by Jamie Droke
Child Life Specialist

While most child life specialist spend most of their days working with children on coping with being in the hospital, I have the privilege of spending most of my days working with parents on coping with their child being in the hospital. I am the child life specialist for the Pediatric Intensive Care Unit and most of my patients either don’t feel well enough to engage in coping techniques or are sedated for most of their PICU stay. So my role focuses more on the coping of parents and siblings. Over the time I have been working in the PICU, I have noticed several very different coping strategies that parents and siblings use to deal with their child or sibling being in the hospital.

• Withdrawal: Have you ever asked someone how they are and they say they are fine? And yet, you know just by the look on their face that they are anything but fine? These families tend to not want to discuss their worries and fears and instead will say anything to make you believe they are okay.
• Family Support: Some families who are not close to one another before a hospitalization can become very close during a time of difficulty. These families learn to lean on one another to help care for everyday things like laundry, meals, and picking the other kids up from school.
• Faith: During a difficult time, many parents turn to their faith and spend their time in prayer, meditation, or reading the scriptures. For these families a visit from a chaplain or a pastor can be extremely helpful.
• Question-Asking: Some parents find it very helpful to have as much information as possible even if the information does not directly relate to their child. These parents will ask nurses and doctors countless questions to get their answers.
• Avoidance: These parents tend to busy themselves with anything other than the matter at hand. If they have a sick child, perhaps they visit for a short amount of time and then leave to go take care of things at home. Perhaps they remain at the hospital but spend their time away from the bedside because it is too difficult for them to remain there.
• Humor: This is my personal favorite because I do believe that laughter is the best medicine. These families use humor to make it through each day. Sometimes their humor is a mask to cover their hurt and sometimes it is instead an indication of their ability to cope.

There is no right or wrong way to cope and this is by no means an all-inclusive list. Many parents seem to utilize some combination of these strategies to make it through each day. It is however to know your coping strategies and for those who cope through withdrawal or avoidance, it is important to know when to ask for help so that you can somehow deal with the situation at hand.

by Jamie Droke
Child Life Specialist

Holidays are meant to be happy, joyous occasion, filled with family, friends, laughter, and smiles, but for the family that is grieving the loss of a loved one, holidays can trigger feelings of intense sadness, isolation, and even guilt. Holidays that used to be a huge deal to families can sometimes seem out of place when a person who used to make that holiday special is no longer present. Traditional holidays such as Thanksgiving, Christmas, Easter and the 4th of July often present difficult issues for families who have lost a loved one; and in addition to these traditional holidays, the birthday, anniversary of death, and other special days of the deceased become difficult to bear. As we talked about a little while ago, extended family members are also grieving and getting the whole family together for the holidays can create a situation where everyone feels less than happy and joyous. Here are some helpful hints on getting through the holiday season (or any day of the year) after a loss:

• Acknowledge that it is okay to celebrate holidays even without your loved one. Many families, particularly when the death has been recent, feel guilty enjoying the holidays or even planning events where they are expected to smile and pretend everything is okay. The holidays will be hard, but when you get to the point when you can reminisce over the good memories of your loved one, this is when you are coping well with the loss.
• Acknowledge that it is okay if the holidays are difficult. And don’t be afraid to share these feelings with those you will share the holiday with. Knowing this ahead of time will help other family members know how to help you enjoy the holidays the best you can.
• Know your limits. Even under the best of circumstances, holidays are exhausting. And even without the holidays, grieving is exhausting. Recognize this and determine what you can and cannot handle. If you have always hosted the family meal but don’t feel like you have the energy to do that again this year, ask for help. On the other hand, if cooking is therapeutic for you, don’t pass off that responsibility.
• Decide and discuss ahead of time how you will celebrate the holidays. Will you stick with all of the age-old traditions, or will you start some new ones this year? There is no right or wrong here, just make sure to let the rest of your family know what your plans are so they can plan accordingly.
• Find a way to honor the loved one you are dearly missing this year. Spend some time at the dinner table sharing favorite memories. Light a candle or pull up an extra seat at the table in their honor. Some families even chose to buy a gift for the person who has died to remember them.

