H is for Healthcare preparation

“…positive healthcare experiences for children shape their long term good health and wellbeing.” (1)

Why prepare for healthcare?
“It took me lots of work to get over my fear of dentists!” Rachel exclaimed. As a child, dental surgeries were “no go zones” with metamorphosis taking place. She became a scratching, biting “wild child”. Now a mother of three, family dentist visits are routine.

Does this remind you of a childhood experience? Healthcare professionals (HCPs), know something small to an adult may be traumatic for a child.

AWCH helps parents
AWCH was amidst an emerging “groovy” movement of international organisations in the 1960’s -70’s supporting emotional care of children in hospital. Others were Action for Sick Children, EACH and Children in Hospital Ireland, yeah baby!

Terrified children aren’t peeled from parents/carers during healthcare today. This is not something to blink at, for a long time parents have been involved in their child’s hospital care (Please don’t leave me film, 1979). AWCH put this best practice in motion in Australia, now seen as the norm, so much so that most people can’t recall it any other way.

AWCH educated parents in the 1970’s about healthcare preparation with AWCH Barwon branch launching a poster (1979), Is your child to be hospitalised? How would you explain to him?

AWCH Child Health Library has great reads for children on healthcare familiarisation including picture books.

Australian parent resources have evolved in the last few years:

  • Child life therapists are healthcare professionals helping children and young people cope with medical procedures and hospital.  Keeping kids needs in the picture, by Renee Campbell (Child Life Therapist) is for parents supporting their children through medical imaging.
  • The Australian Commission on Safety and Quality in Healthcare, NPS Medicine Wise and AWCH partnered to create awareness for parents on medical imaging and kids. There’s now an App for parents and professionals.

Hospital familiarisation and healthy kids
AWCH WA runs Hospital Familiarisation Program (HFP). “Designed to prepare young healthy children for possible hospitalisation or visits to the doctor or dentist. The aim is to minimise anxiety, fear and misconceptions children may have about medical intervention.”

Sydney Children’s Hospital, Randwick, Health education unit offers “Hospital Explorer Box: a play and learn resource kit for stage 1 students” (contact Schools Project Officer, Health Education Unit). Other community hospital incursions are available.

Thanks to the children who coloured in cut-outs
from Althea adding their colourful interpretation.

Preparing in an emergency?
One quarter of children in NSW visit an emergency department in a year. In an emergency parents may not pack a hospital bag especially not with their child’s help (children learn this way). Also stressed parents may not bring a toy, book, soft toy or comfort blanket. Going out usually involves taking a drink and snacks but in an emergency and chance of medical procedure, don’t give food or drink.  Parents can ask health professionals about medical procedures and become advocates for their child, taking a moment to ask questions if unsure. Parents are there to comfort kids.

If you liked this blog, you might also like The three little “P’s” – Playgroup and Peppa Pig which touches on one parent’s traumatic experience of hospital without preparation. We’d love to hear from you if you have related comments/experiences.

Jillian Rattray
AWCH librarian
October 2015

Four ways parents can increase their protective role and pain-reducing effect at medical procedures

Many people believe that medical procedures have to hurt, particularly if they involve needles or other sharp instruments. They can hurt, of course, but you may be surprised to know that pain is not a given.  Fear and pain are natural protective mechanisms that parents can help switch off — and the earlier you start, the easier it is.

Checkout this video from Professor Denise Harrison and the Be Sweet to Babies team (Baby vaccination; the secret to a calm and peaceful immunization). 
 

Do your homework and go prepared.  It’s not hit and miss whether a child learns to cope – it’s a combination of their previous experiences, how well prepared they are, and what the adults say and do.  Instead of relying solely on the healthcare professionals, find out in advance how you can be a positive influence, reduce the perception of threat and help your child feel safe and comfortable.  You may be surprised how much research has already been done.

Get all the important tips from a tiny tot in It doesn’t have to hurt from the Centre for Paediatric Pain Research in Canada.

