Maureen Heneghan is a certified child life specialist at UPMC Children’s Hospital of Pittsburgh. She discusses tips and strategies for parents taking their child to visit with their health care provider.
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This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.
– So, maybe your child doesn’t like going to the doctor’s, or there’s an upcoming medical procedure they may be worried about. There are things you can do to help get them ready. Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat podcast. And, joining us right now is Maureen Heneghan. She’s a certified child life specialist in the cardiac intensive care unit at UPMC Children’s Hospital. Thank you so much for joining us.
– You’re welcome. I’m so happy to be here.
– All right. So, let’s just first talk in general about your work in the hospital and how that can help kids get through medical issues.
– Absolutely. As a child life specialist, we have a unique role, especially in the inpatient units. So, my day-to-day can look different every single day. I would say, just to highlight a few of the big things that I do every day, you’ll often hear child life specialists referred to as “the play people.” But play oftentimes in the hospital is an intervention for us, right? So, bringing toys to a patient who’s inpatient to normalize the environment. So, a lot of the toys you’ll see in our playrooms at Children’s Hospital is toys that kids play with every single day at home. And it helps normalize the environment, especially for our younger kids who may be feeling scared, unsure of the people around them, the room around them. So, play is a big one. It really helps normalize the environment. We also do a lot of medical preparation, medical play. So, kids have these procedures, these shots, or “pokes,” as we like to call them. And sometimes kids come into the hospital for the first time, and they just have no idea what’s going on. They’re kind of shocked. So, a big thing we can do is talk to them at a level they can understand. So, using developmentally appropriate language to talk them through a procedure, using words that feel less scary, words they’re used to hearing every day. So, we try to just make the hospital environment less scary through play, and then we can talk to them about upcoming procedures. We can support them through procedures they’re awake for. So, IV starts is a big one. MRI scans, things like that, we can take them down and be with them. We answer questions, things like that. We also organize fun events for the kids at the hospital. Our pet friends come in, and kids come down from their rooms and hang out in the atrium with these dogs. So, we do a lot of fun things to keep the hospital environment, you know, feel normal.
– Right. So, a lot of fun things to really get the kids used to what they’re going to go through.
– Absolutely.
– What can you do, what of these can transfer to home? If you’re a parent and you have a child at home, doesn’t like to go to the doctor’s or may be coming up on a medical procedure, where is a good place to start?
– Yeah, absolutely. So, I think a big thing to start with taking your kid to a doctor who doesn’t like it is just being honest with them. It’s important to never lie. I would say the biggest thing is if they have a question they ask you, like, “Mom, am I going to get a shot?” Or, “Am I going to have this done?” And you’re, one, not sure how to answer it because you do know the answer, but you’re nervous about their response, or you truly don’t know, what is in store for that doctor’s appointment, you could respond by saying, “Well, that’s a really great question. I’m wondering the same thing, too. Maybe we could talk to the doctor when we get there.” So, you’re not lying to them, but you’re also kind of deflecting the question so that they then feel like, “Oh, mommy isn’t sure, so let’s ask the doctor.” I think being honest is the biggest piece of that. I also think another piece of it is bringing something they enjoy, whether that’s a toy, their favorite thing from home. I know iPads are a very iffy topic with children and adults, but, you know, if an iPad’s a good reward or a good treat for a kid, it can also be distracting. So, it can kind of distract their mind while they are sitting in the doctor’s office, and it can keep their mind from wandering about what’s going to happen. So, distraction is always a great thing to bring with you for your kids.
– Let’s separate into going to the doctor’s, and then we’ll go for a procedure. Just when it comes to going to the doctors, you already said don’t lie. Just say you don’t know if you don’t know. Is medical play recommended for preparing a child to go to the doctor’s?
– Absolutely. I think familiarizing your children with medical equipment is important. It could be using something like a play doctor kit. It’s not going to be the same as a child life specialist. We have lots of training, we have 600-hour internships, some of us have master’s degrees. But just familiarizing them through these play items is great. They know what a stethoscope looks like. They know what the thing the doctors use to examine the children’s ears. So that when they’re in the doctor’s appointment and they see the doctor going for their stethoscope or whatever they may need, the kids are like, “Oh, I know exactly what the doctor is going to do.” So, they have a level of predictability of what’s going to happen in the doctor’s appointment. So, absolutely familiarizing your kid, even with just a play doctor kit, I think is very beneficial.