There is no right way to get through the holidays after a loss, but hopefully these tips can help you manage. Just because your loved one is not physically present for the holidays does not mean that he or she will ever be forgotten.

by Rachel Franklin
Child Life Specialist

In yesterday's post, I covered some of the basics of the CT scan. So, today I want to give some times on helping your child feel comfortable during the scan. The preparation can start with anticipating and neutralizing unfamiliar or possible worrisome elements of the CT scanning process:

Height and size of scanning camera: As the photo at the right shows, our CT camera is tall, round, and donut-shaped. Some children enjoy thinking about the scanner looking like a spaceship. Some enjoy thinking about going for a ride on the bed with a family member. Giving children a fun and positive perspective on the camera and upcoming process helps children anticipate the process with greater familiarity and pleasure. 

Possibility of pinches or pain?: Your child may need your reassurance that the process of being scanned will not involve anything that pinches, pokes, or induces pain. Sometimes, a pinky promise gives just the right amount of reassurance needed to get started. (If your order involves "contrast," see your child life specialist for more information and assistance with IV preparation, support, and placement.)

Movement of scanning bed and body moving "inside scanner": Our scanning bed will move slowly upward from low position on ground to its proper scanning height (approx. 5 feet above floor). Actual scanning occurs when the area being imaged enters the center of the camera. Some children prefer to first watch the bed move up and into the scanning camera to feel a sense of understanding and familiarity before transitioning into laying position on the scanning bed. Seeing our Dora or Diego doll or a familiar family member model laying still on our slowly moving scanning bed with a calm and relaxed or smiling affect may communicate to younger children that the process is safe, non-threatening, and pain-free.

Red lights: When entering the center of camera on the scanning bed, red lights shine on the bed to assist technicians in adjusting your child into proper position to result in best images possible. As some children want to know to expect this, you can give your child notice about the "laser light show." 

Separation from or brief loss of visual contact with caregiver: While transitioning inside the scanner in proper scanning position, some children may temporarily lose visual contact with the caregiver at bedside. Even as young infants' brain development allows them to better recognize and be comforted by familiar faces around them, temporary absence of that familiar face in an unfamiliar environment may be worrisome to your child. Older children may even experience an  increased sense of safety and security in a new place when knowing that their caregiver is nearby. If it helps your child and is appropriate for you, you may try leaning over our scanning bed to keep visual contact with your child or even laying with or sitting with your child throughout his scans.

Remaining still and in laying position throughout scans: For busy children, laying still and quiet may be quite a challenge! For example, we know that toddlers love moving and exploring their environments. Even when the level of invasiveness of a procedure is low, the experience of needing to remain still or being slightly restrained in a seated or laying position can be highly frustrating. Simulating familiar routines are helpful in assisting some children with laying still while remaining calm. For example, as younger children often are familiar with needing to remain in a still, laying position during diaper changes or storytime, simulating this process assists some active toddlers in successfully doing so throughout the duration of a few quick CT scans. "Getting pictures taken" with that familiar caregiver, Dora doll, or Diego doll may also be a fun motivator for your child. 

by Rachel Franklin
Child Life Specialist

Tips and Tricks for a Successful CT scan 

You might have recently heard your physician talking about a "CT" or "CAT" scan. A CT scan, also known as a Computerized Axial Tomography scan, is often a quick and very useful way to achieve detailed images of bones, muscles, organs, arteries and blood vessels. CT scans can result in more detailed images than X-Rays and can help your physician diagnose cause of illness symptoms or serve as a good check-up 

following accidents or injuries. CT scans result in many images from multiple angles (front to back and side to side) and perspectives while only requiring a very short amount of time. We want to assist you in having a successful experience with us! Below are a few tips to get you started:

Utilize your "CT Teammates" and partner with our staff for success: After checking in with our front desk staff, you will be greeted by one of our CT technicians. Our technicians and child life specialists are welcoming staff who can help you and your child feel informed about and comfortable with the scanning equipment and process. When you meet us, this is a great time to start asking any questions you or your child might have about the equipment, timing, experiences and sensations associated with your upcoming CT scan, and the overall process. This is also a great time to share information with us about what we might be able to do to help your child feel more comfortable and ready to begin the scans.

First impressions speak volumes: From birth and throughout development, we know that children look for cues from caregivers to help them understand how they should perceive and experience things around them. Together we have great potential to help your child have a positive perception of his or her Radiology experience. 

