Madeline Schmitz, a child life specialist in the Children’s ER, introduces elements of medical play to young patients so they will know what to expect.
Child life specialists at Oakland Children’s Hospital help youngster cope with complex medical procedures and conditions.
Deidre Goe’s typical day starts like this: Her first patient at the outpatient oncology clinic at UCSF Benioff Children’s Hospital Oakland one morning in September was a 7-year-old girl with acute lymphoblastic leukemia, a cancer that affects the white blood cells. The youngster had undergone a few rounds of chemotherapy, but the weekly infusion was still a new and scary experience.
Goe brought with her a medication doll, which the young girl named after her uncle who was bald, like the doll. And just like the child, the doll had a special port, attached to the center of its chest. The port makes it easier to administer medication without having to start a new intravenous line for every infusion, but it still requires a poke with a needle each time.
The child was nervous; the poke hurt last time. So Goe went through the steps of the procedure. First, they talked about the child’s job that morning, to hold her body still and put her shoulders back so the nurse could access her port easily. Next, they talked about the salty taste she would get in her mouth when the port was flushed with a saline solution; for that, she chose to have a lollipop to suck on. Then they cleaned the doll’s chest with a wipe to sterilize the site. And together they poked the doll’s port with a needle and pushed a syringe filled with water into its chest using the same equipment the nurse would use a few minutes later with the patient. “Putting the needle in requires some pressure, a push. When the child has a chance to feel what it takes to penetrate the doll’s skin—the fabric—it gives her a better understanding of what the nurse has to do,” said Goe.
Goe is a child life specialist at Children’s Hospital in Oakland, and what she described is called medical play. “Play is how children learn. Our goal is to use play education to help kids cope with being in the hospital and to feel normal, so it doesn’t feel as scary and intimidating,” explained Goe.
The child life specialist helps the patient feel like she is a part of her care and has a say in what happens about the things she can have a say in—like which flavor lollipop she wants or whose lap she sits on during the procedure, Goe added.
Children’s Hospital has had a child life department in place for over 30 years and now has 12 child life specialists, all with master’s degrees in child development and certification in the field. They support children and families in the inpatient units, like intensive care and on medical floors, and the outpatient clinics, like radiology, surgery, and oncology. They help children who experience trauma, who have chronic conditions like diabetes, asthma, and sickle cell disease, and who are facing end of life. They serve as translators. “We explain the medical conditions in kids’ terms,” said Goe. “This helps the kids process their medical experience and helps the medical team understand how and why they react.”
A typical day for Madeline Schmitz, the child life specialist in the Children’s emergency department, changes by the minute. Children’s ER treats an average of 150 patients a day for everything from fevers, bumps, and bruises to seizures, car accidents, and brain injuries. During Schmitz’s 10-hour afternoon-to-midnight shift, she visits with up to 35 families and provides in-depth support to 15 or more patients.
The previous night she had worked with a 2-year-old boy with a laceration, a deep cut to his head, after a fall on the playground. “We see a lot of trauma here,” said Schmitz. She had him squirt a doll with what she calls the cleaning gun, a large, long syringe filled with water, just like the one that would be used to clean his wound. Together they sang, counted, and played games on the iPad, all coping strategies she used later with the young boy while staples were placed in his head.
After that, she worked with a 6-year-old girl who had been transported to the hospital via helicopter. She lay strapped to a board with her neck in a brace with a flurry of hospital staff members buzzing around above her. Schmitz found her way to the head of the bed. She held the girl’s hand and talked her through the trauma examination.
“She had a ton of questions,” said Schmitz. Why do they keep giving me medicine? They are flushing your intravenous line with fluid. What’s that cold stuff on my tummy? They are doing an ultrasound, a scan to look inside your tummy. The cold feeling is from the gel they use with the wand. “Where am I?” Children’s Hospital in Oakland. (The only time she had flown before was in a plane to Texas to visit her aunt. She wondered where the helicopter had landed.)
And how does Schmitz feel at the end of one of her typically hectic days? “I work with young patients and families during what can be one of the scariest, worst nights of their lives. It’s rewarding to be there during those difficult times, to answer questions, relieve some stress, and provide comfort with a hug or warm touch,” said Schmitz.