– So, you said you can bring along something from home, be it a toy or an iPad that can help them. Should you bribe your child? Should you say, you know, “If you’re good at the doctor’s, you know, we’ll go get a treat afterwards,” or, “I’ll get you that present”? Does that set a bad precedence? What does that look like?
– Right. So, rewards, they’re a tough one. Rewards can be great, and they are something that we as child life specialists use often, but it’s the parameters around which the reward is given. So, a lot of times on the inpatient side of things, we do sticker charts, especially for our younger kids. So, let’s say we have a new-onset diabetes diagnosis, and the child needs to get pokes in their finger multiple times a day, every day. That can be really, really tough for some kids. So, we can incorporate a sticker chart. So, one poke equals one sticker; one sticker equals a prize. That’s how it would start. As the kid gets used to the pokes, we could do three stickers is a prize. So, one poke, one sticker, and you have to get three stickers to get a prize. So, you make it a little bit harder for the kid to get that reward. Now, that’s hard when you’re just going to one doctor’s appointment. Sticker charts can be tough, but it’s just making sure that the reward is appropriate for the event. So, if a kid has to get a shot, and they’re really terrified about it, and you feel helpless, you could say, “Hey, we’ll get an ice cream cone after.” I don’t think that’s going to hurt anything. But, if you’re giving your kid this big, giant reward for going to the doctor’s one time for a very small appointment, you might get yourself into trouble there. But, there’s no harm in rewards. Unless, you know, every kid’s different. So, you have to be careful. You know your own child best. So, I think it’s just understanding and knowing who your child is and how will they respond to rewards in the future.
– Is it better to make the reward a surprise? Like, maybe not say to the child up front, “If you do this, and you don’t cry at the doctor’s,” instead of saying that to them, maybe at the end of the appointment, “You did so well. Let’s go get an ice cream cone.”
– Right. Right. I think that could be awesome because it’s like, “Whoa, oh my goodness, that’s so exciting.” I think the biggest thing, especially with what you said there is like, “Oh, you can get a reward if you don’t cry.” Crying is an appropriate response to pain, to a feeling. So, I don’t think it’s necessarily appropriate to tell your kid, “Nope, you can’t cry.” Because they may be feeling that emotion at that time. But, you could say, “Oh, we have to have a poke today at the doctor’s. If you’re able to sit still and follow the doctor’s directions, we could get a reward after, or we could get a treat after.” But the surprise aspect of it kind of might make it a little bit better for the kid. I mean, think about it as yourself. If you had to do something really hard, and you finished and someone was like, “OK, that was really hard, let’s go get a treat.” Like, you’d be excited. I’d be excited, right? Who doesn’t love an ice cream cone? But I think it’s important with rewards to not suppress emotions, so they can get a reward if they’re able to stay still and if they’re able to follow the directions of the doctor. But crying is an appropriate response.
– OK, and I notice you’re using the word “poke,” not “shot.” Tell me why.
– Yes. So, it’s important with little kids, and even older kids, too, to use non-threatening language. So, “a shot” doesn’t sound, you know, that sounds really scary. A poke is something they’re used to. They know what a poke is. So, a lot of times, we’ll use non-threatening language. Sometimes, we’ll say like with an IV, we call it “a straw” as opposed to an IV because “IV” is just two letters to a kid. If a kid asks, “Oh, well, is that going to hurt? Is the shot going to hurt?” A good response would be, or, “Is the poke going to hurt?” a good response would be, “Well, I feel things differently than you. So, something that hurts for me might not hurt for you, and something that hurts for you might not hurt for me. So, I’m interested to see if it’s going to hurt for you. Why don’t you let me know how it felt after it happens?” So, kind of giving them something to focus on. So, especially in the hospital, a lot of times I’ll say, “OK, you know, tell me what that felt like so I can share with other kids,” because it gives them a job. Then, they can help other kids. Like, I can then use their language to help other kids. So, I think giving them something to focus on is important, for sure.
– Right. OK. So, let’s move to a medical procedure, and particularly, you know, if it’s something unknown for the whole family, what is the best approach there? Is there a thought that you could talk about it too much? Can kids pick up on their parents’ fears or emotions?
