by Thomas Hobson
Child Life Director

So, for the past several Mondays, I have been talking about video games and children.  Up to this point, research, ESRB ratings, and video games in general have all been covered.  There are a lot of factors to consider with video games and children.  Still, the fact remain that video games have become, and will continue to be, a part of the childhood experience.

After everything discussed in the previous Video Games & Children posts, I would like to leave parents with some practical advice:

1. Know Your Child: When figuring out the right age for a child to begin playing video games, think about your child.  If you’re child has shown interest in video games, it might be time to look into it.  You know if they’re ready.
2. Age Appropriateness: The age and stage of your child will go along way to help you decide what kind of video game system to buy.  Just because your child is interested doesn’t mean you need to go out and buy the top of the line system, with 35 buttons.  There are some great options for young children.  Don’t be afraid to start there.
3. Know the Games: The rating systems are great, but know about the actual game is even better.  Many of the current video game titles aren’t cheap.  So, take time to read the reviews of the game.  It will take you just a few minutes, and you’ll know lots about the game.  Some sites I would recommend are Game Informer, G4, IGN, What They Play, and 1Up.
4. Set Limits: Even with the right system and right video games, you still need to set the limits for your child.  Develop rules for when they can play, and what they have to do before the can play.  Time limits are another useful rule.  This could serve as a motivator to do other responsibilities, like homework.
5. Play Along: One of the most important things that you can do is play the video games with your child.  If you know the games that they’re playing, you’ll have a better idea of the content.  It is also a great opportunity to spend time with them doing an activity they enjoy.
   

by Thomas Hobson
Child Life Director

I’ve talk about the dedication that Le Bonheur Children’s has to children’s health and the wellbeing of children and their families.  What I don’t talk about often is the hospital’s dedication to the community and the world.  So, today, I thought I would start by telling you about how the new Le Bonheur Children’s will be green and will apply for Leadership in Energy and Environmental Design (LEED) certification.

LEED is an internationally recognized certification program that focuses on “the design, construction and operation of high performance green buildings.” It was established in 2000 by the U.S. Green Building Council, and focuses on five major categories: sustainable sites, water efficiency, energy and atmosphere, materials and resources, and indoor environmental quality.  All factors are evaluated and then a score is given.  Le Bonheur Children’s is hoping to have the results in 2011.  To put this in perspective, nationally, less than 3 percent of hospitals (not just children’s hospitals) are LEED certified.

It has been exciting to watch the new hospital building being built at Poplar and Dunlap.  If you are like me, you’ve been following the progress since the previous structure on the site was being torn down.  What you may not realize is all of the green initiatives you were witnessing.  For instance, at least 50 percent of the demolition waste was recycled.  Additionally, the new building is built with recycled steel and concrete.

The green initiatives don’t stop there.  The hospital operates 24-hours a day, seven-days a week, and uses a great deal of energy.  The new Le Bonheur Children’s is designed with plumbing fixtures that will reduce water consumption by over 20 percent.  In the design of the new building, the building will capture the maximum possible natural light.  This is additionally beneficial for the healing process, as research in design has seen on the impact of healing.

There have also been several steps to reduce CO2. For instance, a preference was given to construction materials with recycled content and materials from within 500 miles.  Additionally, a recycling program has been put in place for staff and visitors.

One final note is the modular energy plant that has been installed onsite.  The plant, which was built by Johnson Controls, is the largest of its kind in the country.  Everything from a fire pump to chillers to boilers to emergency power is included in the modular energy plant.  What’s more amazing is that the new plant is approximately 14 percent more efficient.

It’s easy to see that Le Bonheur has made being green a big part of the hospitals identity.  There are still more efforts that the hospital is taking to be sustainable.  Check back next week, and I’ll tell you more about it.

by Thomas Hobson
Child Life Director

Yesterday was a pretty exciting day at Le Bonheur Children’s.  It was the day that we held our first mock patient move.  In all of our planning for moving to the new hospital, we knew that we would only have one chance to get move the patients right.  Moving patients and their families from one building to another may sound like it would be simple; however, it is not as easy as you would imagine.

Even as excited as we are about the new building, our primary purpose is to take the best care possible of our patients and their families.  When you consider who many patients the hospital has and the variety of how ill or injured they are, you can see why we would take the moving process so seriously.  However, we have been planning, and yesterday’s mock patient move was our first practice at the process.

