If you have ever had the joy of being the parent of a child on the receiving end of gifts, especially during a birthday party, it can be exciting.  There is no better feeling than seeing your child’s eyes light up with excitement over their new toy(s).  However, there is a price for that fun, and it’s paid when your child wants the toy out of the packaging.

Removing toys from their packaging has become a tremendous battle fought by parents everywhere.  It is often filled with whining, questions (i.e. is it out yet?), and tears (usually the parent’s).  It can leave you asking whether or not you need an engineering degree to complete the task.

Nothing is more disheartening than watching it take four times longer to take the toy out of the package than it did to unwrap it.  Doing a large chunk of our work with children, Child Life Services has had to learn to open toys (and to do it with some sense of quickness).  So, in order to help, I thought I would share some of our tools and tricks.

• Small Screwdrivers: Be sure to have both Phillips- and flat-heads because you never know which one a manufacturer will use.  Remember, the toy could be screwed into the packaging or have batteries that need to be put in place.
• Needle Nose Pliers: If you get a toy with the dreaded plastic-covered metal twist ties, this tool can be your best friend.  Most needle nose pliers have a wire cutter attachment to it.  You can slip it under the twist tie, cut it, and use the pliers to pull the twist tie out.
• Trash Bag: I can’t tell you how many times I’ve forgotten this, and paid to price of trash every where.
• Batteries: Save yourself the headache by keeping AA and AAA batteries on hand, and for bigger toys, don’t forget C and D batteries.  Also, don’t forget that most remote control vehicles need a 9-volt.

So, whichever toy-giving season draws close, remember that a little advance preparation can speed up this task.  You’ll look like a hero to your child, and you’ll realize that after all, it’s just child’s play.

The other day, I was getting my children ready for bed, and we were going through our typical routines.  Going to the bathroom, brushing our teeth, asking for one more hug, you know the usual stuff.  As I was talking with my children, I noticed something; they were not looking at me.  Instead, they were looking at themselves in the bathroom mirror. 

To take it one step further, they were “acting” to it.  They were entranced by their reflects, make facings and watching themselves as they spoke.  Then they broke that ever-important parent rule: they quit listening to me.  Instead, they were wrapped up in a world of themselves, just two five-year olds playing to the mirror.

This is not an isolated incident to my house, but instead is played out repeatedly. I’ve even had some people ask me if their child is being narcissistic.  If we remember our mythology, Narcissus feel in love with his own reflection (after shunning the love of Echo), and spent the rest of his life looking at his own reflection.  Needless to say, people have been worried about this for a long time.

Here’s the good news: a child entranced by their reflection is completely normal.  As a matter of fact, children can learn a great deal from mirrors, and you can use them to see developmental growth. The truth is children learn a concept of self through mirrors.  The child realizes what people see when they talk, make faces, and other activities.  You especially see this between 12 to 24 months, as children develop their sense of self.

For instance, place a small dot of lipstick on the nose of an infant and put them in front a mirror.  You can see the developmental growth as they realize that the mirror is not another baby, but instead them, which you can tell as they touch the spot on their own nose.  As a parent, this is an exciting developmental step to see first hand.

So, don’t worry if your child loves watching themselves in the mirror, it’s completely normal.  That's why so many children's toys have mirrors on them, they’re exploring the world and themselves.  Besides, you can always do what I do, make faces right along with you child.

As February starts, many people dread the upcoming festivities that involve red, white, and love.  However, that's not true at Le Bonheur Children's, we love Valentines Day.  There is nothing more wonderful than helping children be able to great masterpieces to help tell those around the patient that they love them.  It is wonderful to watch the excitement build as the creativity sparks and the patient starts to get everything "just right".

Now, I can explain this all I want, but as they say, "a picture's worth a thousand words".  I hope you enjoy the photos our child life specialist took over the Valentines Day weekend.

As many of you are aware, Le Bonheur Children's sent a medical mission team to help treat the children and families in Haiti.  As an organization, we knew that sending a team was how a world leader in children's healthcare needed to respond.  It is our duty to not only help children in the Mid-South and United States, but any children around the world that need our care.  As the team returned last Friday, it was obvious that we had lived up to our mission.

For the next installment of A Day in the Life, it only seemed fitting to share the experience and perspective of the Le Bonheur Children's Haiti Medical Mission Team.

The team kept a blog of their experiences, which will give you a far more in-depth explanation of their work in Haiti.  I encourage all of you to read it and see all of the good this team did.

There are tens of thousands of children that come through the doors of Le Bonheur Children's every year.  It seems mind boogling, when you stop to realize that each one of those children have their own unique perspective and experiences.  The great news is that these children have a group that serves as their voice:  The Le Bonheur Children's Teen Advisory Council!

