Offering realistic choices

Why offer choices?

Choices offer people control over their environment. When a child is facing a stressful situation, such as a medical procedure, they usually aren’t in control of the situation. The child’s doesn’t have many choices. The medical staff have decided what procedure is necessary and how that procedure needs to be done. When we offer children choices that they can make, such as which arm to look at first or what color bandage they would like, it gives them a sense of control over what’s happening.

Be realistic about the choices you offer

When you’re offering choices to a child, make sure that those choices are realistic. Don’t ask the child, “do you want your IV in now?” because they don’t have a choice to say no. The IV needs to happen to give them important medicine. Present choices that offer the child a sense of control but are also realistic. Which arm would you like me to look at first? Do you want me to count or not? Do you want to look or look away?

Another example is getting children on the exam table. Whether they get on the table or not isn’t a choice since they will need to be there for the x-ray or other medical procedure. “Want to get up on my exam table?” wouldn’t work because no is not an okay answer. But an easy way to reword the question would be say “Do you want to get up on the table by yourself or should I help you?” This way the child can pick either choice since both options are realistic.

How do you offer your patients control during their medical procedures? I’d love to hear your ideas!



Enema Prep

Sometimes the doctor will order a patient have an Enema in the medical imaging department. For this kind of Enema, the doctor is going to fill the child’s belly with sparkly highlighter water (contrast) and then take pictures of the full belly (intestines) with an X-ray style camera.

When patients come into the hospital for this kind of enema, I explain that the doctor wants to see what happens in your belly when you have to go poop. So the doctor is going to fill your belly with sparkly highlighter water and then take pictures of your insides. Many kids say they feel much better after the enema because it helps with the constipation that they are usually feeling. Below are the typical steps for the enema. Every hospital is different so there might a different order or additional steps, but at least this is a basic intro to what it’s like for a child to get an enema in the Medical Imaging Department. To make it easier for you, I’m going to write out the steps as though I’m talking to a child.

  1. First you are going to put on the special hospital jammies.
  2. Next we are going to pictures of your belly, just to make sure you didn’t swallow any pennies. 😉 [I wait to explain anything else that is happening until after these first pictures].
  3. After these photos, you are going to lay on your side with your knees bent and your hands above your head. I often give kids a stuffed toy to hold in their hands so they have a job.
  4. While you are laying on your side, the doctor is going to put a little tube where your poop comes out. This tube is used to fill your bell with the sparkly highlighter water. It’s important to stay relaxed so I usually demonstrate for kids with my fist that its easier to stick my finger into my fist if it’s relaxed and open instead of clenched tight. I then practice deep breathing with the child and we rehearse relaxing. Party Blowers and bubbles often help kids practice their deep breaths.
  5. After the tube is in, the doctor will come in and start taking pictures of your belly while another staff member fills your tummy with the sparkly highlighter water. The doctor might have you move around a little just to make sure that the sparkly water is all over in your belly.
  6. While they are filling your belly, you might feel like you have to go poop. It’s important to use your muscles and not go poop until the doctor is done with his pictures.
  7. When they are done taking pictures, you will be able to go use the bathroom. The doctor might want a few extra pictures after you’ve emptied your belly and then you will be all done and able to go home.

IV Prep

These prep posts are helpful for students and families alike. For students, it’s helpful to know some of the basic preps before you go in for an interview. Whether it’s a practicum, internship or job application, it’s often helpful to give examples of how you would prepare a child for an upcoming procedure. For families, here are some simple explanations of common medical procedures.

I wanted to start with IV prep since it’s one of the most common procedures that children encounter in the hospital setting.

  1. First is why are you getting an IV? An easy explanation is that the doctor wants to give your body a special drink that goes straight into your blue rivers (veins).
  2. Next comes the tourniquet. It’s like a big rubber band that gives your arm a tight hug. This helps the nurse find your veins.
  3. Alcohol Swab is easy because it doesn’t hurt at all. I usually just explain that the nurse will use a cold and funny smelling wipe to make your arm clean before doing the IV.
  4. The next step depends on the hospital and the person doing the IV. Many pediatric facilities use a numbing agent so that kids feel pressure but not the pinch. These might be J-tips (which makes a popping sound like a soda can), Synera patches or Emla Cream (both of these need to be on the skin for about 30 minutes before they numb the area) and Pain Ease spray (which is a cold numbing spray).
  5. Now comes the IV placement. I don’t tell kids there’s a needle unless they ask or already know. I focus on the fact that it’s a little straw used to give your body a drink. I like to let kids touch and manipulate the IV (without the needle of course) so that they can understand that it’s small and flexible. The needle doesn’t stay in your arm.
  6. It’s not over when the IV is placed. There are still bandages and tape that are used to hold the IV in place. It’s important to be honest with kids and make sure they know ALL the steps which includes the final step with the “stickers.”


