VCUG Prep

A VCUG (Voiding Cystourethorgram) is done to see what happens in a child’s body when they go pee. Below are the steps of a VCUG;

  1. First the X-Ray tech will take pictures of their belly. These are called scouting pictures and they are done to that the doctor can make sure there’s nothing in their belly.
  2. Next the child will lay on the bed and girls will put their legs in frog position while boys can leave their legs straight.
  3. Once they are in position, the tech will clean their private parts with a special soap that sometimes looks like chocolate.
  4. After cleaning the area, the tech will insert a small straw (catheter) into where they go pee. This is done so that the tech can will up the bladder with sparkly highlighter water. This highlighter water is used to help the child’s bladder show up on the pictures.
  5. Once the straw is in, the staff will use a piece of tape to hold it into place and then fill up the bladder. Your child might feel as though they have to go pee but they need to hold it until the tech says it’s okay to go pee.
  6. The next step is the hardest, the child needs to pee on the table. The reason for this is that the goal of the VCUG is to get pictures of what happens when they go pee so they need to take x-ray pictures while the child is peeing.
  7. Once they have peed on the table and staff has taken the pictures then need, your child will be able to go the bathroom and then put their own clothes back on.

Children’s Mercy has YouTube videos going through the steps of the VCUG, check them out below.

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Fabulous Find Friday: Patient Puppets

Today’s Fabulous Find is Patient Puppets.  It can be really hard to find the right doll to use for procedural teaching. Most Child Life Specialists know the feeling of ordering dolls that don’t come as pictured online and then trying to adapt to use them to demonstrate medical procedures for patients. Patient Puppets has these dolls for you! Besides offering a variety of customizable dolls, Patient Puppets also has child sized and table top models of medical items.  Patient Puppets also will customize dolls for whatever you need.

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.

Book Review: Surgery Day

I recently got the chance to check out Surgery Day by Julie Kaderabek and Laura Wolfe and I loved it! Using non-threatening language, Surgery Day walks children through the steps of their upcoming surgery. With developmentally appropriate language, Surgery Day describes the different medical equipment and experiences that will encounter in the hospital and gives children accurate information to prepare them for their surgery. Research shows that children cope better with new experiences if they are given the time and information to prepare for success. Surgery Day allows parents and caregivers to prepare their children for the new and often intimidating experience of surgery.

Visit 2 RNs to check out Surgery Day and learn more about the talented authors that created this book.

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MRI Prep

As a Child Life Specialist in medical imaging, MRI preparation is the bulk of my work. Unlike X-Rays and CT’s which only take a couple minutes, an MRI typically takes 30 minutes to an hour and is very noisy. Like a CT, the MRI scanner doesn’t touch you. There are three main things that I go over with the kids.

1) I focus on the importance of them keeping still for their pictures. If they move (and this includes something as small as licking their lips or wiggling their toes), then their pictures could come out blurry. Although the pictures can be up to an hour long, they are lots of smaller pictures that add up to a longer timeframe. So if the kid does really need to itch their face or wiggle their fingers, they can do that inbetween the pictures.

2) Next I talk about the noises. The MRI machine can sound like a construction site or even an alien spaceship, but those are good sounds that mean that the camera is taking pictures. The patient’s big job is to stay still and the camera’s job is to take their pictures. It’s important to tell kids ahead of time about these sounds because they can startle or scare kids if they aren’t prepared.

3) The last thing that I go over with kids is that they can only talk when we talk to them first. Because the machine is noisy, staff won’t be able to hear them if they talk during their pictures. So they will need to wait until staff says something to them before they can say anything. Most hospitals will have headphones and it is usually through these that staff talk to the patients.

CT Prep

A CT or Cat Scan is another noninvasive procedure that is relatively common. While a CT means taking pictures like an X-Ray, it does require a little different prep. For the CT Scan, kids will need to lay still on a table when they go “into the doughnut.”

