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PEDIATRICS Vol. 106 No. 5 November 2000, pp. 1156-1159
AMERICAN ACADEMY OF PEDIATRICS:
Child Life Services
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ABSTRACT |
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Top
Abstract
Conclusion
Recommendation
References
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Child life programs have become the standard in large pediatric settings to address the psychosocial concerns that accompany hospitalization and other health care experiences. Child life programs facilitate coping and the adjustment of children and families in 3 primary service areas: 1) providing play experiences; 2) presenting developmentally appropriate information about events and procedures; and 3) establishing therapeutic relationships with children and parents to support family involvement in each child's care. Although other members of the health care team share these responsibilities for the psychosocial concerns of the child and the family, for the child life specialist, this is the primary role. The child life specialist focuses on the strengths and sense of well-being of children while promoting their optimal development and minimizing the adverse effects of children's experiences in a hospital setting.
Most hospitals emphasizing pediatric care have child life
programs,1 and the number of these programs has doubled
since 1965. In a 1988 survey of 396 hospitals (including general and
children's hospitals) with pediatric residency programs, 82% of the
286 responding hospitals employed professional child life staff,
whereas a 1998 survey of its 152 members by the National Association of
Children's Hospitals and Related Institutions found that 97% of 112 responding hospitals employed child life specialists.2,3
Child life services could be offered in inpatient pediatric health care
settings as well as ambulatory and emergency departments. The National
Association of Children's Hospitals and Related Institutions has
stated that provision of such services is a quality benchmark of an
integrated child health delivery system.4 A number of
states have identified the importance of child life services through
the regulatory process; for example, in a draft regulation, the state
of Florida mandates that child life programs must include preparation
services for children and families, training of volunteers, and
provision of age-appropriate play and activities.5
Although most child life specialists work on inpatient units, an
increasing number are now employed in outpatient settings in response
to the general trend toward ambulatory health care. A ratio of 1 child
life specialist to 15 or 20 patients has proved to be successful for
many institutions for their inpatient areas; however, the patient's
age, mobility, and type and acuity of illness and the nature of the
population on the unit should influence actual
practice.6,7 Ratios for outpatient areas have
not been established, but the same factors should be considered. Child
life specialists are responsible to a child life manager who typically
reports to the Department of Pediatrics through its chairman,
administrator, or child/maternal nursing director.
The credentials of a certified child life specialist include at least a
bachelor's degree in child development and the completion of a child
life internship. Child life specialists often develop specific areas of
expertise related to the patient population (eg, infants, oncology
patients, critically ill children) that they serve. They are trained to
recognize the developmental issues specifically related to health care
experiences and to understand how to mitigate fears, fantasies, and
concerns. Information about the child life profession and certification
of child life specialists is available from the Child Life Council, Inc
(see Additional Resources).
An effective child life program provides children and adolescents with
developmentally appropriate play, offers informative and reassuring
psychological preparation for and during procedures, and provides
support to family members.8
Play is the primary modality of a child life program, making the
health care experience less intimidating and more comfortable. Child
life programs provide opportunities for play in inpatient areas,
intensive care units, outpatient clinics, emergency departments, presurgical waiting areas, laboratory waiting rooms, and sibling care
centers. Engaging in developmentally appropriate play and reading
activities moderates children's anxiety and minimizes the possibility
that health care encounters will disrupt normal development.9,10 Child-directed play and guided (or
issue-specific) play experiences allow children to be active and exert
control over their endeavors.1,7,10,11 Observation of play
offers insight into the patient's concerns and level of understanding
of the health care events and, thus, affords an opportunity to correct
misconceptions. These observations are shared with the rest of the
health care team so that all are better prepared to respond
appropriately to the individual patient.