We're here for you! A very important part of our role as staff committed to family-centered care includes our desire to help your child and accompanying family members through your CT experience. Ask questions. Share your ideas and insight. We want you to be a true part of our team. We are excited to work with you!

In tomorrow's post, I'll give some pointers on how to make your child as comfortable as possible while having a CT scan. 

by Jamie Droke
Child Life Specialist

The loss of a child has a profound impact on many people. Of course, the people closest to the child, particularly those who live in the same house as the child, are often affected the most because of how the loss has changed many details of their everyday life. Extended family members, however, can also face unbearable grief over the loss, even though this grief is often overlooked by others.

Consider, for example, grandparents who lose a grandchild. Their grief is complicated by the grief they experience while watching their child suffer the loss of a child. This can be true for aunts and uncles, cousins, and other extended family, who have suffered the loss of the child and now feel helpless in aiding the parents of the child in their grief.

I think we have talked about the stages of grief before on our blog, but it might have been a while, so here is a refresher, crash course on the stages of grief and particularly how these stages play out or affect extended family members. Just a reminder, someone who is grieving may experience these in any order, may move onto another stage and then return to a previous one, skip a stage all together, or stay in one stage for an extended period of time while hurrying through the others.

• Denial: This is often, but not always, the first stage of grief. For extended family members, denial often comes in the form of numbness as they attempt to simply get through the first couple of days, supporting the parents and siblings but not paying much attention to their own grief.
• Anger: This stage is sometimes experienced as guilt, as in a grandparent feeling guilty that the child’s life ended before their own. Sometimes anger is felt towards God, medical staff, or the circumstances surrounding a child’s death.
• Bargaining:  Extended family members often find themselves bargaining with God, that they should have been “taken” instead of the child that was lost. Some family members will make resolutions to be a better person if only the pain and hurt will go away.
• Depression: Sadness and depression is a normal part of any grieving process, and in my opinion, evidence of this stage is present throughout the entire grieving process. Sadly, sometimes extended family members do not feel comfortable sharing this stage with others. They may think they need to hold it together for the parents, or that by experiencing their own sadness they are detracting from the parents’ sadness.
• Acceptance: This final stage of grief is a difficult one to reach. Accepting the loss does not mean forgetting the child or no longer missing him or her. And for extended family members it is also complicated by accepting a change in the legacy they are leaving behind. Part of a person’s legacy is in their children and grandchildren, and to lose a grandchild is like a loss of part of your legacy. Acceptance means that family members are able to remember the happy memories of their lost loved one and regain a new normal.

If you or someone you know has lost a grandchild, niece or nephew, cousin, or other extended family member, give yourself and them time to grieve the loss in any combination of these stages. Listening and providing emotional support by validating their feelings of loss can help family members move towards acceptance over time.

by Jamie Droke
Child Life Specialist

How to calm your own anxieties.

Over the last several weeks, we have addressed the basics of parent-child anxiety transfer and how to provide helpful distraction for your child during potentially anxiety-provoking situations. The last piece of this topic is how to calm yourself so as to prevent the transfer of anxiety. Even if you know that your anxiety can induce anxiety in your child, if you can't calm yourself down during stressful situations, knowing this information will not be helpful. And while distraction is a great way to prevent anxiety in children, adults cannot always ignore or distract themselves from anxiety-provoking situations. In fact, these anxiety-provoking situations most often demand your full attention. So, how can you lower your own anxiety in situations where anxiety is an appropriate reaction?

The first step is to know your coping strategies. Just as each child has a different coping mechanism, so does each adult. Some children are watchers and some are easily engaged in distraction. Some cope by question-asking and others by avoidance. Once a parent knows a child's coping strategy, helping them cope with stressful experiences becomes much easier. The same is true of us adults. Think about a stressful experience you have faced and what helped get you through. Was it exercise or keeping busy? Was it a strong support system from your family or faith? Or was it getting good rest and good meals? Once you have put some thought into it, most people can determine what their coping style or strategy is. And many people use more than one strategy to cope with difficult situations.