– Yeah, absolutely. So, I would say the biggest thing with talking about an upcoming procedure, especially if you’re thinking about younger kids, is simplicity. You need to use simple words. Keep it short and sweet. I wouldn’t say it’s dangerous. Danger is a really strong word, right? But, kids digest information as kids. So, concrete language, using, “You may see, you may feel, you may hear,” as opposed to abstract concepts. Kids don’t understand abstract concepts, right? So, very simple language is the best way to talk about it. And, as kids have questions, like I’ve said before, it’s important if you don’t know the answer, you don’t feel comfortable responding to their question, is just to kind of deflect and responding by “Wow, that’s a really great, great question. I’m wondering the same thing.” But, I don’t think there’s a danger in telling your kids. Going into the unknown can be really scary. Us as adults, we know how scary it is to go into the unknown. So, I would really suggest just using simple language, asking providers for language to use, or, “How can I explain this to my child?” And, not being afraid to say, “I don’t know how to tell my kid this.” But, you can remember the concrete language of, “You may feel, you may see, you may hear,” using their five senses, because that’s how kids best understand things around them.
– And when you are doing this and you’re working with a child in the hospital, parents are around you. Do you talk with parents through this sort of thing at home?
– Absolutely. Yeah. So, on my specific unit at Children’s, I work with a lot of babies. So, a big thing I do is hand-over-hand with parents, is helping them help their child, right? Because it can be intimidating to have a baby with many lines, and tubes, and things that parents aren’t familiar with. So, I do a lot of talking to parents and saying, “You can stand here, you can rub his or her head, you can hold her, you can do this while the team is doing their work.” I validate, you know, the parents’ emotions and feelings about seeing their child go through things. We do help the parents in a lot of ways. Especially, too, when I’m preparing a child, I’ll invite the parents to join us so that they can hear the language I’m using, so that if I step out of the room and the kid thinks of a question, the parents can kind of take what I said and use that to re-explain it to their child. Because sometimes kids take in information, and then five minutes later they’re like, “Oh, I don’t remember what she said.” So, I always invite parents to join me when I’m preparing a kid so that they can understand, too. Because as lay people and not medical people, parents don’t always understand what the doctors and the providers are saying. There’s a lot of big words. And, especially with a cardiac diagnosis, there’s a lot of big words, there’s a lot of procedures. So, sometimes I’ve had parents say, “Wow, now I understand what’s actually happening.” Which is wonderful, and I think that we are child life specialists, right? But, we can support parents, we can support the patients, and then we can also support siblings. So, a lot of the language we use with our patients, we also use with siblings as well, so that they can kind of understand what their brother or sister is going through.
– And do you find a lot of those soothing techniques that you teach the parents in the hospital, they can transfer to home as well?
– Absolutely. Especially with our inpatient population, a lot of those kids go home with, you know, tubes and lines that need to stay in. And it can be hard for parents who now have become not only the caregiver, but then the medical provider, especially with feeding tubes, G-tubes, things like that. But, providing those comfort positions for kids. So, one parent can hold the baby in a comfort position while the other parent has to, you know, do that poke. Especially, I know I talked about new-onset diabetes. So, kids have to go home, and they have to have pokes, and a lot of times, it’s the parents giving that poke. So, switching parents, who has to do the medical care and who can, you know, comfort that child while they’re giving that poke or doing something hard with that child.
– Right. I wanted to go back to the appointments, and just being nervous about to go to the doctor’s in general. Are there certain times of day that a child might be more successful in a doctor’s appointment? Around naps? Or, what basically do you want to leave parents with, what they should be thinking about?
– Yes. I would definitely say if you can, around nap time is important. You don’t want to bring a tired child or a child who’s going to fall asleep. I always say the biggest thing, especially, this can relate to outpatient, this can relate to doctor’s appointments, but we always wake a sleeping child when we have to do a procedure. If the procedure, or the poke, or vaccination has to happen right then and there, wake up the child. You do not want to do an invasive poke or anything to a sleeping child because then they may fear falling asleep again because they’ll think, “Well, I fell asleep, and they gave me a shot. If I fall asleep again, are they going to give me a shot?”
– I would not even have thought of that.
