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Child Life Services POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of all Children Child Life Services Barbara Romito, MA, CCLS,a Jennifer Jewell, MD, FAAP,b Meredith Jackson, MD, FAAP,b AAP COMMITTEE ON HOSPITAL CARE; ASSOCIATION OF CHILD LIFE PROFESSIONALS Child life programs are an important component of pediatric hospital-based abstract care; they address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life specialists focus on the optimal aChild Life Program, The Bristol-Myers Squibb Children’s Hospital at development and well-being of infants, children, adolescents, and young adults Robert Wood Johnson University Hospital, New Brunswick, New Jersey; and bThe Barbara Bush Children’s Hospital at Maine Medical Center, while promoting coping skills and minimizing the adverse effects of Portland, Maine hospitalization, health care encounters, and/or other potentially stressful Ms Romito provided the benchmarking data and the majority of the experiences. In collaboration with the entire health care team and family, child writing; Dr Jewell designed the outline for the policy, noted and life specialists provide interventions that include therapeutic play, expressive updated information that was irrelevant since the last revision, provided assistance with the writing, and presented the content to the modalities, and psychological preparation to facilitate coping and Committee on Hospital Care; Dr Jackson provided technical assistance, draft review, and content expertise for the portions related to medical normalization at times and under circumstances that might otherwise prove education; and all authors approved the final manuscript as overwhelming for the child. Play and developmentally appropriate submitted. communication are used to (1) promote optimal development, (2) educate Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and children and families about health conditions, (3) prepare children and external reviewers. However, policy statements from the American partner with families for medical events or procedures, (4) plan and rehearse Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. useful coping and pain-management strategies with patients and families, (5) The guidance in this statement does not indicate an exclusive course help children work through feelings about past or impending experiences, and of treatment or serve as a standard of medical care. Variations, taking (6) partner with families to establish therapeutic relationships between into account individual circumstances, may be appropriate. patients, siblings, and caregivers. Child life specialists collaborate with the All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, entire interdisciplinary team to promote coping and enhance the overall revised, or retired at or before that time. health care experience for patients and families. DOI: https://doi.org/10.1542/peds.2020-040261 Address correspondence to Barbara Romito, MA, CCLS. E-mail: [email protected] CHILD LIFE INTERVENTIONS: PSYCHOLOGICAL PREPARATION PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). This document is copyrighted and is property of the American Preparing children for hospitalization, clinic visits, surgeries, and Academy of Pediatrics and its Board of Directors. All authors have filed diagnostic and/or therapeutic procedures is essential during a child’s conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process hospitalization and an important element of a child life program. It is approved by the Board of Directors. The American Academy of estimated that 50% to 75% of children develop significant fear and Pediatrics has neither solicited nor accepted any commercial anxiety before surgery; recognized risk factors include age, temperament, involvement in the development of the content of this publication. baseline anxiety, past medical encounters, and caregiver anxiety.1 FINANCIAL DISCLOSURE: The authors have indicated they have no fi Children’s anxiety in the perioperative environment is associated with nancial relationships relevant to this article to disclose. impaired postoperative behavioral and clinical recovery, including increased analgesic requirements and delayed discharge from the To cite: Romito B, Jewell J, Jackson M, AAP COMMITTEE ON recovery room.2,3 Preparation can reduce anxiety and distress before HOSPITAL CARE; ASSOCIATION OF CHILD LIFE PROFESSIONALS. Child Life Services. Pediatrics. 2021;147(1):e2020040261 surgery and/or during mask induction and may also decrease emergence Downloaded from www.aappublications.org/news by guest on September 25, 2021 PEDIATRICS Volume 147, number 1, January 2021:e2020040261 FROM THE AMERICAN ACADEMY OF PEDIATRICS – delirium after surgery.4 7 More than stay, a clearer understanding of Child life specialists can effectively 50 years of research and experience procedures, and a more positive provide developmentally appropriate supports 3 key elements of the physical recovery as well as nonpharmacologic pain management preparation process: (1) the provision posthospital adjustment for children and provide coaching and support to of developmentally appropriate enrolled.16 Patients spent less time on patients and caregivers before, information, (2) the encouragement narcotics, the length of stay was during, and after medical of questions and emotional slightly reduced, and caregivers were procedures.40,41 They can also expression, and (3) the formation of more satisfied. In other studies, provide valuable education and a trusting relationship with a health researchers have found that child life training to nurses, physicians, care professional.3 A recent interventions play a major role in students, and other personnel, systematic review of preparation calming children’s fears and result in supporting health care team member effectiveness evidence concluded that higher parent satisfaction ratings of competencies in the provision of children who were psychologically the entire care experience.8,17,18 developmentally appropriate, prepared for surgery experienced psychosocially sound care.42,43 fewer negative symptoms than did Multifaceted institution-wide children who did not receive formal CHILD LIFE INTERVENTIONS: protocols, such as the Ouchless Place preparation.3 Findings included PAIN-MANAGEMENT AND COPING and other similar programs, a decrease in posttraumatic stress, STRATEGIES incorporate the standard use of both lower levels of fear and anxiety, When combined with preparation and pharmacologic and increased cooperative behaviors, and appropriate pharmacologic nonpharmacologic techniques, better long-term coping and interventions, nonpharmacologic preparation of the patient and family, adjustment to future medical pain- and distress-management environmental considerations, and challenges. Research also strategies have proven successful in training of all health care team 44,45 demonstrates that preparation and terms of patient and family members. coping facilitation interventions experience, staff experience, and cost- Research has demonstrated that 17,19,20 decrease the need for sedation in effectiveness. Strategies such children are less fearful and procedures such as MRI and as swaddling, oral sucrose, vibratory distressed when positioned for radiotherapy, resulting in lower risks stimulation, breathing techniques, medical procedures in a sitting for the child and cost savings in relaxation, and guided imagery have position rather than supine.46 Child personnel, anesthesia, and been shown to decrease behavioral 8–12 life specialists are often involved in throughput-related expenses. distress and pain experience in facilitating the use of “comfort holds,” Preparation techniques, materials, children during invasive medical techniques for positioning children in 21–25 and language must be adapted to the procedures. a parent or caregiver’s lap or other developmental level, personality, and comforting position. In addition to Distraction strategies have been unique experiences of each child and reducing the child’s distress and highly effective in reducing reported family. Learning is enhanced with gaining cooperation, these techniques and observed pain and distress in hands-on methods versus exclusively generally require fewer staff to be children in inpatient, emergency verbal explanations. Photographs, present in the room, facilitate safe department (ED), and clinic diagrams, tours of surgical or – and effective accomplishment of the settings.26 32 The emergence of treatment areas, actual and pretend medical procedure, decrease parent virtual reality, Internet technology, medical equipment, and various anxiety, and increase parent and electronic and digital devices has 47,48 models (dolls, puppets) are used to satisfaction. With a goal to been found to be an effective means reinforce learning and actively engage – severely limit the use of papoose of distraction in reducing pain.7,33 38 the child.1,13 Caregivers should be boards and eliminate the practice of Child life specialists may also included in the preparation process multiple staff members holding develop comfort kits for use in because this can decrease parental a child
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