Children sense and watch what’s going on around them and adults need to stay calm; it is the key to a child’s sense of security.  As a parent, I also know it can be hard and may require faith, combined with an Oscar-winning performance, to present the medical world as a safe and friendly environment. “You have to be brave for your child” is how one experienced mum put it.

It’s not helpful when parents identify with their child’s potential or actual suffering and show their own emotions.   If you are releasing a cascade of anxiety-producing hormones, then your young child will too, amplifying any fear and pain.

Remembering to breathe and watching the natural rhythm of your breath can make a big difference.

There is a long, history of parents being excluded from the care of their children in the medical setting.  Fortunately times have changed, and parents no longer have to hand over their children and their power to the healthcare providers.  You can speak up, maintain your authority and become a vital member of the team.  Calm, informed parents provide the ideal protection from fear, pain and trauma for children.

It’s not about being demanding.  It is what works for my son.  We are positive and confident when we go for procedures and we have never had a problem.  It has changed our perspective on the hospital.”   Parent and health rights lawyer Liz Bishop, who has more to say in the video Listen to a parent’s experience.

When parents and health professionals all work together as one harmonious team, each bringing their complementary areas of knowledge and expertise, medical procedures can become a source of resilience and mastery for children.

REPLACE THE OLD MALADAPTIVE CYCLE

Procedures→Threat→Fear→Distress→Pain→Aversion→Avoidance

WITH

Procedures → Normal→Sense of safety→Coping→Happy to go back again→Mastery


Angela Mackenzie
Paediatrician/author
29 June 2015

Keeping Kids’ Needs in the Picture


When it comes to medical imaging why won’t kids just smile for the camera? Children have trouble staying still at the best of times and when feeling unwell, unfamiliar experiences can become especially daunting. Their parents are often anxious too, about their child’s health and radiation risks. As children can have increased risks from radiation exposure so it’s important that scans are completed with a minimum number of takes.  So how do we get kids to comply?
Paediatric hospitals have the benefit of staff who are trained and experienced with kids. Many employ Child Life Therapists specifically to prepare children for procedures like scans and help them to develop coping strategies. University trained Child Life Therapists have extensive knowledge of both child development and medical procedures. This places them in a unique position to bring the two together as harmoniously as possible.
But what about the non-paediatric facilities where staff are trained for, and treat, mostly adults? In 2012 The Royal Australian and New Zealand College of Radiologists approved a new policy on Paediatric Imaging to guide those clinicians in how to limit radiation, trauma and possible pain to children in their care. It is also recommended reading for parents wanting to understand the options for children but please note the ages mentioned are a guide only. Younger children have achieved successful scans without sedation and appropriate preparation.  For further research read here: Minimising the use of anaesthesia / sedation in paediatric imaging and radiotherapy : The role of play therapy and patient education or if you want quick information, see our tips below …
When your child needs a scan:  How you can navigate these potential pitfalls.

1) RADIATION:   

  • Check with the doctor: is the scan necessary? Is it need immediately?  Are there any alternatives with less radiation?   

  • If booking with a private radiology practice for a non-urgent scan, ask if Radiography staff have experience with children.  How, specifically, do they help kids with scans? If you don’t feel assured of a child friendly approach, then shop around (if possible).

 

2) INJECTIONS:

  •  Check in advance whether the scan requires an injection of contrast. This will allow you to prepare your child for every aspect of their treatment.
  • If yes, then request a numbing cream such as Emla or LMX4 be used.
  • Is your child needle phobic? Discreetly let the staff know. If child life therapists are not available, try distracting your child with a book, game, or reassuring words.

 

3) SEDATION:
There are instances where it’s necessary to sedate children, either to avoid pain or because zero movement can occur.

  • Check the necessity for sedation, which type, and the risks associated.
  • Prepare your child for having that type of sedation
  • If general anaesthetic will be used, prepare your child for an overnight hospital stay.