How do you explain an IV to children? I’d love to hear how you “translate” big scary procedures for children?

My Experience as a Patient

I want to start this post by saying that I am okay! I realize that my entire head is bandaged, but I actually just had a small cut on the back of my scalp. The bandage goes around my entire head so that the gauze on my wound would stay there without someone holding it. I went ice skating with friends this past weekend and took a little spill about ten minutes into the afternoon. My feet went out from under me, my butt hit the ice and then my head. My first thought was, naturally, “darn, that’s embarrassing!” I wanted to get back up brush it off, but I quickly realized that was not possible. Although I did not pass out or become dizzy, I was very light headed. My friends dragged me over to the side of the rink, but I was able to walk off the ice and later walk to the car and into the hospital. So that definitely felt like an accomplishment! A nurse and a surgeon’s PA both came over after my fall and were very helpful in stopping the bleeding and taking care of me before the medics got there. While I was sitting on the ice withe everyone taking such good care of me, I quickly realized that you can’t turn off the child life specialist within you. I might not be certified yet, but I believe that I think and act like a child life specialist. I noticed that there were some kids in the group standing very close and trying to see. In my head, I wished that someone would engage them in interactive play away from here so they wouldn’t see all the blood. Since I couldn’t easily convey that to those around me, I tried to use an enthusiastic voice and suggest that they go ice skating some more. I might have been bleeding from my head, but I sure wasn’t going to let those children see the blood and get scared.


After the medics at the ice rink wrapped my head, our next stop was the emergency room. Now one of my strengths is communication and I talk A LOT when I’m nervous or when my adrenaline is rushing. I’ll let you imagine what the car ride was like…. One of the things that I later realized I did was prepared the others in the car for what might happen when we got there. But I think that I was actually trying to calm myself by walking everyone through the procedure. One of my practicum supervisors from this summer was an ER Child Life Specialist, so we spent a lot of time working with kids with lacerations. I knew the steps; numbing medication (probably EMLA cream since it was an open wound and a J-tip wouldn’t be practical), irrigation (the big syringe that washed your wound) and then the sutures. My friends must have thought I was crazy as I told them what each step would be and the associated sensations. Lucky for me, they are great friends and just listened as I blabbered on!


After the drive to the hospital came the fun part of waiting. The registration and triage went very quickly, but then we were sent back to the waiting room for what would be a four hour wait. As I mentioned earlier, I can’t turn off the child life specialist in me so I had Play-Doh in my purse that was nice to squeeze while waiting. As we were waiting, I tried to look around and imagine how it might look to an injured child. The hospital we went to was next door to a large Children’s Hospital, so this emergency department didn’t have anything for children as kids would be brought next door. But regardless of whether the hospital is a children’s hospital or not, there is always a wait time. And this wait time is a time of the unknown, a time to imagine what might be going on behind closed doors in the ER and also about how the doctor might decide to treat the wound.

After those four hours, I was admitted to an ER room and the doctor came in shortly after. He looked at the wound on the back of my head and then left to talk to his supervisor before they both returned to start fixing my head. While they were gone, the nurse brought in the supplies that they would be using. I had been wrong about how the doctor would take care of my head wound, and they actually used a numbing agent that is injected into the skin and they stapled my wound instead of doing stitches. But when the nurse brought in the supplies, I was able to identify them. I knew what the sterile water was for (irrigation), I recognized the irrigation kit and the large syringe, I knew that the small vial of medication was the numbing agent that would be injected and I could easily figure out which device was the stapler. But what if I hadn’t spent my summer in the hospital? What if I was a scared child who just saw a nurse bring in the supplies? As I named the items, I realized how important it is to properly prepare kids before procedures. Before my accident, I did know that preparation was important. But the experience of being the patient let me realize it’s importance from another point of view, the point of view of the child instead of the student who has studied stress, trauma and child development.


In the end, I only needed two staples for the one centimeter cut on the back of my head. While I’m glad I didn’t have a concussion and that it’s wasn’t more serious, a larger wound might have made a more dramatic story! But I can’t complain about how things worked out. 🙂 I’ve never been seriously hurt before this (and I realize that this injury wasn’t very serious either) but it did allow me to experience the hospital in a way that many children do each day. It allowed me an opportunity to grow in empathy towards those who are in the hospital, to those children that I hope to one day serve as a Certified Child Life Specialist.