At large facilities and children’s hospitals, it’s not uncommon for interventional radiologists to work closely with skilled child life specialists (CLSs) who are trained to help navigate children and families through the complicated and sometimes scary medical environment. These specialists not only help prepare patients for procedures but can also help keep pediatric patients calm during lengthy interventions, reducing the need for sedation.
But not all IRs who see pediatric patients will have a CLS on call. IR Quarterly spoke with Maddie Bozikis, MS, CCLS, CTRS, a child life specialist at University of Chicago Medicine on the purposes of a CLS and considerations for keeping pediatric patients calm and informed.
What is a CLS?
Maddie Bozikis, MS, CCLS, CTRS: We are experts in child development, and our role within interdisciplinary teams is to focus on patients’ and families’ psychosocial needs. We help kids cope with being in the hospital and use play as a modality to help normalize the environment. We also help prepare patients for procedures, sometimes accompanying them or even providing procedural support—whatever is needed of us. Our ultimate goal is to decrease trauma in the medical environment.
What are some key considerations for physicians working with pediatric patients?
MB: Play is their language—it’s how they learn and communicate, so it’s a modality that must be incorporated when working with them. Getting down to a child’s level is a huge benefit as well in order to even the playing field. I also believe that giving children opportunities to interact with real medical devices and materials—whether that be an IV or a catheter—before it’s used on them is a great way to ease fear. Giving kids the opportunity to manipulate those materials in a nonthreatening way is an easy way to start making them comfortable and showing them that, while the situation may be new and scary, their medical team is there to help them understand and get through it.
I’ve also learned that you can have all the distractions and toys in the world, but ultimately you are your best tool. Sometimes that means you have to sing the ABCs or nursery rhymes, or even just engage in normative conversation. If you’re working with a school-aged child or teenager, asking them about school, their hobbies, etc., and having the kind of conversation you would have outside the hospital setting can normalize the environment and make them feel more comfortable.
What are some easy ways that a physician or provider can adjust their language when speaking to children?
MB: It’s not necessarily easy, but using softer language is a great way to start thinking about how a child can conceptualize different information. It spurs you to consider your word choices. For example, if you tell a child you’re going to flush their IV, consider that the only time a child may have heard the word flush is in regard to flushing the toilet. Thinking about how you can break things down into easily understandable terms is crucial. It’s part of meeting them on their level and understanding what is developmentally appropriate for their age and your assessment of the patient.
What does consenting look like for a pediatric patient?
MB: Those in pediatrics talk about assent, rather than consent—which is what the child’s legal guardian must provide. With children, you’re looking for their assent and to make sure they understand, to the best of their ability, what will happen to their body. This is really important, especially when a patient undergoes something invasive or that involves their private parts, like a voiding cystourethrogram (VCUG) or a lower GI study. It’s important to tell them that their parents said it was okay, and to tell them where they will be touched, or where the tubes or catheters are going to go. I focus on the symptoms they’re experiencing and tell them that the doctors need to perform this test or intervention to help them feel better. The goal is to make sure that the child is okay with what is about to happen and give them an opportunity to have an open dialogue. It helps to have their parent or guardian present as well, and part of the conversation.
What other role can parents play in helping the medical team, especially if an IR doesn’t have a CLS?
MB: In our training, we focus on the concept that while we may be experts in children, parents know their child best. Incorporating the parents or caregiver into the care will often have a better outcome. For example, comfort positions are a great way to utilize a family member if you’re performing something invasive. It can be difficult with imaging, but if it’s possible, consider having a parent at the head of the bed in a fluoroscopy suite, giving them lead so they can stay in the room or even having the child sit on their lap if feasible.
Do you have any resources you’d recommend?
MB: Absolutely. If your institution has a CLS, they should be your first stop. Our entire scope of practice is about supporting the child and their family, in whatever way is needed. But if you don’t have a CLS, you can learn more about play modalities at the Association of Child Life Professionals. In addition, the Simply Sayin’ app, developed by Phoenix Children’s, is a great resource that uses pictures, sounds and child-friendly language to explain common procedures, treatments, conditions and medical discussions.
