Child Life Professionals in the Children’s Hospital

**Special thanks for Stephanie Barta, CCLS for co-authoring this publication with me. Your help in our Dental Department with our Residents has been invaluable.**

Child Life Professionals in the Children’s Hospital

Have you ever had surgery before? Have you or anyone you know ever needed to be in the hospital for an extended period? The last time that I had surgery I had my husband with me. I felt very vulnerable and a bit scared.  I kept thinking “if I feel this way as a grown woman, what do our pediatric patients feel?”  Now let’s take it a little further. If a child with special needs medical diagnosis like Autism must have surgery or if the child has been traumatized in the past for whatever reason- how would they cope? If they need extensive dental work, how does one do that on such a child in the most humane and pain-free way?

The beauty of the Pediatric Dental specialty is that our goal is to complete dental work on a child in a kind and compassionate way that is appropriate for each child depending on their age, health, and situation.  We want the child to become an adult that will want to come back to the dentist later in life.

When I went to Dental School in the mid 90’s, the idea of a Child Life Specialist that could aid in improving healthcare experiences for children was not something we learned about.  When I went back to the University of Washington and Seattle Children’s to train in my residency a decade later, Child Life Specialists were utilized in the Operating Room- but we never saw them in the Pediatric Dental Clinic.  We were taught the basics of behavior management for children and were expected to be able to handle all aspects of such- along with doing the necessary dentistry and handling any concerns from a parent that may be present. Many times, this can be done well.  There are other times it isn’t.   In my humble opinion, (and I’m sure I may get some pushback from my Peds Dental colleagues) we could have spent a whole extra year learning about the emotional stability and healthy development of children undergoing treatment while also mitigating the fear and pain associated with treatment.  So far, this is not the plan for Pediatric Dental Specialty training.  With that being said, I am very thankful for our Child Life Specialists that help us.

The Child Life Professional:  A Quick History

The evolution of the child life profession in the US and Canada has been developing since the 1920’s in order to improve and focus on the advent of family centered care.  There was research completed in the first half of the 20^th century that was in reaction to the high incidence of infant deaths in hospitals/orphanages and the inability of babies to tolerate sensory deprivation due to the absence of human contact.  These studies ended up becoming a “cautionary tale” and inspired others to start thinking about the actual capacities of young children and adolescents to interpret and experience painful/frightening hospital and surgical experiences away from the comfort and safety of their home and family unit.

Early child life workers involved teachers and recreation specialists to provide schooling and support for children that faced longer hospitalizations.  Over time, much was learned about the medical interventions that caused children the most distress and pain.  By the 1960’s, early child life groups were being formed.  The 1970’s brought more collaboration and definition to this professional practice to include what the requirements would be for an educational program that could prepare students for this profession.  By 1982, the Child Life Council was established, and a method of professional certification was born.  This was a major step that assured a standard of child life specialist practice.  Standards of clinical practice along with the standards of education preparation were produced.

So, what do they do?

According to the Association of Child Life Professionals, “Certified Child Life Specialists are educated and clinically trained in the developmental impact of illness and injury…They provide evidence-based, developmentally and psychologically appropriate interventions including therapeutic play, preparation for procedures, and education to reduce fear, anxiety, and pain.” While to some onlookers, interventions may look much like child’s play, child life specialists play with purpose and develop therapeutic goals to address stressors and needs with patients, siblings, and families. When preparing children and adolescents for any necessary procedures, the following elements need to be established to insure effective preparation:  the provision of developmentally appropriate information, the encouragement of emotional expression, and the formation of a trusting relationship with a healthcare professional.

Thankful to our Child Life Professionals

Sitting through a dental appointment can be challenging for the best of us adults- even more so for children.  With that being said, we realize it is important for children to be able to develop resilience so they can cope with these type of appointments as adults.  In mitigating situations that can build resilience, early childhood educational research shows us that challenges should fit the child’s developmental stage because impossible challenges set up a child to fail. For instance, a child that has not learned to multiply cannot learn algebra.  A “goldilocks” type situation exists- just as the challenge shouldn’t be too big, it also shouldn’t be too small.  If the challenge is to build resilience, then the challenge needs to be just right.  Finding the “just right” can be particularly challenging for children with special needs or those who have experienced trauma.  In the dental situation, what may seem to be a moderate challenge for one child, may be an overwhelming demand on another.  Our Child Life professionals can be a great help in guiding us through these situations with children and adolescents.  They continuously prove to be an important source of help and information/education opportunities for us as clinical dental providers.  I am so thankful for our Child Life professionals at Children’s Colorado.

**Thank you to our Certified Child Life Specialist, Stephanie Barta, for her consultation on this subject.

D, K. (2007). Preparing Children and Adolescents for Medical Procedures:Child Life Council Evidence-Based Practice Statement. Peer reviewed across North America and approved by Child Life Council, Maryland, USA. Retrieved from Childlife.org.

History of Child life Profession. (2021). Retrieved from Childlife.org.

Marsac M, K.-A. N. (2016). Implementing a Trauma-Informed Approach in Pediatric Healthcare Networks. JAMA Pediatrics, 70-77.

Romito B, J. J. (2021). Child Life Services. Pediatrics, 1-10.

Certified Child Life Specialist, Stephanie Barta, shows us the pretend dental equipment she uses to have hands on medical/dental play to help our patients become more familiar and comfortable with dental treatment.