To help a child cope with painful treatments and intrusive procedures,
a child life specialist often uses "medical play," involving
nondirective exploration of medical equipment, dramatic play in which
situations encountered by the child are reenacted, use of games or
puzzles depicting medical themes, or the creation of art work using
health care materials (eg, bandage strips, tongue depressor,
syringes).1,7,10,11 Such activities allow a child to
approach a threatening situation with greater familiarity and a sense
of mastery.12
Preparing children for hospitalization, clinic visits, or
diagnostic and therapeutic procedures is another important element of a
child life program. Many hospitals and other health care facilities
have developed preparation programs that familiarize the children and
their families with the circumstances and procedures they will
encounter. These developmentally appropriate programs help reduce
emotional disturbances in hospitalized children.9,13,14
Oncology clinics, day surgery units, radiology departments, dialysis units, primary care clinics, emergency departments, and other clinics
have used child life specialists to help children anticipate and manage
health care experiences.15-19
When providing information to children and families, child life
specialists share accurate descriptions of the experiences children
will have. In addition, they provide opportunities for children to
examine equipment and give them developmentally appropriate explanations of their use. The information and opportunities to handle
equipment help make the unpredictable more manageable and enable the
child to plan and rehearse coping strategies.20 Strategies
used may include relaxation, visualization, and pain management
techniques. A child life specialist who is present during a procedure
can enhance a parent's ability to support the child and contributes to
a patient remaining calm and more cooperative during the
procedure.21 In the absence of parental support, a child
life specialist often provides the support, enabling the staff members
to use their time more efficiently.
The third major area of child life services involves education and
support of parents and other family members. Because the presence of
family members has an important positive effect on a child's
adjustment to the health care experience, pediatric health care teams
encourage family involvement in patient care.22 Anxiety
experienced by parents and siblings also can be transmitted to the
children receiving treatment.9,11,13 As agents for the
provision of family-centered care services, the frequent contact of
child life specialists with family members enables them to develop
therapeutic alliances, monitor reactions to events, and provide timely
information. Child life staff members help parents understand their
child's response to treatment and can assist well siblings to
comprehend a brother's or sister's illness. Specially trained child
life specialists also may provide grief counseling and sibling support
in the event of catastrophic injury or death.
The age distribution of hospitalized children has shifted to an
increasing proportion of infants.23-26 In addition,
although fewer children are being hospitalized, the children who are
admitted are more seriously ill and often require longer
stays.27 Child life programs have had to adapt to less
mobile patients who have more complex medical problems. As a result,
fewer group interactions are possible, and greater individualization of
care is needed. Staff members are challenged to meet each child's
developmental, emotional, and educational needs more quickly and
efficiently than before and to provide as "normal" a life
experience as possible. At the same time, the expansion of outpatient
care has resulted in more demands for ambulatory child life activities
as their value and benefits have become recognized.
Child life services provide important contributions to the
organization's efforts to meet the standards of the Joint Commission on Accreditation of Healthcare Organizations (ie, developmentally appropriate care, patient education, and assessment of patients), and
they help health care team members communicate issues on the basis of
age-specific competencies and individual needs.28 The
child life program has become important for students in medical and
nursing fields and other human service programs to become educated in
child development and understanding behavior. The role and competence
of pediatric unit volunteers are enhanced when they are educated,
guided, and supervised as part of a child life program.29
Child life specialists are valuable consultants about the physical
environment of pediatric settings and the effect of the settings on the
behavior and adaptation of children because they are keenly aware of
the perspective and concerns of children and their families. Child life
specialists offer a useful perspective on hospital committees, such as
ethics or bereavement committees.
Child life expertise has application beyond conventional hospital care.
Child life skills and interventions can help children make the
transition back to home, school, and community and cope with home care
experiences. The interventions can facilitate family communication and
coping when a parent has a serious illness.30,31 Child
life specialists use their skills and training for positions in
disease-specific camps, hospice programs, supplemental child care for
technology-dependent children, programs for high-risk infants, and
courtrooms for pretrial support of juvenile victims.
