Child life specialist helps prepare kids for medical procedures
June 18, 2009
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Amy Fuller
SPECIAL TO PARENTCENTRAL.CA
From a child’s eye view, a hospital is a blur of white coats, strange voices and sharp needles. And when your medical vocabulary is limited to “boo-boo” and “ouchie,” it’s hard to figure out what’s going on or why it hurts. If you’re lucky, though, someone like Christine Shadd will use toys to explain. She might even let you blow bubbles in the operating room.
Shadd is a child life specialist at the Hospital for Sick Children in Toronto, where she helps children and their families prepare for medical procedures and cope with the interruption to familiar routines. “The way kids learn is play,” Shadd says. “Sitting and talking to them about something won’t help.”
However, the grown-ups among us often dismiss “play” as something trivial. So while Shadd is a qualified professional with a post-graduate diploma in child life studies, she sometimes has to correct the notion that what she does is unnecessary—even among colleagues at the hospital.
“This hospital is very nursing-oriented and nursing-run,” she explains. “For some people, when they walk by the room it looks like we’re just playing.” But that play is actually a way to help children resolve their fears and questions about an upcoming surgery. It generally means the procedure is a success on the first try, saving the hospital the money and time it takes to make multiple attempts.
Once nurses see a child life specialist at work—whether during the insertion of an intravenous line or needles for blood work—they generally appreciate the help. “They see how quick it happens when child life is there,” Shadd says. “Once they get that, they call us all the time.”
Currently, Shadd works primarily with children who have kidney problems. Some have infections. Others are waiting for transplants. In the meantime, they visit the hospital as many as five times per week for dialysis, where a machine does the job of the kidneys, cleansing the blood. Each patient spends up to four hours connected to the machine via tubes to and from the chest. Given the amount of time these children spend on dialysis, it’s important to provide activities to ensure a more normal quality of life.
Shadd also meets with patients who have just been diagnosed. She helps them cope with the news and gauges how well they understand what it means. If the patient hasn’t been told yet, she encourages the parents to break it to their child: “That’s who they’re comfortable with.”
Later, if a transplant is needed, Shadd shows the child a book of photos of the waiting room, the operating room, where he or she will stay following surgery and the playroom. She has one patient, a three-year-old, who speaks no English. So they use dolls to rehearse the procedure, putting in the tubes the child will have when she wakes up. Shadd also places a mask on the child herself and asks her to practise taking deep breaths.
By interacting and watching body language, Shadd decides whether a patient is prepared for the surgery. In conversation with one teen girl in need of a kidney transplant, Shadd learned the girl was intentionally defying her mother by hanging out with boys, doing drugs and drinking. Concerned the drugs could interact with the medications the girl would need after surgery, or that she would simply refuse to take her meds and have blood work done regularly, Shadd notified her colleagues and the team decided to postpone the surgery, since in this case a short wait would not be harmful."
During the procedure itself, the child life specialist can stay with the patient until the child falls asleep, if a parent isn’t available. Shadd brings distractions such as bubbles or an I Spy book.
As an undergraduate, Shadd intended to become a teacher. When she discovered she preferred one-on-one interaction with children to classes of 30, she pursued McMaster University’s one-year child life studies program instead. Founded twenty years ago this September, the program is the only post-graduate training program of its kind in Canada. Students complete seven courses and 480 hours of clinical experience to achieve certification with the Child Life Council based in Maryland. This year, only 10 applicants of 70 were successful, according to co-director Cathy Humphreys. In Ontario, graduates can expect a starting wage of $45,000 to $50,000.
Since graduating in 2005, Shadd has worked with a range of ages (up to 18) and in a variety of areas including general paediatrics, HIV, diabetes, transplants and emergency. While she doesn’t stand at a blackboard, she considers herself an educator, whether of patients or family members. “Sometimes siblings have more coping issues than the patients,” she says. “Diabetes kids get a lot of attention when they are first diagnosed, and their siblings start acting out.” Siblings need to know what’s happening, too.
However, she can only meet with a limited number of children each day. Two days per week, there are two child life specialists on the kidney unit and they see 60 per cent of the patients. The rest of the week, only one specialist is available and that number goes down to 30 per cent. Children receive care according to age, familiarity with the hospital, coping skills and whether family members are present. “We focus more on quality of care than quantity of kids,” Shadd says.
Still, the economic downturn concerns her. This year, the hospital got enough government money to continue to offer her services. But in 2000, one of Shadd’s predecessors was let go due to lack of funds. Humphreys emphasizes that while hospital funding is an issue, the child life profession is expanding into community settings such as dental offices, women’s shelters and funeral homes. “It’s the basic premise of helping children cope with new situations.”