It’s important to remind kids that while they will go into the “doughnut,” nothing will touch them. They might come close to the sides but it won’t touch them. Some beds have “seat-belts” that will go around the child to remind them to stay still.

Although nothing touches them, the CT machine does make some funny noises. Not as noisy as an MRI, but the CT machine makes some swishing sounds. I usually explain to kids that it sounds like a washing machine.

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X-Ray Prep

An X-Ray is probably one of the easiest medical procedures to prepare a child for because it’s non-invasive. The easiest way is to explain that an X-Ray is a special picture of your bones and insides so that the doctor can figure out why you aren’t feeling good or why something hurts.

The child’s big job during their X-Ray pictures is to stay still. Just like when mommy or daddy take pictures of them on their phones, if the child moves than the picture will be blurry. So it’s important for the kids to stay still so that they don’t have to take more pictures. The pictures usually only mean a minute or two of keeping still and then the pictures will be over.

Some kids are nervous about being in the medical environment, even if there won’t be any pokes. It can be helpful to explain what each thing in the room means and does, like the bed where they will lie down and the camera that will take their picture.

 

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?

Adult Consults – Discussing a Diagnosis

In the Fall of 2017, I completed my internship at a Pediatric Unit within an Adult Hospital. Although the pediatric population was our primary focus, we also provided support to adults who were struggling to talk to kids about hospital issues. One of the main things we did was work with parents to explain a new diagnosis to their children. If the parent had just been diagnosed with cancer or needed an organ transplant, we would often meet with the families to talk more about what these changes would mean.

You could probably define our main job as translation. Parents know their children best so most of them knew what to say but they struggled with how to explain medical terms like cancer, chemo, etc. That’s where Child Life’s developmentally appropriate experience and knowledge of the medical environment was needed. We would chat with parents about their children and what they’re like and then suggest ways to define big and scary words like cancer.

We also provided affirmation. With many of the families that I met with, the parents knew what they wanted to say and how to do it but they were unsure if they were “doing it right.” When we explained to them that they know their child best and their desire to be honest with the children is most important, families calmed down. It was interesting to see how helpful it was for them to have someone else say, “Yes, you’re doing it right.”

Obviously there were so many resources we provided for the families. For the parents, we gave them Kathleen McCue’s book How to Help Children with a Parent’s Serious IllnessThis book is an excellent resource that provided families with practical guidance for talking to children about illness and also death. Because it’s broken up into smaller categories, parents could focus on the area that they felt they needed help with and they didn’t have to read the whole book. Some general books that we provided families with for their children were When Someone Has a Very Serious Illness and A Terrible Thing Happened.

For the children, we would share diagnosis specific books for the families about whatever illness they were facing. There are so many books available for children about illness and the medical setting, but they aren’t easily found in your local library. As Child Life Specialists, we knew resources that were available and we could share them with the families.

Finally, I loved to give families Worry Eaters or give them instructions to make their own worry eater. What’s great about Worry Eaters is that it encourages kids to write down their questions and fears but they can share those thoughts when they feel ready or when the caregiver is ready. It often takes some pressure off both the parent and the child. There was one family that I met during my internship who I gave Worry Eaters to mom to give to her two school aged boys. For the rest of dad’s hospitalization, they carried those Worry Eaters with them wherever they went. We invited the boys to many hospital events that were happening for our pediatric patients, and they brought their Worry Eaters to every event.

Do you work in a setting where you help adults talk to kids about overwhelming topics? I’d love to hear more about your experiences in the comments below!

Fabulous Find: Gabe’s Chemo Duck

Cancer treatment can be scary for kids. As Child Life Specialists, we know the importance of preparation. Chemo Duck is a great tool to help prepare kids for a port, central line, or really any procedures they may encounter during their treatment. Chemo Duck comes with a port or a central line and he can be a child’s companion throughout treatment or just during medical play sessions.

 

Visit their website to learn more;  http://chemoduck.org/for-kids/meet-chemo-duck/