Focus on Pediatrics

Keep information concrete for school-age children

Focus on the five senses

When working with school-age children in a medical situation, it is important to tell the children what will happen providing concrete information, says April Elwood, CCLS, a child life specialist in the Cardiology Department at Children’s Healthcare of Atlanta. Cover the five senses, she advises. When teaching about medical equipment, a child’s hospital stay, impending surgery, or a procedure, educators cover what the child will feel, see, hear, smell, and possibly taste.

It’s important to make sure children understand what will happen. For example, when children are being admitted for heart surgery, they are told everything they will experience before their anesthesia and when they awake following surgery.

The education is completed through medical play, which means a child life specialist sits down with the child, and using a body outline doll, demonstrates what will take place. Elwood provides children with as much information as they want making the teaching very individual. Some children want to know every little detail and others are avoiders and want to know very little, or the global picture. "We try to find out from parents ahead of time how the children like to receive information, how they learn and how they do when in an unfamiliar environment," she says.

The child life specialist also notes how the child is acting during the education session. If he or she is anxious or very quiet the specialist the child life specialist doesn’t hurry the teaching but tries to find out what is going on. Children often know someone who had heart surgery, usually an adult, and therefore they have lots of misconceptions, says Elwood.

When working with the 6- to 12-year-old patients, it’s important to give them choices. "They like to feel in control and a simple choice as to whether or not they want to do something is helpful. They don’t have a choice about taking their medicines, but they can have a choice on which one they want to take first," says Elwood.

In addition to providing school-age children with some choices, allow them to help with their care, she advises. For example, they can help change a bandage by taking the tape off.

Peers are an important part of a school-age child’s life, says Elwood. They need to be able to socialize with children their age so that they understand the rules of society, its concepts, how to work together, how to problem solve, and just how to be a social person. Therefore, children go to school while they are in the hospital and participate in peer activities on the units.

Younger children might see their hospital stay as punishment for something they have done wrong. The older children don’t have that perception anymore. Six- and 7-year-olds might think they did something that caused the disease or caused them to be admitted to the hospital.

When this happens, the educator should go over the illness and surgery with them so that they understand that it is something going on inside their body and not something they had control over.

Adults often try to protect children thinking that providing information would cause them to be overwhelmed and afraid. Therefore, they arrive at the hospital feeling anxious because they haven’t been told anything. While a child’s anxiety level might increase during the initial education, it dramatically decreases when it is time for a procedure and they know what to expect, says Elwood.

"When adults are going around whispering or there are people talking outside the room, what children imagine is going on is probably three times worse than the actuality," she says.

In addition to teaching, children should have an opportunity to work through their feelings and emotions. This can be accomplished through expressive art or even through normal play.

"It’s important to let them work through some of the anxiety and emotions they may be having in a form that is familiar to them," says Elwood.

For more information about teaching school-age children, contact:

April Elwood, CCLS, Child Life Specialist, Cardiology Department, Children’s Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322. Telephone: (404) 315-2083. E-mail: april.elwood@choa.org.