Guest Blogger, Emily Margolis, MS, CCLS
Do I want him to download some calm or upload my chaos? This was the question I asked myself over and over again, hands shaking, driving my three year-old to the local emergency room for stitches. I know this particular community hospital does not have a child life specialist integrated into their practice yet. I also know that some emergency rooms still practice restraint as a first and only option. This may involve strapping a child to a papoose board or wrapping a child up in a sheet to keep everyone safe and to keep potentially combative arms and legs restrained. Over a decade of professional work as a child life specialist in an intensive care unit ensures that I am all about safety first. However, I am also all about helping children feel safe and empowered while receiving medical care. So in the quick five-minute drive over to the hospital I have got to emotionally pull it together fast and be the very best version of my mommy and child life specialist self that I can possibly be. My attention tunes into the backseat where my 9 year-old is applying pressure to the forehead of my 3 year-old while simultaneously coaching him to sing some silly version of the theme song to his favorite TV show. As I pull into the driveway of the emergency room my child life instincts take over and I remind myself of three tips that I often coach parents and caregivers to access when they find themselves in the scenario of having to support their child through an unexpected medical procedure.
1. I am going to find the breath. I can encourage my child to sing, talk about something they see on TV or in a book, or to gently blow away something that is bothering them. As a seasoned anesthesiologist reassured me many years ago, if we are talking or singing we are breathing.
2. I am going to focus on the positive. In medical environments there is a lot of chaos and the potential for things to feel overwhelming and scary. Instead of worrying about what could happen I can choose to focus upon the good that is happening right now. This can be especially challenging for scared and worried parents but as a child life specialist we can help parents to tune into the positive so that they in turn can help their child focus upon the good in the moment. Maybe a child’s favorite TV show is on? Maybe the child’s nurse or doctor is wearing an interesting scrub top? Maybe the child has had a previous medical experience that was successful and we can remind them of that success?
3. I am going to be the calm. Finding the breath and focusing on the positive creates the opportunity for a parent or caregiver to become an encouraging source of calm for their child. Children look to their parents when there is a new experience to try to figure out if they should be worried, scared, confident or relaxed. Do I want my child to download some calm or to upload worry, fear and chaos?
I am going to find the breath, focus on the positive and be the calm. I repeat this to myself over and over again as my son is triaged and we are brought back to the exam room. The Physician Assistant (PA) quietly walks into the room, takes a look at my son’s forehead, applies some numbing gel, places new gauze on his injury and quietly leaves the room. A whole cartoon later the PA returns with an assistant who is an experienced extra set of hands for every conceivable type of procedure that this community emergency room has provided over the past 20 years.
I gently re-engage my son by saying, Hey Bennett, your hospital helping person is back and she has brought along her helping friend. A tray rolls into view with a suture kit open and the PA starts putting on gloves. The assistant assumes her place at the top of the stretcher and starts to bring the head of the bed down. We have not discussed the game plan but I continue to breathe and talk calmly to my child who is equally calm and full of curiosity. He is looking at me to figure out what is happening next.
So Bennett, your hospital helping person’s job is to help make your booboo feel better and she has a special type of slow bandaid that she is going to put on your sore spot. I briefly break eye contact with my child and make eye contact with the PA. Without words she quickly looks at the assistant and gives her a nod. The assistant begins to put her hand on either side of my son’s head. It’s “go time” and I can sense they are all waiting for my next breath. Slow breath in and slow breath out. Hey Bennett, let’s keep watching your TV show. She is going to put a special slow bandaid on your booboo now and her helper is going to hold your pretty curls out of the way so that she can do her job. And we are going to sit very still together and talk about the TV show. If you feel the special slow bandaid tickling your nose or if you feel your curls in the way you can just blow out slowly and then we can keep talking about the show. Deal? I got a “sure mommy” from Bennett and then the PA starts slowly placing the stitches.
It took about 5 minutes. I was determined to continue to find the breath to stay focused on the positive and to remain the source of calm energy for all of us. The PA and her assistant worked quietly. When the suture string briefly brushed Bennett’s face I reminded him to just blow it away and without missing a beat he slowly breathed out and kept on watching the TV. I quietly dolled out positive feedback to everyone. Bennett you are doing the best job staying so still while you are watching TV. And you are doing such a nice and tidy job with that slow band-aid – you clearly get to put them on little kids all the time. And you are also doing a terrific job up there gently keeping the curls out of the way. We make a great team!
As we went over the discharge paperwork I just had to take a few minutes to discuss the procedure. How do you think it went? I was impressed with how well my little three-year old did sitting still, how about you? What did you notice? What do you think kids need to feel safe and empowered when they are receiving medical care?
The PA and the assistant were both open with me about how surprised they were that “such a young child could stay so calm and sit so still”. They told me that their plan was to have me leave the room and they were going to wrap Bennett in a sheet to keep him safe while they put the stitches in. They shared that they noticed how calm I was and because of that they decided to do things differently and let me stay in the room. They went on to share that they noticed how relaxed Bennett was and that he was listening to my every word and was being very cooperative. The assistant admitted that in all her years she never thought that what they just witnessed was even possible. She laughed as she shared that she was really proud of him proving her wrong and that all he needed was a calm family and a gentle set of hands holding his head to “keep his curls out of the way”.
Here was my moment to allow my child life specialist self to provide some education, encouragement and advocacy. I praised both of them for working quietly, efficiently and with kindness. I encouraged both of them by acknowledging that every child is different and that some children truly struggle with being compliant when they are challenged by sensory input or have had previous negative experiences in medical environments. I thanked them for giving Bennett and I a chance to do things differently. I also encouraged them to remember us the next time they meet a cooperative child and a calm parent so that maybe they will once again consider parent presence and minimal restraint with supportive hugs or gentle helping hands as a first option.
I left that experience appreciating that I could find a way to be a child life specialist and a parent with my own child. This experience with my own child galvanized for me the game changing power that parents can have. By choosing to find the breath, focus on the positive and be the calm energy in the room I afforded everyone the opportunity access what they needed. I was calm and positive, he was calm and positive, the medical team was calm and positive and took the opportunity to do something differently – to suture up a small child with a parent present and without the use of restraint.