During the mock patient move, we practiced moving our patients, and to make it more realistic we had some actors to play children.  Well, who better to play children than children themselves?  We had several children from the community, as well as Le Bonheur Children’s Teen Advisory Council.

Our actors went through the process several times, and got a feel for the experience.  This is tremendously helpful for Child Life Services because we are going to prepare patients and families for what the move will be like.  Having feedback from mock move participants gives us the information we need to address appropriate concerns that patients have.

One of our actors, Taylor, said, “it happened really fast” and that helped it to be more fun.  Allie, another actor, said that the hospital bed “was bigger than her bathtub at home.”   Another actor, Avery, said that her favorite part was “being pushed around in the bed.” Everyone said that they were surprised by how quickly the move happened.  Catie mentioned that “the process was extremely organized and there was great communication between all of the teams”.

When I asked the participants for advice for kids going that will be actually moved was:

• “Don’t be scared, it’s going to be awesome!” (Taylor)
• “Don’t worry, you won’t fall off the bed.  They’re there to make sure you’re safe.” (Avery)
• “Everyone taking care of you does a great job” (Allie)
• “You are in great hands, so there’s no need to worry.” (Catie)
• “They’ve got a great plan, so relax while they do all of the hard work.” (Emily)

In hopes of giving some perspective of the process, we gave some of the Teen Advisory Council members cameras and asked them to take pictures of the experience. You’ll probably notice that some of the pictures are blurry.  It was caused from the moving that they patients were going experiencing at the time. Most of these pictures are taken from a patient’s eye-view, and can give you a feeling of what they might see.

Editors Note:  Realizing that school is either out or just about out for many students, the yearly struggle of summer begins.  One of the most frustrating things can be "watching" your child forget what they learned during the past school year.  It is for that reason that we invited one of the Le Bonheur Children's School Teachers to give some advice for parents wanting to keep their child from forgetting.

by Ginger Joe, Ed.D.
School Teacher

Are your kids ready for summer?

Are YOU ready to keep them learning during the summer months?

Let’s take a look at these following statistics from Ron Fairchild, Executive Director of the John Hopkins University Center for Summer Learning:

• All students experience learning losses when they do not engage in educational activities during the summer
• On average, students lose approximately 2.6 months of grade level equivalency in mathematical computation skills during the summer months.

To succeed in school and life, children and young adults need ongoing opportunities to learn and practice essential skills. This is especially true during the summer months. We all seem to have a wonderful image of summer as a carefree, happy time when kids can be kids.  We take for granted the prospect of enriching experiences such as summer camps, time with family, and trips to museums, parks, and libraries.

There are lots of great resources out there that you can tailor to your familiy.  Conduct a search on summer learning family education. You’ll find a wealth of ideas in the areas of language arts, science, math, social studies, art, activities, and fun on the road ideas. Then there is my favorite freerice.com, where each correct answer 10 grains of rice are donated through the United Nations World Food Program to help end hunger. There are six categories to choose from:  Art, Chemistry, English, Geography, Language Learning, and Math.

By taking simple steps to keep your child educationally engaged you can help them retain their learning and provide great opportunities for enrichment.  Remember that it's the summer and they don't have to know that they're learning.  In their mind, they're just having fun!

by Thomas Hobson
Child Life Director

Over the past decade, it would seem that there has been a great deal of research done on the impact of video games on children.  So, when I began this series, I started by doing a review of the research in medical journals on the topic.  What I found was that typically video games were lumped together in the concept of media, and the studies looked at the overall impact that media had on children.  Media was typically thought of as television, movies, video games, print, radio, computers, and the Internet.

In an extremely simple summation of the research, children are exposed to a great deal undesirable experiences through media.  For instance, one article, by the American Academy of Pediatrics (AAP) stated that in 2001 children were spending an average of 6 hours and 32 minutes a day with media. This is more than any other activity in their day.  So, you can imagine the impact that all of this can have on children.

In the previously mentioned AAP study, it was mentioned that by age 18 most children have viewed over 200,000 acts of violence, and that is only through television. There have been numerous research studies done on the increase of short-term aggressive behaviors in children after exposure to media that includes violence.  I’m sure we’ve all heard about people becoming desensitized to violence or other behaviors.  This research begins to make sense of it.

