Maggie McKay (Host): When it comes to our children, we always want the best for them. So today, Erin Frost, certified Child Life Specialist, will discuss the importance of children-specific health care.

Welcome to BayCare HealthChat. I'm your host, Maggie McKay. Thank you so much for joining us, Erin.

Erin Frost: Thank you for having me today, Maggie. I'm excited to be here.

Host: Absolutely. I can't wait to learn more about this. So, what makes pediatric care so special?

Erin Frost: So, honestly, what makes pediatric care so special is the children itself. You know, pediatrics is more than just tiny adults. I think a lot of times people are like, "Oh, they're just smaller adults," but they're not. You know, their imaginations are still running wild, and their minds are constantly at work. So, that's really what makes pediatrics special is that we have to buy into everything that makes a kid a kid still in that medical setting. So, that means still doing things with bubbles and laughter and joy and comfort items, and teaching children about the hospital in a way that they can understand.

The people we are treating now, the pediatric patients we're treating now, are future generations of our leaders and our parents and professionals. And it's our responsibility in the medical setting to continue to let those children be emotionally safe in medical situations, which really means bringing the fun and joy of pediatrics all throughout the hospital.

Host: And what's the role of a Child Life Specialist psychosocial support?

Erin Frost: So, as Child Life Specialists, our goal is to truly provide psychosocial, family-centered care. So, in pediatrics, you know, you're not only treating the child, you're also treating the family that comes in with them that has stressors and that has fears for their child or, you know, whoever they may have guardianship over. We're also treating the siblings. This changes their daily life. If they're, you know, a close person, their confidant is admitted. So, we truly try and provide family-centered care to the whole family to reduce trauma and promote emotional safety for children undergoing medical diagnosis and treatment.

So, this means explaining procedures or treatment in a developmentally appropriate way to help children understand, process, and cope with the hospital environment. We work collaboratively with a multidisciplinary team. So, we work together to create a comprehensive plan to promote the child's coping, understanding, and reduce that medical trauma. So for example, let's say we're doing an IV, you would see the Child Life Specialist explain the IV to the child in a developmentally appropriate way, and then work bedside along with the nurse and the physician doing distraction during that IV, trying to reduce fears, traumas, support the family, give the family a role. So, it's really, really a collaborative approach with the entire medical team that helps us do our job.

Host: What about emotional safety for kids?

Erin Frost: So, the Association of Child Life Professionals defines emotional safety as an intentional interdisciplinary practice to promote resiliency, healing, and trust for pediatric patients and their families during medical experiences. For a very long time, physical health was the main priority when it came to receiving medical care. But when it comes to pediatric patients especially, we must really also prioritize that emotional safety. So, this means individualizing that care for children. You know, if a child, let's say, has a needle phobia and they're 17 years old, like, people are like, "Seventeen? Okay, come on, like, you can get over it." But this fear has been developed over years of possibly traumatizing experiences. So to be emotionally safe, you have to treat that child, that teenager, where they are, give them tools for coping and give them tools to reduce that stress and then create new coping blocks in place for them. So whether that means doing needle play to help desensitize them from the needle 20 minutes before they are going in for something that is a needle-related procedure and truly trying to develop an emotionally safe procedure for them to try and continue that resiliency and building them up so they don't have those fears later in life.

Host: And Erin, what about pain management when it comes to pediatric care?

Erin Frost: So, in a literature review conducted by the Journal of Pediatric Nursing, children regularly undergo painful medical procedures and treatments. And a lot of times I think we think that that pain is 10 seconds or it's right here right now. That's not the case when it comes to pediatrics.

So, when this pain and stress is left untreated, it can have both severe short-term and long-term consequences for children. So, short-term consequences are perceived increased pain, fear in subsequent procedures, need for higher doses of things, higher analgesics. And also, long-term consequences like PTSD related to the medical environment, development of needle fears, health care avoidance behaviors. This can also affect a child if they were inpatient, say, for a couple of days and had to undergo a couple painful and fearful experiences. They can have up to weeks of disrupted sleep after leaving the hospital, inability to concentrate in the school setting, and it really can be a domino effect from that experience.

So, really making sure that we treat the pain so we have, you know, a cold spray that we can use for numbing prior to an IV. We have a numbing lotion that we can use for children before their port accesses that have to get you know our oncology population that's coming in again and again and again, they don't feel that port being accessed then because we use a pain management on that. And a lot of these things, you know, take some forefront thought. A lot of these methods can sometimes take up to a half hour to 45 minutes to work prior to being able to use them. So, it's really important to kind of have that plan in place and always keep that pain management aspect at the forefront of our mind. We have little vibrating devices that help desensitize needles that we can use for kiddos. We have shot blockers that we can use.