4) BREATH HOLDS:

  • Is your child required to perform breath holds for their scan? These are generally needed for abdominal and chest scans. Learning this skill in advance of scanning helps the radiographer get the pictures they need. This means less retakes and less radiation.
  • Take the time to coach your child in breath holding in advance. Try to make it fun by doing it in the bath or pool, using counting games and blowing bubbles.

5) WAITING LISTS:

  • Non-urgent scans at paediatric hospitals may involve waiting lists. If you’d like the scan sooner ask your referring doctor if it can be done by another hospital or clinic. Consider your options in consultation with them.
For further assistance with preparing children for scans and injections, or appropriate distraction techniques during those procedures, contact Child Life Therapy at your child’s hospital. If attending a private clinic you can consult a Child Life Therapist in private practice.
Blog written by: Renee Campbell
Renee Campbell is a university trained, registered Child Life Therapist with the Australian Child Life Therapy Association (ACLTA) and a member of the ACLTA Certification Committee.
Renee has over 7 years’ experience as a Child Life Therapist (formerly Play Therapist) at the Sydney Children’s Hospital Randwick (SCH) where she helped establish their MRI Play Therapy program. In that time she conducted research into children’s coping in medical imaging and helped children as young as 4yrs old to have their scans without anaesthetic.
Currently, Renee remains employed at SCH part-time in the Medical Day Unit assisting children and adolescents to cope with invasive procedures. She also has a private practicehelping children with healthcare needs and parents of newborns with sleep guidance.

My trip to hospital – DVD



Queensland Health, Lady Cilento Children’s Hospital
Nic, 8 years old, was recently admitted to hospital after an accident. Nic watched My trip to hospital DVD at home shortly after the hospital visit to Emergency in a Sydney hospital. His older sister was with him in the Emergency waiting room and also watched the DVD…
They had different parts about going to hospital that most kids would not know. Probably they would only know about tongues, ears and temperatures and scales. Probably they need to show a little bit more about cuts, twisted ankles and broken bones since most accidents happen that way. I thought it was funny when they sang about radiology and you got to know all about hospital equipment.
Nic’s sister (aged 13 years) 

The DVD was good, they looked at the ward and I think one of the things worth knowing about was the rollout bed where your parents could stay. It was comforting to know that your parents could sleep there. They showed you hospital equipment and told you the needles were only going to hurt for a short time, the pain would be over and done with. Another thing was they told you about waiting and what your parents would be doing, ‘more paper work’. You are prepared because you know what to bring, pyjamas and a book. The playroom is great because hospital is not just about going and staying in a bed doing nothing, there are other things to do besides just sitting there. You could ask the nurse to go to the play area with you and you can be with your siblings and be with other children in your age group.

My trip to hospital DVD and bookscan be borrowed from the AWCH library. Visit Queensland Health, Lady Cilento Children’s Hospital for the My trip to hospital program.  Find useful information about preparing your child for hospital, written for children, young people, parents and families. Importantly, there are some general tips about when to tell your child and what to tell them about going to hospital.

Other preparation includes medical play with stuffed animals and toys, reading books and helping to pack the hospital bag.

Jillian Rattray
AWCH librarian
May 2015


F is for Feelings – from fear to resiliency


It can be hard for a teenager when her peers move from the excitement of “can I sign your cast” to “it’s really going to hurt when they take it off”?

Fresh out of a visit to hospital with my daughter yesterday, I’m reminded of the importance of feelings. It seems all too obvious, that a trip to hospital will result in feelings of anxiety and fear.

Photo from: http://www.clipartpanda.com

Yet my thirteen year old had shown stoicism from the outset of breaking her arm. She picked herself up and trudged across the sporting field asking for her water bottle. Meanwhile I hastened to keep up, asking her to slow down. Over the weeks she coped with waits at two hospital emergency departments, an adult’s hospital and a children’s hospital, then repeated waiting at orthopaedic and x-ray clinic queues. She had it down pat and knew where to go and what to do, seeing herself as one of the many other children waiting for treatment.
There were certainly challenges along the way, worst being no food or drink and for me watching the pain under gas as her arm was manipulated and put back into shape. Once again I had to hasten to keep up as she jumped up after the procedure to head off to make an appointment at the orthopaedic clinic. The only sign of something being wrong was the cast from wrist and over bent elbow.
Later that night the pain and challenge of sleeping with a heavy bent elbow came. This was followed by challenges of dressing, washing, undertaking school work with her weak arm and carrying a heavy  bag which included books and a laptop. Transport on the bus with kids pushing and pulling also led to pain and concern. Despite all this she managed to walk, run and dance her way through the weeks.