Child life services make a difference in pediatric care. Research
and practice have demonstrated that child life services, such as play
and preparation, help to contain costs (ie, reducing the length of stay
and decreasing the need for analgesics).14,21 Observation
and consumer satisfaction feedback further confirm the positive effects
of child life programs on children and families and staff. Yet it
remains essential for the child life personnel to adapt and grow with
the current health care system as they join forces with other care
professionals in support of the emotional well-being of children and
families.32
CHILD LIFE PROGRAMS
PLAY
PSYCHOLOGICAL PREPARATION
FAMILY SUPPORT
CHILD LIFE SERVICES IN A CHANGING HEALTH CARE ENVIRONMENT
ADDITIONAL CONTRIBUTIONS
CONCLUSION
Top
Abstract
Conclusion
Recommendation
References
RECOMMENDATIONS
Top
Abstract
Conclusion
Recommendation
References
Committee on Hospital Care, 2000-2001
John M. Neff, MD, Chairperson
Henry A. Schaeffer, MD, Immediate Past Chairperson
Jerrold M. Eichner, MD
David R. Hardy, MD
Paul H. Jewett, MD
Jack M. Percelay, MD, MPH
Ted Sigrest, MD
Erin R. Stucky, MD
Liaison Representatives
Susan Dull, RN, MSN, MBA
National Association of Children's Hospitals and Related Institutions
Mary O'Connor, MD, MPH
Hospital Accreditation Professional and Technical Advisory Committee
Elizabeth J. Ostric
American Hospital Association
Sheila Quinn Rucki, RN, PhD
Society of Pediatric Nurses
Eugene Wiener, MD
National Association of Children's Hospitals and Related Institutions
Jerriann M. Wilson, CCLS, MEd
Child Life Council
Robert Wise, MD
Joint Commission on Accreditation of Healthcare Organizations
Section Liaisons
Michael D. Klein, MD
Section on Surgery
Theodore Striker, MD
Section on Anesthesiology
Staff
Stephanie Mucha
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FOOTNOTES |
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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.
For further information, please contact: Child Life Council Inc (CLC), 11820 Parklawn Dr, Suite 202, Rockville, MD 20852 (Web site: http://www.childlife.org; e-mail: clcstaff{at}childlife.org).
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REFERENCES |
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Abstract
Conclusion
Recommendation
References
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- Thompson RH, Stanford G. Child Life in Hospitals: Theory and Practice. Springfield, IL: Charles C Thomas; 1981
- Roberts MC, Maieron MJ, Collier J. Directory of Psychosocial Policies and Programs. Bethesda, MD: Association for the Care of Children's Health; 1988
- National Association of Children's Hospitals and Related Institutions. 1998 NACHRI Annual Survey: Part II. Alexandria, VA: National Association of Children's Hospitals and Related Institutions; 1998
- National Association of Children's Hospitals and Related Institutions. Pediatric Excellence in Health Delivery Systems. Alexandria, VA: National Association of Children's Hospitals and Related Institutions; 1996:9-10
- Agency for Health Care Administration. Florida's Inpatient Pediatric Standards for Hospitals: Draft 8/13/98. Tallahassee, FL: State of Florida; 1998
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American Academy of Pediatrics, Committee on Hospital Care
Staffing patterns for patient care and support personnel in a general pediatric unit.
Pediatrics.
1994;
93:850-854
[Abstract/Free Full Text] - Child Life Council. Brown C, Gaynard L, McCue K, Wilson J, eds. Guidelines for the Development of Child Life Programs. 2nd ed. Rockville, MD: Child Life Council; 1997
- Thompson RH Child life programs in pediatric settings. Infants Young Child. 1989; 2:75-82
- Thompson RH. Psychosocial Research on Pediatric Hospitalization and Health Care: A Review of the Literature. Springfield, IL: Charles C Thomas; 1985
- Thompson RH Documenting the value of play for hospitalized children: the challenge of playing the game. ACCH Advocate. 1995; 2:11-19
- Gaynard L, Wolfer J, Goldberger J, Thompson R, Redburn L, Laidley L. Psychosocial Care of Children in Hospitals: A Clinical Practice Manual. Rockville, MD: Child Life Council; 1998
- McCue K Medical play: an expanded perspective. Child Health Care. 1988; 16:157-161 [CrossRef]
- Vernon DTA. The Psychological Responses of Children to Hospitalization and Illness: A Review of the Literature. Springfield, IL: Charles C Thomas; 1965
- Wolfer J, Gaynard L, Goldberger J, Laidley LN, Thompson R An experimental evaluation of a model child life program. Child Health Care. 1988; 16:244-254
- Williams YB, Powell M Documenting the value of supervised play in a pediatric ambulatory care clinic. J Assoc Care Child Health. 1980; 9:15-20 [Medline]
- Klein D Rx for pediatric patients: play while you wait. Young Child. 1979; 34:13-19
- Pearson JE, Cataldo M, Tureman A, Bessman C, Rogers MC Pediatric intensive care unit patients: effects of play intervention on behavior. Crit Care Med. 1980; 8:64-67 [Medline]
- Alcock D, Goodman J, Feldman W, McGrath PJ, Park M, Cappelli M Environment and waiting behaviors in emergency waiting areas. Child Health Care. 1985; 13:174-180
- Krebel MS, Clayton C, Graham C Child life programs in the pediatric emergency department. Pediatr Emerg Care. 1996; 12:13-15 [Medline]
- Goldberger J, Gaynard L, Wolfer J Helping children cope with health care procedures. Contemp Pediatr. 1990; 7:141-162
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Wilson JM,
Goldberger J
Children in the process of becoming.