– Right. Nap time. Going around nap time is very important. Also, if the kid’s freshly napped or just freshly woken up from a full night’s sleep, they’re happier. Same thing as if you’re going to take a kid to a park. If you’re skipping nap to go to a park, you’re going to see more meltdowns and tantrums. If you’re skipping nap to go to a doctor’s appointment, you’re going to see more meltdowns and tantrums. I mean, I know sometimes it can be hard to get doctors’ appointments, and sometimes you have to do what you have to do, but then maybe do nap earlier in the day. Or, just make sure that they aren’t overly tired and stressed.
– And do you recommend they eat before they go, or?
– Yeah. I mean, if the kid’s hungry, fill that belly. If it’s right before lunch, go for it. Unless, obviously, there’s, you know, parameters in place that the child is having something done where they can’t eat. I think eating is so important for our kids. It keeps them happy, right? So, if they’re hungry and there’s no parameters around eating prior to their appointment, absolutely let them have a snack, let them have their lunch. Because think about it as an adult. When you’re hungry, you’re a little more crabby. You’re a little bit more, you know, stressed, right? So, if you can have your kid well-fed, and not tired, and not overly tired, it’s just going to help your kid be more successful. It’s going to make the appointment less stressful for you.
– Right. And I know you also share with parents, there are a couple things we’ve talked about: the poke for a vaccine. When a child has to have a wound changed, talk about some of the things you say about, what can parents do so a child isn’t squirming all over the place?
– I would say the biggest thing is talking to them about it before. So, usually wounds are covered up. So, whether it’s stitches or like a bigger wound, we always refer to the tape on top as tape or a sticker. And, a lot of times with wound changes, or removing stickers from those stitches, the biggest thing is taking the tape off. That can be the hardest thing for kids. So, if it’s not a sterile field and the kid can participate in helping take that sticker off, that’s great. Because if you think about it, so it’s like taking a Band-aid off. You don’t want someone else taking a Band-Aid® off of you. You want to do it, you want to be in control. So, if the kid is old enough, and the kid is able to participate in terms of, you know, infection prevention, allow the kid to participate. Or, ask the provider, “Hey, do you think that they could peel the sticker for this one?” And, if the provider says, you know, “Due to infection prevention we can’t have that,” then a big thing you can do is distraction. So, talking to them. With my older kids, my teenagers, I do a lot of social conversation. So, these kids don’t really understand what I’m doing, and they’re like, “Oh, we’re just chatting,” but I’m distracting them, and I’m engaging them in conversation about things they like to distract their mind from what’s happening on their body. And, then, for our little ones, our biggest thing we use, I always say, is light spinners, because little kids love that. We do use iPads a lot, putting on their favorite show on the TV or on the iPad. Because sometimes, it just gets kids’ attention like that, and they don’t even notice something’s happening. And, the other thing I do is distraction prior to it. So, prior to the doctor coming in and removing the sticker, or removing the stitches, is distract them so that their mind isn’t wandering and they don’t get all worked up prior to it. They may get worked up during the actual change of the wound sticker or of the stitches removal, but it’s what you do before and then what you do after. So, after, that might have been really hard for that kid, but OK, can we play? Can we make this environment feel more friendly? Can we make this environment something they’re going to remember? So, they might remember after getting that or having that hard procedure, they might forget the hard procedure, and they might remember, “Wow, after that I got to make slime with my child life specialist.” So, it’s just the beginning and the follow-up. Because sometimes you can’t control, you know, how painful things are going to be. Some things are just painful, but it’s what you do before and after.
– So, bottom line, what do you want to say to parents about what they should be thinking about if their child does have to go to the doctor’s or have a medical procedure?
– I think the biggest thing I can leave parents with is just being honest with our children. I think that’s so important. So often, we see kids who, you know, come into the hospital, and they think they were going to the zoo, or to the movies, or going somewhere fun, and they end up at the hospital. Lying to your child can be very detrimental. And, just being honest, we just see better outcomes. We see more successful outcomes in kids being able to sit still and not having to hold down children to get a vaccine in or to grab some blood work off of them. So, just being honest. And, then, the second thing is just bringing stuff from home that they like. You know, making this as enjoyable as it can be. It’s not enjoyable for anyone. It can be stressful, and it can feel a little scary for you as a parent, right? But, just bringing along that toy, bringing along that iPad, can make a world of difference.
– Yeah. Well, we thank you so much for coming in and spending time with us today. Some great information. We appreciate your time.
– Of course. You’re welcome. This was awesome. Thank you for having me.
– You’re welcome. I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.