Photo from:
http://www.kleurplaten.nl/kleurplaten/12308.gif

So where in all this resiliency do fearful feelings occur? It can be hard for a teenager when her peers move from the excitement of “can I sign your cast” to “it’s really going to hurt when they take it off” and so the stories begin.
I wasn’t prepared for my daughter’s sleepless night that preceded the day when the cast came off or for the impact of some of the “kid-fabricated” stories.  As we waited one last time in the waiting room she was distracted by the funny things around her, a parent talking to their young child about what was on TV, “look there’s a penguin with a rainbow coloured beak”, no it’s a puffin she thought! Just when things weren’t looking good she was called up. One boy had cheered earlier when his name was called, adults chuckled, a moment of relief.

Photo from:
http://www.123rf.com/clipart-vector/zombie_arm.html

What made the difference to my daughter’s trepidation were the explanations health professionals gave. Speaking to her and demonstrating the procedure of having the cast taken off made all the difference. Phrases like “what you can expect”, “what you might expect” were really helpful. She even smiled as the cast came off. She was glad her arm was not green.

Being “armed” with information makes all the difference. The first test of this was as she reluctantly passed by the swings on our way to the car. It was great to know that she understood and can resist the temptation to hop on a swing, bike or other moving object.
How can books and resources help?
As parents, we won’t always know what our children are feeling. The AWCH library holds books to help adolescents and children understand what they are feeling. There are books written to help children identify and manage how they are feeling so they can develop self-esteem and coping skills.
 A book to help adolescents is the Stress reduction workbook for teens: mindfulness skills to help you deal with stress. Teenagers can use this easy to read workbook with activities to develop an understanding of what stress is and how to live in the present moment, “mindfulness”. They will gain a sense of control over stressful situations and develop resilience. 
 
There are books too for school children such as Relax, which teaches relaxation techniques or Be the boss of your stress : self-care for kids and Be the boss of your pain: self-care for kids.  
Nowadays there are plenty of online resources to help children and families prepare for hospital experiences, an example for young children is the child-friendly free app Okee in medical imaging. This fun app will help young children learn all about medical imaging and feel relaxed and supported.
Help! My Child’s in Hospital has practical advice for parents on preparing their child for hospital. Visit the website to find out about other families experiences.
Everybody stay calm: how to support your young child through medical tests and procedures will also help families prepare. These books will help parents with practical skills to support their children through stressful times, so they gain confidence and better health.
So I invite you to borrow a book and be well prepared for that next encounter with the doctor, dentist or hospital.

Jillian Rattray
AWCH librarian
April 2015

Calico Dolls – A process of play


by Maree Matthews and Gerry Silk 
Kiwanis International, 1994.

 

What are calico dolls and who makes them?
Calico dolls are simple in shape and made with plain fabric. The dolls are without features and they are plumply stuffed with polyester fibrefill, so they are lightweight. They are made in a range of skin tones. Children draw with textas or felt tip pens on plain calico giving personality and so each doll is unique. Since 1993 over 60,000 dolls have been made for children in hospital. Most of the dolls are made by volunteers and in the past Girl Guides have made calico dolls for AWCH in Sydney.
Where and how are they used?
Calico dolls are used to help children in healthcaresettings: in hospital emergency departments, radiology departments, routine healthcare admissions and when children are transported between healthcare settings. Calico dolls are also used in community settings by psychologists and child life therapists.