The Teen Advisory Council is an advisory board for the hospital that provides insight to the concerns and interest of children impacted by Le Bonheur Children's.  To date, the group has given input on the new hospital layout, the teen room for the FedExFamilyHouse, the television channel lineup, and specific recipes served with patients.  Additionally, this group has served as advocates for children's health.  Members have appeared on educational videos providing perspective, spoken with various elected officials, and made their opinions known in the national conversation.  Even with all of the previous, I am only skimming the surface (not to mention I haven't talked about the fun stuff).

The board is comprised of single timers (a single admission), frequent fliers (lots of admissions), siblings, and "future" patients (lucky enough to not have to go to the hospital).  Why so many different areas?  Simply put, each "type" of member represents a different perspective to the children impacted by the hospital.  For instance, siblings can easily be forgotten when discussing how certain policies should be set up, but their view is different from that of the patient, giving a fuller view of the family.  Those members that are current and former patients represent units and service lines from across the hospital.  The members are between the ages of 12 - 18, and are not afraid to share their opinions (then again, what teenagers aren't).

I have had the pleasure of working with this group for the past several years and they amaze me with their insight and understanding of the hospital.  The work that they do is invaluable, and Le Bonheur Children's is a better place for it.

In our last post, I shared some advice from members of our Family Partners Council on waiting while in Le Bonheur Children’s Emergency Department (ED).  Waiting is such a major element of the process that there are still more bits of advice.  ED visits usually surprise people, and as Sheila, a member of the Le Bonheur Children’s Family Partner Council, put it, “it is sometimes hard to think quickly when it becomes an emergency.” 

After talking with some more parents and the ED child life specialists, here are the pointers we received:

• Comfort Items: If there is a favorite pacifier, stuffed animals, or blanket.  If your child gets upset, it is always nice to have a familiar item there to comfort them.  It helps to bring a little bit of home to the hospital.
• Toys and Activities: If time permits, grab some age appropriate activities.  Handheld games (i.e. PSP, Gameboys), favorite toys, portable DVD players, iPods, or any other toys (or gadgets) your child might take on a long car trip.  It’s always a good idea to grab headphones to help your child and you.
• Entertainment for Mom: Additionally, Sheila recommends “likewise for mom bring your Blackberry, iPhone, or whatever.”  Le Bonheur Children’s has free wireless internet access, so feel free to bring along a laptop.  All of these devices are great helps in keeping other people aware of what’s going on.  Crystal, one of the ED child life specialists, mentioned the importance of grabbing charging cables.

Don’t be afraid to create games and play with your child.  It will help to keep both of you focused, and help the time pass faster.  One of my favorite games has been to count ceiling tiles, and to see who can do it the fastest.  Other games might be I Spy and 20 Questions.

Two of the most important things that will help make waiting a little easier on everyone are humor and patience.  Everyone who comes to a ED is in a stressful situation, and sometimes just being able to laugh things off can go a long way.

Perhaps one of the most difficult parts of visiting any Emergency Department (ED) is the waiting.  As I was asking some parents for advice on the ED, waiting came up time and again.  Renee, a member of the Le Bonheur Children’s Family Partners Council, described the experience in an ED as being a lot of “hurry up and wait.”

Whether it is to be taken into the back, for a nurse or doctor, to be admitted, or to be discharged, waiting is a part of the process.  One of the hardest parts of waiting for the ED associates are that they cannot tell you how long you may have to wait.  As we discussed the triage process, there may be critically ill patients that may be arriving by ambulance and helicopter, and you might experience a slight delay.

There are steps that you can take to help make the waiting a little easier on yourself and your child. 

Michelle, another member of the Family Partners Council, suggests that parents try their best to leave other children at home.  As she puts it, “it makes everything so much more stressful for everyone – patient, parent, nurses and doctors when there are other children running around.”  It is not that other children are not welcome, in experience of our seasoned parents, it adds another layer of stress for the parent.

Additionally, Renee wanted to stress the importance of not letting your child eat anything while waiting.  She states that “certain tests will require that [your] child be NPO [nothing by mouth], but you may not know that coming into the hospital.”  This can be stressful for parents, but it is important to help you get through the process faster.  Once in your are being treated, you can ask the nursing staff if your child can have something to eat.

In the next post, we’ll look at some other strategies that can help make the waiting go by faster.  And if you have any suggestions, leave a comment to pass them on.

Yesterday, I talked about the importance of the triage process, and how a decision is made to determine the degree of treatment need for your child.  If the decision is made that a lessened degree of treatment is needed, you will be assigned to the Le Bonheur Children’s ED Fast Track.