However, does that mean that there is not a time and a place for these activities?  No.  The fact is that there were some positives seen from various forms of media.  In the arena of video games, there were improvements noted in hand-eye coordination.  Additionally, it was discussed that in certain medical situations video games have been a useful tool in pain management.

The role that parents need to play is both simple and complex: know the media with whom your children are interacting and set limits.  Set up family guidelines on what, were, and when.  This may mean setting rules like the television cannot be turned on until all homework is completed.  It may mean that your child has to meet certain criteria (i.e. grades, behaviors) before being able to play video games.  If there was one repeated theme in most of the research, it was that limits needed to be set by families.

by Thomas Hobson
Child Life Director

Since, this is the official child life blog, I like to talk about things that go on in our department.  I would be missing the mark if I didn’t take the opportunity to say congratulations to Jenny Shelton for her promotion to Child Life Manager.  We are excited to have in this new role, and we know that she will do a wonderful job.

Jenny has been with Child Life Services for over eight years serving in a number of different roles, including her most recent as Lead Child Life Specialist.  Additionally, she recently completed her Masters of Social Work from the University of Tennessee.  Jenny brings a wealth of experience and wisdom to this role.

She will be joining Lauren McCann, our other Child Life Manager, and myself, on the department’s leadership team. Lauren will focus on the managing the day-to-day operations of the outpatient portions. In turn, Jenny will focus the inpatient portion of the child life program.

Over the past several years, Child Life Services has grown and taken an active role in numerous areas.  Our expanded roles in both the inpatient and outpatient areas have lead to the need for a more robust leadership team.  Jenny’s promotion allows the flexibility to provide the necessary leadership to tailor child life services to each specific area of the hospital.

On a personal note, I know that having both Lauren and Jenny has made our program run smoothly and effectively.  They have been tremendously valuable to the team and a great asset to me personally.  Our program deals with a great number of projects and elements of patient care, and there is no way we could do it with out the help.

Please help me in congratulating Jenny Shelton!  She’s going to do wonderfully in her new position.  Who knows, maybe I’ll get her to write a couple of these posts too.

by Thomas Hobson
Child Life Director

Most people would agree that coming to hospital can be an overwhelming experience.  There are lots of new sights, sounds, and, of course, smells.  Combined, they make a visceral experience that, depending on the complete circumstances, can stay with you.

In Child Life Services, we realize that children experience their time here at Le Bonheur Children’s differently from adults.  One of the most obvious factors is their height, or perhaps, lack of height is a better way to say it. 

Another factor is the ability to read and/or reading comprehension.  Children see signs, and may not understand what they are seeing.  We try to be aware of the message a sign projects to non-readers.

Realizing how a child experiences something can help you to better prepare them for it.  Take time to look around your house and look at little things.  What is at your child’s eye level?  How do things look when they lay in their bed? You’d be surprised how different the world looks from their level.

Now, imagine that you are five years old, and you are coming to the hospital.  You are a towering 45 inches tall, and you think that you’ve seen it all.  You walk into the front door, and find that the hospital is like nothing you’ve ever experienced before. Here's what it might look like:

by Thomas Hobson
Child Life Manager

When it comes to video games, families can quickly feel like a fish out of water.  If they’ve played video games previously, there is a good chance that the technology is extremely different.  They may even feel they as though they have to learn a totally different language.

When choosing a video game for a child, it can be an overwhelming decision.  A parent may be faced to selected a game that they know little, if any thing, about.  So, then comes the tough choice of selecting the must have game your child wants that could be full of inappropriate content or saying no to a reasonable game that leads to a moody child. What’s a parent to do?

Have no fear, there is help.

The Entertainment Software Rating Board (ESRB) has been around for about 16 years and they maybe the best resource available.  The ESRB is the group that provides a rating for video games.  Awareness of the rating system can help parents to make a more informed decision about which games to rent or buy.

ESRB’s rating system breaks into the following levels:

• Early Childhood (EC): Ages 3+
• Everyone (E): Ages 6+
• Everyone 10+ (E10+): Ages 10+
• Teen (T): Ages 13+
• Mature (M): Ages 17+
• Adults Only (AO): Ages 18+
• Rating Pending (RP)

The ESRB has a wonderful explanation of each of the rating levels, as well as the symbols associated with them.  I highly recommend reading their guide, and becoming familiar with the system.  It mentions the levels of violence, suggestive themes, and others in it.