And then also, on our role as a Child Life Specialist, distraction is huge in pain management. Taking your mind off of one thing and focusing it on another thing, and truly taking your mindset out of that. You know, our mind is one of our biggest enemies when it comes to a lot of things that are fearful and painful in life and create anxiety. So really, kind of redirecting that mind and redirecting that behavior and promoting that coping. So, there's a lot of non-pharmacological ways to promote pain management as well as pharmacological. So, that's advocating for an anxiety-reducing medication for a child that is very fearful and not just saying, "Okay, let's hold them down and get it done with." It's really taking those steps to put into place to help that child cope and cope with that pain. I think a lot of times we think, "Oh, it's not that painful" or "It's really quick." But for a child, that really sticks in their mind for a long time and can help them be fearful for the next time they go to the hospital. And when you can talk about these pain management things and families can learn, they can implement that then into their regular pediatrician appointments and keep that for long-term for their child to help promote their coping.

Host: It's so great that there are all these options kids have today because you think back even maybe 10 or 20 years when they were just sort of treated like adult patients. So, thank goodness.

Erin Frost: Exactly. I always have parents going, "Why don't I get this?" And I'm like, "I know, I know."

Host: You mentioned that cold spray. I just had that the other day at the doctor's office before a cortisone shot, and it was awesome.

Erin Frost: Exactly. Yes. That's great.

Host: So, you know, you often hear the experts say, "Tell children only what they need to know." So Erin, can you talk a little bit about developmentally appropriate education and support?

Erin Frost: Definitely. So, I always reiterate to my staff, you know, developmental age is different than chronological age. So, I always encourage them, don't go by what you see, just the age number on a census. Let's say it was a six-year-old. They may not understand or process things as a six-year-old. They may have a three-year-old understanding or maybe they're incredibly intelligent already and they can understand and process things as a nine-year-old. So, I truly always recommend starting with that, just kind of like seeing where the child is at. So, taking time to assess the child's level is important when deciding how to help them in a medical setting. So, using super clear, concise definitions and descriptions of things.

I always use these as an example. Like, if you tell a child, "I need a sample of urine," they're going to say, "You’re in where?" Like, "What do mean you’re in where?" But when you tell them pee, they're like, "Oh, okay." Or say, "Can you get on the stretcher?" And they're like, "Why are they going to stretch me?" And it's like, "No, the bed on wheels." And it's so funny because I feel like when I put it in those context, people are like, "Oh, yeah." But to a five-year-old, they've never heard the word stretcher before. They don't know what you're talking about.

And so, it's really, really important to use these clear, concrete, simple explanations to reduce those misconceptions that can develop from them not understanding. Even the word numb, you know, when we use that numbing medication, to help children cope, I had a kid as old as nine years old the other day, and I said, "Do you know what the word numb means?" And they said, "No, I've never heard it." And so, if someone's sitting there telling them, "Oh, it's going to be numb," they're like, "Okay, it's going to be what? I don't know," and they're still afraid of it. So, really, really helping them understand what is happening in their diagnoses, especially with patients who have new diagnoses. For example, a five- or a six-year-old that has a new diagnosis of diabetes, helping them understand this isn’t your fault. You didn’t eat too much cake to wind up here. You didn’t eat too little of something. This is just something that your body needs extra help with, and you didn’t cause that. But now that we know what’s happening with your body, we can help you fix it, and we can help you feel better in the future. So really tailoring the care to those individual needs of the child.

And kind of like you said, only tell children as much as they need to know, asking the child what they want to know. Say, "Does knowing a lot about what is happening make you feel better? Or does it make you feel more afraid? Do you feel better if we only tell you what we need to tell you and then tell you the rest when it's over?" And some kids are problem-focused copers and they need to know every detail. Why this? Why that? Those are the kids that you get asking, you know, 100 questions. And then, you have some kids that are like, "I don't want to know. Don't tell me what it's going to be. I just like want to focus on leaving and when that gets here, that's great." So, that's an avoidant coper. And really truly honoring those coping styles because if you do tell too much or you do tell too little to the child that's seeking more, or seeking little, you can, you know, inadvertently create extra stress and trauma on that, if you are giving too much or withholding information from them.

Host: Right. I would never even think of that, but you're so right. There's a whole other language children speak and understand.

Erin Frost: CAT scan is one. "CAT scan? Does that have to do with cats?" I'm like, "No cats here."

Host: Well, it sounds like you guys have it nailed when it comes to reducing children's fear of health care, but how do you do that with a kid-friendly facility and treatment like you do every day? How do you reduce their fear?