Health professionals such as child life therapists and nurses use the dolls with role play to help children, particularly younger children who are not abstract thinkers.  The dolls help prepare children for common medical procedures such as IV insertion, suturing, blood tests, insertion of naso-gastic tubes, changing dressings, manipulation and plastering of fractures under local anaesthetic and  X-rays

Calico dolls have been used to help transition children to hospital and medical procedures. The play is therapeutic because it gives children permission to express themselves. The role play helps children by providing them with emotional support when they are in unfamiliar healthcare places and having unfamiliar experiences.  

 

She coloured in the doll, giving it a happy face and a red line down its right leg which she explained as “the dolly’s sore leg”.

The dolls are also known as trauma dolls and can provide a positive way of coping, reducing stress and trauma. Children become empowered because through doll play they know more about what will happen to them and they can express themselves. Through parallel play they can tell family, friends and health professionals about what is happening to them and how they feel. How the doll is used is up to each child, their personality and developmental stage. Some children will focus on the doll as a means of gathering information and other children will use the doll as a tool for self-expression as well as understanding.
Calico dolls : a process of play is a great book for introducing health professionals and students to the value of calico dolls and their uses. Vignettes illustrate some of the uses, such as for diversion from pain, discomfort, anxiety and boredom. Other uses are for expression of feelings, as preparation for painful procedures, when working with siblings, for children who do not speak English, in bereavement care and for parent involvement. The book also explains how health professionals can make doll play a successful experience as well as how to talk to children in health care settings.
Calico dolls: a process of play is available for loan from the AWCH Library. The AWCH office also has a doll pattern for people who would like to make one.
Reviewed by:
Jillian Rattray
AWCH Librarian
February 2015

A is for anxious parents & children

Parents’ emotional response to child’s hospitalization
Helen Gofman, Wilma Buckman, George H. Schade

What was it like for children in hospital in the late 1950’s? This article is from the Pediatric Mental Health Unit, University of California Medical Center. In 1957, understanding of children’s emotional response to hospitalization as well as parents was little understood.

This interesting article looks at parents’ perceptions and what it was like for families with hospitalized children. Parents were interviewed and questions asked included what information was provided by doctors as well as admission procedures. Interestingly, as the study progressed researchers became aware of the impact of separating children from their parents without preparation of any kind and modified their admission procedure. There were one hundred parents who were interviewed at the time of their child’s admission and 68 parents were interviewed again at discharge from hospital.

This is a very touching article, with parent vignettes. Readers can see how difficult it was for both child and parent to be separated, vulnerable and fearful. The article describes the traumatic admission procedure where children were placed in bed in an isolation unit and parents were escorted to a nearby waiting room where they could hear their child crying calling for them but could not see or be with them. The modified procedure led to a more gradual separation. The changed procedure involved a nurse being assigned to the care of the child and parents, accompanying them to a room where the child was no longer isolated. The child shared a room with others of a similar age and the nurse acquainted the child with roommates before assisting parents to put the child in bed. Parents were encouraged to stay until the physician was available.
The article describes visiting hours and the success of a “further extension of visiting hours”, some of the nursing staff were sceptical about the extension.

In the summary section of the article major points made were children and parents needed adequate preparation for hospitalization;

  •  An admission procedure which allowed for a more gradual separation of parent and child;
  • During hospitalization health personnel needed to focus on both the child’s emotional and physical needs;
  • Continuing preparation of child and parent throughout hospital procedures and treatment;

At discharge, health professionals provide understanding of findings and implications both orally and in writing for further care of the child at home.

This article has been cited approximately 35 times, Google scholar.

Link to first page of article to read more:
http://archpedi.jamanetwork.com/article.aspx?articleid=498653

View the record in the AWCH catalogue or contact the AWCH Librarian for more information:
http://awch.intersearch.com.au/cgi-bin/koha/opac-detail.pl?biblionumber=13531


Jillian Rattray
AWCH librarian
August 2014

Painful paediatric practice

I was out to dinner with my girlfriends last night and at dinner the topic of pain relief in hospital came up. One of my girlfriend’s children had broken his arm and to fix the fracture pins had been placed in his humerus. To have pins removed, my friend took her son to the local paediatric hospital. Before Bob had his pins removed he was offered no pain relief and this is where the story really starts…..