Additionally, the symbols for the ERSB ratings are listed both on the front and back packaging of the video game.  Specifically, you will see the main symbol on the front, and the backside will have the symbol with an explanation.

Knowing this rating system can help you to buy the most appropriate games for your child, and do so without having to “test” every game that comes home.  If you think of them as the same way as movie ratings, it gives you to the tools to make the most informed decisions about the media your child sees.

by Thomas Hobson
Child Life Director

The other day I was talking with a friend about a recent illness their child had gotten over.  Quickly, the conversation turned to some of our own experiences as children and some of our fondest memories during our childhood bouts with illness.  We were amazed to see the traditions that we had brought into use with our children.

For instance, when I was a child growing up in North Carolina, my parents would give me Cheerwine (a black cherry cola) as a treat to have me drink fluid.  My friend had the tradition of extra noodle chicken soup, and their father bringing home a coloring book.  And an experience we both shared was lots of time lying on the couch, watching public television.

Most families have these rituals, whether they realize it or not.  They are small gestures or actions that serve to show your child that you love and care for them.  It’s amazing the warmth and loving memories that are quickly recalled during those experiences.

My guess is that by this time, you’ve already figured out your family’s customs during illness.  If you don’t have any of those traditions, perhaps now is the time to start some with your own children.  You don’t have to have grand plan, but instead, one or two small things done with love.

If you family has traditions/rituals, think about indulging in them while you and your child are at Le Bonheur Children’s.  There is a great deal of stressful events that can make families feel like there is nothing “normal” about being in the hospital.  These small things can be a strong bonding moment, and will serve as a small reminder of home.

Families can feel helpless to do anything while their child is in the hospital, but these traditions can breathe new life into the situation.  In Child Life Services, our thought is that all families are unique and have customs that are unique to the family.  You are a family before coming to the hospital, and you’ll be a family when leave.  Sometimes people just need a little encouragement.

What are some of your family’s traditions when a child is sick?  Leave a comment below, I’d love to hear them.

by Thomas Hobson
Child Life Director

Sports have been a part of childhood for generations.  The sports may look differently, but in the end they’re still an organized game.  And inevitably, there comes a point when a child is enrolled in an organized sport of some kind. 

If you are like my children (5 year-old twins) and I, it may be a variety of different sports.  Currently, we have tried basketball and soccer. I don’t think the NBA scouts are going to breakdown our door any time soon.

In most of the early sports experiences, the focus is on learning skills and the rules of the game, instead of keeping score.  This allows children an opportunity to learn the game in a lower stress environment and “try on” the sport.  Typically it is just as fun for the families to watch as it is for the child to play.

However, one question that I have been asked by a few parents is “what can I do, my child isn’t even trying?”  It can be frustrating to see your child standing on the field of play, not even remotely engaged in the game.  Sure, we all realize that it’s normal for children to do that, but what happens when it’s your child?

Let me start to answer the question by telling you about some research.  In December 1983, Dale Schunk published Ability versus effort attributional feedback: Differential effects on self-efficacy and achievement, an article in the Journal of Educational Psychology.  To give a basic summary of the article, they tested several students in math.  Some students received praise for skill in math, and others received praise for their effort.  The results found that those children praise for effort saw more significant improvements in math skills.

My advice is in line with the study, and for families to provide reinforcement for positive behaviors associated with effort.  When the focus is on effort, you might be surprised with the results.  Focus on the fact that they tried hard, and on specific behaviors that were positive.  Remember that it may start with just staying on the field the whole time.

So, if your child doesn’t seem to be trying on their sports team, change your focus and watch the magic.  Besides, if nothing else, it’ll feel good to both you and your child to have the positive interaction.

by Thomas Hobson
Child Life Director

Quick question: What was the last video game you played?  My guess is that the response will vary greatly by the person answering the question.  The fact is that video games and children seem to be a combination that has been linked for the past several decades.

There have been many strides and changes to the systems.  From the birth of the Galaxy Game, in 1971, to the latest video gaming systems on the market, there have been many changes in the technology.  Video games have moved from giant coin-operated arcade games to sleek specialized computer systems that are played at home.  One fact remained constant during this change: children and teens flocked to them.