In the situations we most often deal with (an injury or illness in a child), parents have good reason to be anxious. But these anxious parents need a way to cope with their anxiety so that their child does not have heightened anxiety simply because their mom or dad cannot cope well with the stresses associated with the child's illness or injury. In these situations, the first thing I encourage for parents is self-care. Parents need rest and good meals even when (or maybe especially when) their child is in the hospital. I encourage parents to take a break from the hospital to go home and take a nap or shower when possible. I encourage parents to take a break to eat three good meals each day. I tell parents that if they cannot take care of themselves, it will be very difficult for them to care for their sick child.

The second thing I encourage parents to do is to know their limits. If you are a parent who cannot handle the sight of blood, it is perfectly okay to step out during blood draws. If a parent becomes easily overwhelmed when standing or sitting in a child's room, I encourage them to come for short visits and to step out when that feeling of being overwhelmed begins to set in. As we have talked about before, children can sense their mother or father's anxiety and if you become audibly or visibly upset after spending any significant amount of time in the room, it would be a good idea to stay at the bedside for only short visits.

These are just a few simple ideas for coping with the stresses associated with having a child in the hospital. Now I want to hear from you. How do you cope with stress and anxiety?

by Jamie Garner
Child Life Specialist

How to help alleviate your child’s anxiety through distraction

A few weeks, I addressed the topic of parent-child anxiety transfer. Just to refresh your memory, anxiety transfer occurs when someone feeds off of someone else’s anxiety. We talked about how a toddler will look around after he or she falls in order to determine what emotions are appropriate. I often notice the same thing here at Le Bonheur with parents. I work in the ICU and anyone who has spent time in ICU knows that there is never a quiet moment in the unit. At least one patient always has something beeping. But parents do not often get alarmed over the beeping as long as nurses and doctors do not seem alarmed. Even adults are affected by anxiety transfer.

Next week, we will talk about how to get your anxiety under control, but today I want to talk about how to help your child’s anxiety, particularly in relation to pain. Especially for younger children, the most difficult part of painful procedures such as immunizations, is the fear of knowing what is coming. As child life specialists we employ distraction during painful procedures all the time. And as often as possible we try to make parents part of the distraction. The truth of the matter is, parents know their children best and know what will hold their attention even during potentially anxiety-provoking experiences. It is our hope that parents will see how well distraction works here and will use the same techniques to help their children during immunizations or any painful procedures when child life specialists are not present.

Many parents probably use distraction without knowing it. For example, if a child wants to play with a toy that a brother or sister is already playing with, a parent might try to keep the peace by entertaining the child with another toy. We use toys as distraction here too. And for many children distraction works very well to alleviate their anxiety and their perception of pain. Toys that engage various senses are often the most effective kind of toy. For example, toys that light up or make noise tend to hold a child’s attention the best.

Parents can even use a favorite book if the child is typically attentive to that book. For older kids and teens, distracting conversation about a recently viewed movie, a favorite hobby, or a well-loved sports team can be effective as well. Deep breathing exercises can be used both as a way to relax the body and as distraction. When children focus on their breathing patterns, they are not only helping their bodies relax (if a child is tense, needle pokes tend to hurt even more), they are also thinking about something other than the pain.

I need to add a word of warning here. Some children are what we like to call watchers. These children actually become more anxious when they are prohibited from seeing what is going on. If this sounds like your child, distraction could be less than helpful. For these children, an age appropriate step-by-step explanation of what is about to happen will be much more effective. Sensory explanations are the best kind. For example, “The nurse is going to clean your arm and it will feel cold and wet.”

I would love to hear from you about what you have found to be effective with your child or children. What kind of distraction have you tried and how has it worked?

by Thomas Hobson
Child Life Director

There are times that death seems like one of the most taboo topics in our society. It is one of the most difficult experiences a family can go through.  To make the situation harder, the thought of talking to children about death can be hard for parents.  Death is a topic that many feel like the have no idea what to say or which words to use.  Having children ask questions about death can be even harder when, especially if you are still processing your own feelings. 

This past Wednesday (April 14, 2010), PBS aired a Sesame Street special dealing with children and grief.  It centers on the character Elmo and the death of his uncle, and is hosted by Katie Couric.  Much like every thing else done by the Children’s Television Workshop, it is extremely well done and is a wonderful resource for parents.

I’ve included a clip from an interview done earlier this week on the special:

If you would like to see the entire episode of PBS’ When Families Grieve, the Sesame Street special click here.

