I had met 9-year-old, Emma* the week before on her last day on the pediatric unit. She was hospitalized due to the stomach bug that was making it’s way throughout the community and taking everyone down with it. She was one of the unfortunate ones that needed to be hospitalized for some quick IV fluids to get her body back in tip-top shape and to help keep her from being dehydrated while her body healed. My interaction with this patient and her family was minimal as she was being discharged later that day. I brought her several movies that she requested throughout the day and by late afternoon, she was discharged.
Fast forward to yesterday when I had gotten a call that a new admit would be having an IV start and the nurse requested that I help with distraction
Side note: I love my nurses. They are so, so good to me and regularly call me for procedures. Yesterday, a high-stress patient needed a quick IV start and was rushed down to MRI. I walked past the room (luckily the child was fairly calm) and peeked my head in as I saw they were starting an IV and drawing labs and I had yet to be called which is unusual. I positioned myself next to the patient to help distract for the remainder of the procedure. Later that night, the nurse texted me and apologized for not calling me. SERIOUSLY people. My nurses are the BEST.
Back to Emma: I unfortunately was with a higher priority need at the time of her IV start and followed up right as the nurse was finishing up. The patient looked familiar and I stated, “Have I seen you folks before?” Mom quickly replied that Emma was hospitalized last week and I immediately remembered bringing them movies. They surprisingly were placed in the same exact room which helped jog my memory! I asked Emma if she had any questions about her IV start and how it went.
Emma responded, “It hurt a little more than the last time,” and grinned as she shrugged her shoulders and stated positively, “but I’m still here!”
Emma requested more movies. I attempted to engage her in something else other than movies but Emma declined.
As I was helping other patients, Emma’s doctor called me and requested that I speak to Emma and her mother. The doctor explained that since Emma was hospitalized late last week (coming up on two weeks) Emma has significantly decreased how much she has been eating and drinking due to the fear of throwing up again like she did when she had the flu. The doctor wondered if perhaps it was associated with anxiety and requested that I work with the patient and mother.
I sat down with both Emma and her mom and discussed how long ago Emma had stopped eating. Emma said it was probably a week or two and when I asked if anything caused her to feel like she didn’t want to eat, she explained to me her great fear of throwing up. She said that prior to eating food, her tummy would begin to hurt and even the times she would eat something, immediately following her meal, her tummy would hurt again.
I talked to her in developmentally appropriate terms what anxiety is:
Anxiety is our brain’s way of telling us that we’re nervous or scared of something happening (for her, it was vomiting).
We talked in developmentally appropriate terms what coping techniques are:
Coping techniques are special superpowers we can equip her with to help when her brain starts to think about vomiting.
We discussed coping techniques such as meditation, breathing exercises, and aromatherapy. Emma decided she wanted to try aromatherapy.
I brought my essential oils into her room. We combined different oils on cotton swabs for her to smell and decided which ones were her favorite. Sometimes, she’d tell me what a smell reminded her of – such as the combination of patchouli and lemongrass reminded her of the first day of spring. I used this instance to talk to her about how aroma-enhanced visualization can also help her better manage her anxiety. When using the aromatherapy scents, she can think of a place that helps calm her down such as her favorite spot in her backyard or the beach and take those few minutes to center her mind to think of something else rather than the possibility of vomiting her food back up. Both Emma and her mother really liked that idea.
We then finished our time together talking about how vomiting may feel like the worst thing in the world, but no matter how well we wash our hands, eat healthy food, or count on others to cover their mouth when they cough or sneeze, sometimes we’ll still get sick. Sometimes that may mean a cough and a runny nose and sometimes that looks like vomiting. And while that’s no fun to do, I reminded her what she said to me earlier that day.
“What’d you tell me when I first met you after your IV start today?”
“I said it hurt a little more than the last time…”
She shrugged as she couldn’t remember telling me anything else. I reminded her,
“You had a smile on your face after something that you said hurt you more than last time but you said that you were still here. What if you see vomiting that way? Yes, it hurts and it’s no fun to do…but after you’re done vomiting, you’re still going to be here, you’re still going to survive it, and it won’t be the end of the world as you know it.”
Next, I offered for her to create a painting with the words “I’m still here” on it so she could hang it in her bedroom as a reminder at home that even if she does vomit that she’ll still be here. Emma’s eyes widened as she grinned. “Yes, yes, yes!” was her answer to me.
Mom hugged me as I left her room and thanked me for empowering her daughter to jump this hurdle on her own by giving her superpowers (coping techniques) to fight the scary thoughts (anxiety) that she feels. It’s all about using developmentally appropriate language when it comes to children and that’s what a lot of people miss when trying to help children fight their mental battles. Anxiety, nervousness, and coping may seem like “easy” words and perhaps a 9-year-old has heard those words be used before, but do they understand what they actually mean?
That’s where we, as Certified Child Life Specialists, come in to educate, empower, and advocate.
*names have been changed due to HIPAA