Amazingly, the current generation of workers joining the workforce has been playing video games their entire life.  They don’t put age caps on playing, and many list “gaming” as one of their favorite activities.  Needless to say, it appears as though the video gaming culture is now an integrated part of our society.

Parents are now left with many questions about what to do when their child asks about playing video games.  It is with that in mind that I’ll start posting about various topics and questions about video games and children.  You can expect to see the posts on Mondays over the next few weeks.

In my effort for full disclosure, I am a casual gamer that has grown-up playing video games.  Despite referring to myself as a causal gamer, I do own two major gaming systems.  Additionally, I have a five-year old son that is deeply interested in video games.  So, I am approaching this from the perspective of a parent and gamer.

The goal is to provide some information and answers about video games and children.  If you have specific questions you would like addressed, please feel free to leave a comment.  I’ll do my best to answer them all.

by Thomas Hobson
Child Life Director

In a follow up from yesterday’s post, I have completed my Le Bonheur Children’s Ambassador Training.  It was a little touch and go as to whether I would make the cut, but I did.  (Okay, there were no cuts, I just thought it would be more dramatic.)  There was even a graduation ceremony, with a lot of pomp for the circumstance.

When I wrote yesterday’s post, I referred to the ambassador role as a tour guide.  That is, in part, true, but I learned quickly that it is more than that.  The ambassador is an important role for telling the story of Le Bonheur Children’s.  We educate on the hospital’s vision for the future, and Le Bonheur Children’s role in the community, nation, and world.  We are here to share the amazing and touching stories of the hospital, both historically and during the building process.

If you don’t know this already, let me be the first to tell you that there is no shortage of those stories.  Also, to put in perspective the size of the hospital, we were trained to provide a two-hour tour, and we are not even covering half of the hospital!

As I promised, here are a few interesting facts about the new Le Bonheur Children’s:

• The new hospital is 610,000 square-feet in size.
• The complete Le Bonheur campus is will be 50 percent larger and will cover more than one million square-feet.
• In the same way the current hospital is designed, all patient rooms are private, and now will accommodate comfortable sleeping space for two parents.
• Playrooms and space for families to gather on every inpatient floor.
• The new hospital includes a movie theater.
• Lactation rooms for moms are available on each floor.
• The Emergency Department will more than double in size, with 64 patient treatment rooms in the new area.
• Almost half of the beds in the new Le Bonheur Children’s are for critical care patients – these beds are in the dedicated pediatric intensive care, cardiovascular intensive care and neonatal intensive care units.

Over the next few weeks, I will share more specifics about the new Le Bonheur Children’s and the exciting aspects of it.  Also, what kind of a blogger would I be if I didn’t take a few pictures?

by Thomas Hobson
Child Life Director

One thing that I have prided myself in is knowledge about Le Bonheur Children’s Hospital.  Besides the facts that I work here and I’m a dork, it is information that I use on a fairly regular basis.  Why do I use this knowledge (other than winning at obscure trivia)?  Tours.

It is surprising the number of tours that I have given during my time at Le Bonheur Children’s.  It has led me to collect nuggets of information about most areas of the hospital.  Additionally, with the exception of a few square feet here and there, I have been everywhere in this building, including the roof.  Needless to say, I’ve developed a fantastic tour, and can spend all day telling you about Le Bonheur Children’s.

Here’s the funny thing about moving into a new building: there are no “tour guides” for it.  Sure, we’ve done construction tours, but most people will be interested in the finished product.  Have no fear because we have a plan: ambassador training.

Ambassador training is a process put in place to train approximately 100 ambassadors (translation: tour guides).  What is more amazing is that ever a tour guide… err… ambassador will have the exact same knowledge and experience.  This means that regardless of who leads the tour, everyone will hear the same information.  Trust me, this is no small feat.

Additionally, the ambassadors will be the group giving tours to the community, as we get closer to the grand opening and move in date.  We know that people are interested in getting a look at the new hospital, and we want to accommodate with tours.  When I have more information on the specific dates of public tours, I’ll be sure to post it.

Today I will be in my ambassador training, and I’ll see if there are any interesting tidbits that I can share.  So, I’ll take lots of notes and pictures and report back tomorrow.  Consider me your inside source from Le Bonheur Children’s Ambassador Corps.