There are situations in the hospital when families have to talk to their child about the death of a loved one.  Here at Le Bonheur Children’s, Child Life Services has served as a resource for families in these situations.  We work together with the rest of the interdisciplinary team to help equip families with the right tools to communicate.

Additionally, there are some wonderful resources in the community that can provide support to you and your child.  If you have a child that has been struggling to cope with a recent death, I would recommend looking into Camp BraveHearts. It is a family grief camp that is hosted by Methodist Hospice and has several of us in Child Life Services working directly with the camp.

Talking with children about death and grief can be one of the hardest conversations that you can have.  Just know that there are wonderful resources in the community to help with preparing for the discussion and providing support during the grief process.  It may not be something that you’re comfortable talking about, but it will be a strengthen experience for both you and your child.

As I am sure you are all aware, a massive earthquake devastated Haiti earlier this week.  Along side of the destruction and human tragedy, it has struck a nerve with the world community, and there are aid efforts being organized on a world level.

We live in a world that has 24-hour wall-to-wall news coverage, and as much as we would like to shield our children from events like this, it is nearly impossible.  Children see the images and hear the news, but often times do not completely understand what they are seeing. As children begin to process this information many parents do not know where to begin talking to their children about it. I thought I would be best to pass along ways to talk to children about the events.

As I began writing this post, I turned for advice from two of Le Bonheur Children’s experts on working with children during traumatic events.  The first person I asked was Jenny Shelton, our Lead Child Life Specialist.  After talking with both of them, here is their advice:

 

Parents/caregivers can help children and/or adolescents that experience trauma by allowing them to openly talk about what happened and express their feelings.  Creative activities such as drawing and writing are excellent ways for children and adolescents to express their feelings.  Parents/caregivers should reassure children and adolescents that their feelings are normal and okay to have after a traumatic event.  It is also important to help children and adolescents feel safe and secure in their environment by maintaining normal activities, rules, and routines in the family system. 

 

If traumatic events happen at the local, state, or global level be aware of the information that children and adolescents are being exposed to via the internet, radio, and television.  Parents/caregivers should provide children and adolescents with age appropriate information and answer questions/concerns about the trauma that has affected many people.    

The second person I asked was Susan Steppe, the Director of Social Services.  She suggested the following strategies to talking your child about the events in Haiti:

• If your child continues to bring up the events repeatedly let them talk about their reactions.  Remember your child may not directly talk about it, but instead may draw pictures or have new “play scripts.”
• Reassure them that these feelings are normal, and lots of people are feeling the exact same way.
• Make them feel safe and secure, and do this as much as the individual child needs.
• Create a plan for something they can do to help.  In this case, it may be helping a local group that is organizing relief efforts.
• Turn off the television (or internet), especially if they are feeling overwhelmed.

You know your child and their reaction to these terrible events.  If they are having a difficult time, don’t be afraid to talk about it, and don’t worry if you don’t have the “right words”.  Most people don’t know where to start, but the important thing is that you do.  Also, listening goes a long way.

If you would like more information, please check out the National Child Traumatic Stress Network website.

My children just turned five years old, and that means another well check up.  I was pretty sure that my children had a vaccination due during that visit (it was my daddy senses).  Since I don't want to be someone that does not take their own advice, I asked my doctor's office to run me through the vaccination process my children would experience.  Now, I'll be the first to admit that I felt a little foolish.  Let's face it, how many parents are asking this question?  Still, I wanted to make sure I was preparing my children with the correct information.

Here's the amazing thing, the doctor's office was great.  They transferred me to talk to a nurse, and got the ball rolling.  I told them that I wanted to be able to prepare my children in advance for their vaccinations, and that they had a rough time with their flu shots.  The nurse completely understood, and even pulled their medical records to give me the most accurate information possible. 

I was informed that my children would need three separate vaccinations, and they would need to be given in three different injections.  Then I asked her to explain what would happen during the actually event.  She explained the process, the equipment, and site (in the thigh), and even took the time to answer my questions.  It was all of the information that I needed to prepare them for the injections.

The first time you ask for this information, you will probably feel absurd.  However, remember that you are the advocate for your child, and if you can find out some information that will help their experience, then you will.  So, please know that this is a successful step, and you should feel empowered to gain the necessary information to prepare your child.  Besides, the only information you need is just a phone call away.