If you are not sent to the ED Fast Track, don’t worry.  Despite what the name may imply, it actually makes visits to the Le Bonheur Children’s Emergency Department faster for everyone.  If a patient is kept in the main emergency department it is because of the need for that level of care.  The ED Fast Track is a little bit closer to a minor medical center.

So, once you check-in with the triage nurse, they will give you a “blue pager.” This circular pager will appear similar to those that you might get at a restaurant on a busy night.  However, this pager will help you more than you realize.  During the wait time, we know that people get nervous about even getting up to go to the bathroom for fear that they will miss their name being called.  There isn’t need to worry about being called.

Once you are sent over to the Fast Track area, you will check-in with their team at the window.  They will give you another set of paperwork to be completed.  At this point, you’re still going to hold on to the pager.  Once you’ve completed the paperwork, you will turn it back in at the window (and still hold to the pager).

Now comes the fun part, you get to wait for the pager to go off.  The great news is that this group works tremendously efficiently, and will do everything in their power to treat you in our child as quickly as possible.  Once your pager lights up and vibrates you and your child will go to the window, give the staff the pager, and they’ll take you to a room to be treated.

So, in a few short paragraphs, that is the Le Bonheur Children’s Emergency Department Fast Track.  Also, if you've been to Le Bonheur Children's ED before, you may have heard of the Fast Track referred to by other names (examples of previous names have been Non-Acute Care and Zone 8).

Once you’ve navigated to the appropriate check-in desk, you begin the process of triage and registration.  This is an important step in the emergency department process, and there are several things that you can do to help.  The first thing you will need to do is fill out the necessary paperwork.  I know it’s not the most fun step, but it is important.

After/while you fill out the paperwork, your child will be triaged.  Triage is a system of prioritizing patients for treatment, and there is a dedicated registered nurse to that will determine the degree of treatment need for your child. Le Bonheur Children's uses a 5 point scale, with a score of 5 having the lowest degree for treatment need and a score of 1 being the most.

One of the things that can be frustrating to families waiting is seeing a child, who arrived after you, to be called back before your child.  Because some injuries and illnesses are life threatening and require immediate attention, emergency rooms cannot operate on a first come, first served basis.  The triage system makes sure that sicker children will be seen first.

During the triage process, you will be asked for information about your child.  This could include their date of birth, a home/cell number for medical follow-up, your child’s doctor.  Additionally, there are other things that you might be able to tell the triage nurse that will help them make a more informed decision.

A parent, with whom I recently spoke, mentioned the important of giving specific information such as “any pre-existing conditions, prior history of the same illness, or whether you were referred by a pediatrician.”  For instance, mention a history of seizures, diabetes, asthma, or any other pre-existing condition can help the nurse to assign the appropriate degree of treatment. 

Additionally, it may be important to tell the triage nurse if your child is not acting like themselves.  For instance, if your child is sitting and watching the room, when normally they would be bouncing off of the walls, it could make a difference.  Explain what a child's  "baseline" will help to paint a fuller picture, and remember, you are the one that knows what your child is like when they're not in the hospital.

This is the first official post in our Parent’s ED Primer, a new ongoing series to help families navigate a visit to Le Bonheur Children’s Emergency Department.  We will tag all of the posts in this series with a Parents_ED_Primer to help you pull up the entire series.  Please feel free to ask questions, and I’ll do my best to answer them.

When coming to any emergency room, it can be overwhelming.  If you have made the decision to go, things are serious enough that you know you need help, and where you check-in at may not be the first thing that you think about.  Typically, you are just looking for help and to get the procress started as soon as possible.

The reason that I am talking about check-in is because there are three possible desks/windows that you see when coming into Le Bonheur Children’s ED.  It may seem confusing but each one serves a purpose.  Here are the desks and their purposes, in the order that you would see them (when coming in the front door):

Security Desk:  This desk is staffed by one of Le Bonheur Children’s security guards.  They are there to help people find areas of the hospital, answer questions, and make sure that the ED is safe and secure.  If you have general questions about where things (i.e. snack machines, bathrooms) are, they are the perfect folks to ask.

 

Admissions Window:  This is an office for the Le Bonheur Children’s associates that work for the admissions department.  Don’t worry about having to stop here because they will come to you to bring necessary paperwork or other things.  However, much like all Le Bonheur Children’s associates, they are more than willing to help you in anyway the can.

 

Check-in/Triage Desk:  This is the first desk that you need to go to.  You can always spot the Check-in Desk by the big green sign above.  This desk is staffed by the Le Bonheur Children’s triage staff, and they will help you check-in.  They will get you underway of receiving care.

Hopefully all of this information will help make sense of the first step when you come to the Le Bonheur Children’s Emergency Department.  In the next post, I’ll discuss the triage process, and help to make sense out of some of the questions that parents often have.