Don’t worry that I’m blogging during it, I do have my tricks…

by Thomas Hobson
Child Life Director

Yesterday, I talked about identifying behaviors that a child is not dealing well with the stress of a situation, or as I call them, stress behaviors.  Identifying stress behaviors is the first step, and can help you keep your parental composure.  Today, I want to go one step further and give you a strategy for breaking the cycle of stress behaviors.

The best strategy for breaking any cycle is to redirect/re-engage the person/people involved.  In the case of children, it can be easier and quicker than you might imagine.  However, it takes a little more than just redirecting.  It is important to complete each of the following steps: 

1. Break the cycle through redirecting: Play a game, talk about school, or anything else that has nothing to do with the current situation.
2. Understand why: During the redirection, ask some questions about the situation to find out what the underlying cause. 
3. Address the underlying stressor: Once you understand, be sure to talk about it with your child, doing so openly in a safe conversation. 
4. Make the request again: Hopefully once you’ve addressed the your child’s concern, they will be more than happy to complete the requested action.

For instance, a child life specialist gets called into help a family in a situation where the patient is refusing to take their medications, the family is at their wits end, and the patient has hunkered down into flat out refusal.  This behavior has become the center of everyone’s world, and is now all anyone can focus on.  As a way to break the cycle, the child life specialist might do something like engage the child in a game or free play.

So, what does play have to do with this?  (Break the Cycle) It stops the cycle and becomes the new focus.  (Understand why) While playing, the child life specialist would ask why the patient doesn’t want to take the medicine.  The patient responds that they are tired of taking medicine and being in the hospital.  (Address underlying stressor) Together, the family and the child life specialist discuss with the child, in developmentally appropriate words, why they are in the hospital.  (Make request again) As the conversation wraps up, the child life specialist asks the patient if they are ready to take their medications.  The child says yes and takes the meds.

For the purpose of time, I’ve given a single example; however, this can easily be applied in lots of situations in your everyday life.  Following the steps may take some practice at first, but it’s well worth it.  The more that you recognize the behaviors the quicker you can pull yourself out of the cycle and address the root concern.

Have you had some experiences with this tactic?  Share your story in the comments, we’d love to hear them.

by Thomas Hobson
Child Life Director

We’ve all been in situations when the stress involved almost (or in some cases, did) make us flip out.  Who hasn’t had a moment where the pressure, anxiety, and/or fear built up to the point when you could pull your hair out and scream at the moon?  As an adult, you probably have learned to control your reactions to stress.  However, I would be willing to wager that you know someone that hasn’t, and there are numerous stories of them acting “crazy” in stressful situations.

In the case of children, most have not mastered controlling the behaviors that arise out of stressful moments. In the hospital, we see it more than you might imagine.  When you take the level of stress that children can experience from the unknown and general fears it’s not surprise. 

Young children may not have the “right” words to describe feeling stress.  They might call it scared, angry, or any other number of feelings.  However, in my experience, they may not try to explain their feelings, but instead make a change in their behavior. One of the easiest ways to tell is from “acting out” behavior in the child.

In a stressful situation a child might respond by refusing to take medicines, participate in treatments, follow rules, and even “purposely” break rules.  At home, this may include refusing simple requests (i.e. brush your teeth, put that toy away).  As you can imagine, this is frustrating to families, who can be left scratching their heads.  Since it’s not the typical behavior, some families will respond by being more firm with the child.  Typically, you can see the child respond by further strengthening their resolve for the behavior.

You can see the cycle of behaviors beginning as each side escalates into a lose-lose situation.  As child life specialist, the most important question we explore is what is causing these behaviors because chances are it may not be on the surface.  Families can use the same question at home to understand the behaviors.  When we understand what the cause is it becomes easier to deal with the root issue.

Now, why would a typically sweet, compliant child do this?  Simply put, it is something that they can control especially when they are in a situation that gives them no control.  The child is trying to regain control over their life.  Remember the classic child development mantra, even negative interaction is better than no interaction.  Or to put it another way, even control with negative consequences is better than no control.

In tomorrow’s post, I’ll talk about some strategies that Child Life Services uses to break the cycle of stress behaviors that you can use at home.  Also, if you have some examples of this behavior with your own children leave a comment below.  We’d love to hear from you.