of us have a bachelor’s degree and many of us have a master’s degree in Child Life. All of us have completed extensive fieldwork as volunteers, practicum students, and most importantly, as interns, completing internships that range from 480 hours to 720 hours.

Most commonly, child life specialists are found in the medical setting, like hospitals, providing support to patients and families. In the hospital, child life specialists can be found in a variety of settings, such as the OR, emergency department, inpatient units, intensive care units, outpatient clinics, etc. Depending on the area that a child life specialist works in, the services we provide may look different. If we look back to the phone call that no parent ever wants, we can see the work of a child life specialist in the emergency department. We prepare children for IV placements, x-rays, and casting. We provide distraction during these procedures and emotional support to both the child and parent.

Personally, I currently work in a surgery center and meet patients before they have surgery. I meet children coming in for every kind of procedure, from tonsillectomies to hernia repairs to fixing broken elbows and wrists. I also meet patients who will receive chemotherapy through a lumbar puncture while under anesthesia, as well as so many other procedures. Typically, my patients will ask about how they will fall asleep for their surgery; if they will wake up during surgery; when they can eat; and if it will hurt. It is my job to answer their questions honestly, age and developmentally appropriately, and at the same time, reduce the fear, anxiety, and stress related to their upcoming procedure. For older children, I will explain how we use monitors to ensure they are breathing and that their heart is beating throughout their procedure. For younger children, I might bring out a toy medical kit, a blank cloth doll, and markers, to give them an opportunity to play out their experience. This helps children to become familiar with their environment and demonstrate mastery over what is happening; after all, they are the ones holding the doctor tools! For many children and teens, I will also show them their anesthesia mask. They can decorate it if they choose to and pick a good smell for the inside of the mask. This makes a strange new object seem more familiar and personal to the child. At times, I will accompany patients to the OR and stay with them until they are asleep, providing emotional support. This is all effective because of the rapport building I do from the moment I meet the patient until the moment they are asleep.

In other areas of the hospital, child life specialists offer a wide range of services to patients and families. Child life specialists provide developmentally appropriate education about new diagnoses to help a patient understand what is happening to his body and the role he will play in his own care. During procedures that occur without anesthesia, such as sutures for large cuts and wounds, child life specialists will prepare the child for the sensations he will experience and develop a coping plan to help the child successfully complete his procedure, and with minimal trauma. During the procedure itself, you may see a child life specialist holding an iPad, iSpy book, bubbles, light spinners or other fun distraction items. These elements of distraction help a patient to not focus on the painful experience or become overwhelmed by the equipment and sensations. And on that note, child life specialists provide one of the most crucial needs for a child in the hospital: the ability to play! Child life specialists provide toys and activities to patients; plan special events; develop incentive plans and promote normalization through play.

Preparation, distraction, support, play, and education are the pillars of child life, and how we help children cope during a stressful time and reduce their stress and anxiety. When a child comes to the hospital, a child life specialist will meet him where he is, emotionally, developmentally, and psychologically, to assess what his needs are, how he is coping and what kinds of supports will be beneficial to him. Children will tell me they are scared, and it is my role to identify what they are scared of, and to reassure and support them through their hospitalization.

The more difficult work of a child life specialist is supporting patients and families who have a child that is dying. Bereavement support can include memory making, sibling support, advocating for the family’s needs, and being comforting before, during, and after the child’s passing. In my experience, I have spoken with siblings when their sick brother or sister has passed away and helped them to process what happened. I have made hand molds and handprint art with the sick and dying patient for the family to treasure as a keepsake after the child’s passing.

Essentially, the work of a child life specialist is to support children through challenging medical experiences. We also provide parents with the tools and resources to help their child cope when a child life specialist isn’t available. Our goal is to help children be in control as much as possible, and to help them maintain and reach normal developmental milestones, even in the hospital setting. The medical world can be so strange, painful, overwhelming, and confusing for a child. A child life specialist aims to familiarize children with the hospital, reduce their pain perception or need for pain medication, and enable them to gain mastery over their experience.

Hopefully, after reading this, your question of “What is a child life specialist?” will become “Where is the child life specialist?” when your child has a hospital or medical encounter.

 
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ADina (Levitan) Rabinowitz

works as a certified child life specialist in the surgery center at Children’s National Medical Center in Washington DC. She has been involved in the field of child life in several hospitals in the Baltimore, DC and New York area. Her love of the child life profession developed after working as a staff member in Camp Simcha and Camp Simcha Special. Adina loves bubbles, stickers, and chocolate. Her ultimate goal is to develop a child life program in Israel.

Rochel Lazar