Last week I wrote about a couple of fun and interactive ways that child life specialists work with children in the hospital. But not every day is full of laughter and smiles in an unfamiliar environment. Some days are full of uncertainty, fear, and sadness.

Child life specialists are typically on the Pediatric/Pediatric Intensive Care Unit (PICU) floors, but child life specialists can go throughout the hospital wherever there may be a need. We help children in the Emergency Department, Outpatient Surgery Center, and Pediatric Hematology/Oncology Clinic. We also can go a step further and help the children or grandchildren of patients, typically in the Adult Intensive Care Unit (ICU).

Imagine, hypothetically, a 35-year-old father of a 6-year-old boy, Roger, is admitted to the Adult ICU after a horrible motor vehicle accident. Roger’s father looks drastically different than he did this morning before Roger got on the school bus. Dad’s face is bruised and swollen due to the impact of the crash; he’s wearing a neck collar to maintain his neck alignment, hooked up to a cardiac monitor, IV pump, feeding pump, chest tube, ventilator, and has a foley that helps collect his urine in a bag next to his bed.

An Adult ICU nurse may call a child life specialist to come and speak to Roger about the condition of his father. What I like to do in this very sensitive situation is first talk to the Adult ICU nurse about the actual condition of the father. Does this look like dad may recover? What is the family dynamic? Is he married? Who is in the waiting room with the child? I try to get as much information as I can about the family and patient before walking out to the waiting room to meet the child.

Next, I’ll pull the wife, girlfriend, grandmother (or whoever is with Roger) aside and ask a few questions. 1) What does Roger know? Does he know that dad was badly injured? (some parents or grandparents just don’t know what to say, so instead of saying anything, they choose to say nothing at all. We all cope differently when something traumatic happens). In those situations, I may be the person breaking the news to Roger that dad was badly hurt. 2) Depending on if the injuries are most likely to end in death, I ask about the religion or belief of the family and children. Do they believe in Jesus? Do they believe in reincarnation? What happens when a person dies? Then, regardless of my beliefs, I will have those afterlife conversations with the children based on their family’s religious or nonreligious beliefs.

But back to the situation I started with; let’s say that the 35-year-old father’s injuries are not fatal, and he is expected to make a full recovery. Let’s not forget though that dad looks drastically different. I would take my iPad and walk through the Adult ICU; first taking a picture of the door taking us into the Adult ICU. Next, the nurses’ station filled with the wonderful nurses and staff taking care of Roger’s father. Then a picture of dad’s room from far away. Finally, a picture of the inside of dad’s room, with a clear picture of what dad looks like; swollen, bruised face, hooked up to all those tubes and wires.

When I go out to the waiting room, I would introduce myself to Roger and ask Roger a couple of light questions so we can begin to connect, and he can trust me as someone that cares.

“How old are you? Were you at school today? Where do you go to school? Do you like your teacher? What’s your teacher’s name?”

I will then ask him what he knows about dad’s condition.

“What happened to your daddy today?”

He may cry. He may be scared. I would first validate his feelings.

“It’s super scary having your dad in the hospital. But your dad has wonderful nurses and doctors who are working really hard to make your daddy feel better. I know you really want to go back and see your dad; I took some pictures on my iPad to show you what the hospital looks like where daddy is staying, and a few pictures of your dad. Would you like to see them?”

As we flip through the pictures together, I would explain each picture in developmentally-appropriate terms. Before we flip to the picture of dad in his room, I would remind Roger,

“Now because of daddy’s accident, he is going to look different. He will have lots of things on him and around him that may look scary, but I promise they are helping daddy feel better, and we can talk about all of those things once you see daddy’s picture.”

Finally, I would give Roger the choice;

“After we see this picture of daddy and talk about it, we can then go back and see daddy if you’d like. However, if that’s something you don’t feel like doing today, we can do that maybe another day and that’s okay too. He’ll be here for a little while until he feels better.”

If you’ve never seen a person in the Adult ICU it can be a lot to handle. There are a TON of monitors and tubes hooked up to the patient and the rooms are usually very small (see picture below). Now, imagine being only 3-feet tall and seeing all of this from that tiny-human’s perspective. The pictures on the iPad help prepare and lessen the distress for a child by gradually exposing him to the situation he finds fearful.

Sometimes the pictures help, and the child feels prepared to see dad. And other times the pictures help the child realize that no, in fact, he’s not quite ready to see dad. When that happens, I suggest something different. I say different things depending on the age of the child, but one of my favorite things to say to pre-school age or school-age boys is,

“I think dad could really use some superheroes on his wall, don’t you? What do you say, we color some pictures and I can have his nurse hang them up on his wall so that way when he opens his eyes, he’ll know you were here?”

A smile grows across his face as he think about the opportunity to have a task or a job in his dad’s care.

“I’m in charge of creating something special for dad to look at when he opens his eyes.”

How special and important it is for children to have tasks when a traumatic event happens. However small it may seem, it allows the child to feel included and significant in their father’s care.

So no. Not every day is a beautiful day in the child life neighborhood. But it is a beautiful honor to meet people where they’re at, and walk through their pain and sadness with them.

For more information and research regarding child life in the Adult ICU, please visit the link below.

 http://hospitalmedicine.ucsf.edu/downloads/how_do_we_talk_to_the_children_reid.pdf