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[Abstract/Free Full Text] - Johnson BH, Jeppson ES, Redburn L. Caring for Children and Families. Guidelines for Hospitals. Bethesda, MD: Association for the Care of Children's Health; 1992
- US Bureau of the Census. Statistical Abstract of the United States: 1996. 116th ed. Washington, DC: US Bureau of the Census; 1996
- US Bureau of the Census. Statistical Abstract of the United States: 1994. 114th ed. Washington, DC: US Bureau of the Census; 1994
- US Bureau of the Census. Statistical Abstract of the United States: 1990. 110th ed. Washington, DC: US Bureau of the Census; 1990
- US Bureau of the Census. Statistical Abstract of the United States: 1988. 108th ed. Washington, DC: US Bureau of the Census; 1988
- National Center for Health Statistics. Health, United States, 1995. Hyattsville, MD: Public Health Service; 1996
- Joint Commission for the Accreditation of Healthcare Organizations. Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission for the Accreditation of Healthcare Organizations; 1997
- Kiely AB. Volunteers in Child Health: Management, Selection, Training and Supervision. Bethesda, MD: Association for the Care of Children's Health; 1992
- Bishop B, Gilinsky V School reentry for the patient with burn injuries: video and/or on-site intervention. J Burn Care Rehabil. 1955; 16:455-457 [CrossRef]
- McCue K, Bonn R. How to Help Children Through a Parent's Serious Illness. New York, NY: St Martin's Press; 1994
- Wilson JM, Chambers EB Child life can (and must) adapt to the new healthcare environment. ACCH Advocate. 1996; 2:36-37
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ADDITIONAL RESOURCES |
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- Alcock DS, Feldman W, Goodman JT, Evaluation of child life intervention in emergency department suturing. Pediatr Emerg Care. 1985; 1:111-115 [Medline]
-
American Academy of Pediatrics, Committee on Hospital Care
Child life programs for hospitalized children.
Pediatrics.
1985;
76:467-470
[Abstract/Free Full Text] - Association for the Care of Children's Health. Child Life: An Overview. 2nd ed. Bethesda, MD: Association for the Care of Children's Health; 1986
- Association for the Care of Children's Health. Position Paper on Ambulatory Care for Children and Families. Bethesda, MD: Association for the Care of Children's Health; 1982
- Bolig R, Gnezda MT A cognitive-affective approach to child life programming for young children. Child Health Care. 1984; 12:122-129
- Child Life Council. Child Life Position Statement. Rockville, MD: Child Life Council; 1995
- Child Life Council. Directory of Child Life Programs. Rockville, MD: Child Life Council; 1996
- Petrillo M, Sanger S. Emotional Care of Hospitalized Children: An Environmental Approach. 2nd ed. Philadelphia, PA: JB Lippincott; 1980
- Plank EN. Working With Children in Hospitals. Chicago, IL: Year Book Medical Publishers Inc; 1971
- Rubin S What's in a name? Child life and the play lady legacy. Child Health Care. 1992; 21:4-13
Pediatrics (ISSN 0031 4005). Copyright ©2000 by the American Academy of Pediatrics
The following policy statement is a revision:
- Child Life Services
- Child Life Council and Committee on Hospital Care
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