Erin Frost: So, counter therapeutic environments in the hospital setting include a lot of equipment, a lot of beeping alarms, white sterile environments, and especially unfamiliar smells. So, when you think about a child, really thinking about all those things, what are they hearing, smelling, feeling, seeing? And think about where a child's eye level is. I reiterate this a lot, the child's eye level is not at like the head of the bed where we are. It is where everything is plugged in, lower levels, and they are coming up to eye level, like this bed is huge, they only come up to the bottom of it. Things are hanging off the bed. That's where their eye level sees all of these things.

So, really changing up the environment to make them feel calm. Our ER here at Mease Countryside just went through a whole revamp. So, it's completely painted, bright colors, there's murals on the wall, there's murals on the doors. That's called the theory of supportive design. So, it states that the design of health care facilities should foster a sense of control and physical social surroundings and positive distractions in the physical surroundings to achieve these goals for children. So, that means characters and themes. That means like designing an MRI machine as a spaceship instead of like a dull, steel piece of equipment. That means having like bubbles. My nurses have decorative WOWs. They have stuffed animals on there, little computer things that they wheel into the kids room. Those are called WOWs. And so, it's giving them toys when they get in here to truly normalize that environment because play is the work of a child. I always say as adults too, we just call it a hobby when we get older to cope with things. You know, we do something fun, something that sparks our interest and our joy and that's the same thing here for children.

So right when they get in, we have tons of toys to hand out. We have tons of crafts to hand out, stickers, all of that. So, connecting that from their normal world to this very unfamiliar environment and setting and saying, "Oh, coloring here. Okay, this is going to help me calm down. This is fun. Oh, I can do this on here." Our CT machine, they can pick whatever design they want to be displayed onto the CT machine. And it provides them this option of control over something and, at the same time like, "Wow, I got to lay on the bed and take these pictures and on a soccer field camera. And I was the ball going into the net." And it's so cool to see children just flourish in these environments when the environment is truly tailored to their needs.

So, I mean, it's just kind of what we talked about in the beginning what makes pediatric care so special and it's truly tailoring to the needs and creating fun, welcoming environments and atmospheres for kids. And it just ends up reducing that stress right away from the second they walk in the door.

Host: Wow. It sounds like you really have put a lot of thought into this department.

Erin Frost: Yes.

Host: Erin, you have touched on this in a lot of different ways, but just what is the best way to engage with kids in general when they're in the setting of a hospital and they're probably scared, they're in pain.

Erin Frost: I'm a true believer in the fact that children can sense authenticity. So, my advice would be to get on the child's level. You're much less intimidating when you're eye-to-eye level with a child as opposed to towering over them. And be open and honest. Acknowledge and validate their fears and concerns.

You know, “I'm scared.” I hear a lot of people say, "Oh, don't be scared. You don't have to be scared." But they are. We can't just tell them not to be and they're going to turn it off, right? It's like, "No, but I am. I am afraid." So, truly validating that. I always say, "I can understand that you would be afraid. This is kind of scary. Tell me how else you're feeling." And let them process that experience with you, because they're going to process it by talking out loud, working through it right there, and tell them that it's okay to be those things, but you're a person that's going to be there to support them and keep them safe.

Let them tell you about their favorite sport team or show and engage with them in something that is familiar and comfortable to them. Children are really easy to win over. You just have to be genuine in your interactions with them. And it always helps to have some stickers on board. I think stickers are for all ages.

Host: And bubbles. I always have bubbles when my nieces and nephews are over.

Erin Frost: Exactly, exactly. Yeah, and maybe fidgets. Pop-its are a big one. But just being genuine validating their fears, and answering any questions they could have. There's no such thing, you know, I tell kids, is a silly question. And certain children at certain developmental ages fear certain things. So, don't dismiss what they're fearing. I had a six-year-old that fainted from the heat the other day, and he was like, "Am I going to die?" And I was like, "No, you're going to be totally okay." But, you know, because of his age and not understanding, and you don't know what they go through outside of these walls either and their experiences from coming in, so really just validating them and supporting them and honoring where each child is and trying to do the best by them. Take the extra 10 minutes to help them calm down before a procedure. Or, you know, if you can switch up the way that you're doing procedures to help promote their coping, do the thing that they're most afraid of last or first, or giving them a choice to do that, those options promote control and that control truly promotes coping over that hospital environment.

Host: Well, Erin, this has been so informative. Thank you so much for your time and sharing your expertise. We really appreciate it.

Erin Frost: Thank you so much, Maggie. I'm happy to talk about it whenever I can. I truly love my job and I'm excited to see where the next decade of pediatrics goes.

Host: Definitely. Yeah. Your passion shows. So, maybe we'll do another one on a different topic.

Erin Frost: That sounds great! Thank you so much, Maggie. I appreciate you having me.

Host: Absolutely. Again, that's Erin Frost. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library.