Recently, I asked some of our readers what we needed to write about. We received several suggestions, and the one that was selected impacts lots of families: The Emergency Department. More importantly is what do parents need to know when coming to Le Bonheur Children’s Emergency Department.

Hopefully you will never need to our Emergency department, but when you do need it, we want you to know the important stuff. In 2009, Le Bonheur Children’s Emergency Department (or ED) treated more than 75,000 patients. As you can imagine, that’s lots of families, and unfortunately, when you need the services of the ED, you don't have time to research "what to do".

We have had families that have spent more time than they care to think about in the Le Bonheur Children's ED, and they have learned some tricks and tips. Our ED staff is another great resource, but how often do families have the time to ask them "specific" questions. Our thought was "why not talk to both groups and see what they have to share." In response, I started working on a Parent’s Primer: The Emergency Department.

I’ve been on a journey of talking with staff, asking parents for advice, and finding all of the answers that you might need to know when you come into Le Bonheur Children’s ED. This week, we’ll be sharing our findings. So, first things first: checking in.

However, there are lots of other areas, tips, and tricks to know about a visit to the Emergency Department. I’ll keep discussing those, and if you have questions or questions leave them, and I’ll try my best to answer them.

Recently, Le Bonheur Children's Family Partner Council went on a tour of the new hospital.  The group was excited to see how the construction was coming along, especially given the level of input they gave on the building design.  Since everyone is excited about this new building, I thought I would share the photo tour of the group with you.  Be sure to turn on the comments by clicking on the "talk box" in the lower left corner.

 As you can see there are a lot of things to be excited about, and the new building will be a wonderful change for our ability to care for patients and families.  I'll post more pictures and information as I get it.  Also, if you want to see some more videos on the new building check out the We're Growing Up section of the Le Bonheur Children's website.

I am intentionally keeping today's post short because I want you to read something else instead.  As many of you know, Le Bonheur Children's sent a medical mission team to Haiti, and they have been there for since Saturday.  The team is keeping a blog of the experience.  It has taken some creativity to get the information back, but there are now pictures, videos, stories, etc.  The address to the blog is:

http://www.lebonheur.org/blogs/lebonheurresponds/?

I have to admit that I check it several times a day, and have been fascinated by the reports.  If you are interested in seeing what Le Bonheur Children's medical team has been doing in Haiti, I strongly suggest checking it out.

Over the course of working for Le Bonheur Children's, I've had the privilege of working with a good number of patients and families.  The more you work with them, the more you can believe that you "know" what they need from you (and the hospital for that matter).  However, Le Bonheur Children's is aware of this trap, which is why the hospital has embraced a culture of Patient- and Family-Centered Care.

Patient- and Family-Centered Care (PFCC) is an approach to healthcare that involves engaging patients and families as partners and  including them in decision making at all levels of the organization.  This philosophic approach covers everything from bedside care to setting hospital policy.  The Institute for Family-Centered Care says the following:

Patient- and family-centered care is an innovative approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. Patient- and family-centered care applies to patients of all ages, and it may be practiced in any health care setting.

The Institute has a wonderful FAQ that I highly recommend reading.

Le Bonheur Children's has taken great steps to create an organizational culture that embraces patients and families as partners and values the wisdom, perspective, and experience they bring.  Two excellent examples of the hospital's commitment are the Family Partners Council and the Teen Advisory Council.  Both of the groups serve as advisory boards, giving leadership, input, and education on collaborating with physicians and staff to make a better-rounded experience for patients and families. Parents know their child better than anyone else does and not including them as part of the treatment team misses the mark.

It is amazing when you begin the journey and ask what it is that families need from us.  There are times that it is not easy to hear, because every children's hospital wants to believe it is completely committed to patients and families.  However, this feedback is not given as criticism, but instead in a loving spirit of improvement.  As the old saying goes, two heads are better than one. 

Just because there was terrible weather on Friday doesn't mean it stop the excitement at the Le Bonheur Children's.  Melissa Conroy came in for her visit, and it was a great success with patients and families in the hospital.  Since her visit was only open to patients and families in the hospital, I thought that I would share some of the pictures from the event.

Melissa Conroy braved the weather, and came in to lead everyone in some creativity.  Using woOberry dolls for an artistic spark, patients and families got to express their imaginations in lots of different ways.  Some people drew pictures, some people wrote poems, and others did there own artistic expression.  The most important thing is that they used their imaginations! 

The event was held in Le Bonheur Children's Creative Arts room, and as you can see from the photos, it was a great time.  I'd also like to thank Dianne Papasan for all of her help with making Melissa Conroy's visit to Le Bonheur Children's a reality.