To remove his pins Bob was placed in a chair. His mother was asked to sit next to him.  A clown doctor was there to distract the child whilst the pin was being removed. To remove the pin the doctor used pliers, which slipped as the pin did not come out easily. This process caused Bob a great amount of distress…. However, as this was happening, the clown doctor was attempting to put a red nose on the mother – impeding her ability to comfort Bob. In addition, there was still one more pin to be removed. Yet by this time the child was hysterical and distraught.

A comedy of errors, or a sheer lack of planning and consideration for the needs of Bob and his mother?

The reason I wish to share this story is that this type of situation exemplifies why AWCH is still relevant in 2014. In our 40 year history we have made lots of progress in advocating for children and their families as they navigate the health care system. However stories like Bob’s and Betty’s still exist.

Betty is an intelligent and articulate woman. She told me that she placed her trust in the medical staff and that if they said that this procedure did not require any pain relief then Bob would be fine. Once Bob became distressed she felt she had no control over the situation and that all she could do was comfort Bob to the best of her ability at that time.

This happened two weeks ago, and prior to the pin removal Bob was always a happy go lucky child with a ready smile and a cheeky sense of humour. Since the procedure he has been having nightmares, being argumentative at school and is scared to play footy or use him arm too much.

For me this story shows that AWCH is still very relevant today and the work we do is still needed.

Ally Hutton
AWCH President

Thanks to Bob and Betty for sharing their story (real names not used)

Jessica’s X-ray


By Pat Zonta, artwork by Clive Dobson
Firefly books, 2006. 27 p. ISBN 10: 1552975770

Jessica’s X-Ray is a great book for children and families to read and familiarise themselves with what an x-ray does and when it is used. Readers follow Jessica as she experiences an
x-ray for her broken arm and accompany her on a hospital tour to find out about radiology and other x-ray techniques including CAT-scan, MRI and ultrasound.

 X-rays are invisible waves of energy that travel at the speed of light
Primary school children will find the best feature of the book is the sixreal x-rays on printed film. Many children are fascinated by broken bones and the human body and they will like taking a look and finding out facts about different types of x-rays. By the end of the book they will have read about identifying bones, muscles and soft tissue from x-rays.
No-fuss information and warm colour illustrations are a feature. The author combines her experience of working in children’s and teaching hospitals as a Medical Radiation Technologist and author of several children’s books. This short book would be a useful addition to a primary school or public library.
Jessica’s X-Ray is available for loan from the AWCH library:
Review by:
Jillian Rattray

AWCH Librarian

The Together Stories Series

By Trish Dearn, illustrated by Lonica Lee
Children’s Cancer Centre Foundation, Richmond Victoria, 2013. ISBN 9780992334260 (paperback)
http://cccf.org.au/

Infant school and primary school children who are living with childhood cancer will find “the Together stories” very engaging. The stories may help them to prepare for hospital, life experiences as well as think about ways of coping and building strength through difficult circumstances.

The books are written with made-up characters, from a child’s viewpoint. The familiar language used is what you might find in an Australian home, school or children’s hospital. Trish Dearn draws on her experience as a parent of Charlotte, who journeyed through leukaemia treatment to become a happy healthy girl.
 
Each book taps into different parts of a child’s cancer journey and feelings are expressed through the challenges. The books focus on adapting, coping and empowering through changes in a child’s health from diagnosis, hospital life and returning after treatment to home, school and community life.
Children will want to read each book cover to cover, finding easy-to-read font and colourful, expressive illustrations. The books are similar in formatting to what you might find in a school reader. They have a practical gloss cover for easy wiping.
The Together stories are simple to read and yet strong in communicating some of the social and emotional hurdles children with childhood cancer face.

The books may be borrowed from the AWCH library, to find out more about each book in the series visit the following links:

 
Review by: 
Jillian Rattray
AWCH Librarian
July 2014