Child life programs in the pediatric emergency department.

Abstract

Child life (CL) programs have long been utilized in the inpatient setting to help in relieving the stress and anxiety associated with hospitalization. The objective of this study was to determine the current availability of such programs in pediatric emergency departments (ED) and what interventions were provided in one ED with a CL program. We conducted a telephone survey of EDs in 44 large children's hospitals in the United States as to their use of child life specialists (CLS). Also, a retrospective review was performed of the CL intervention in one large pediatric ED over a two-year period. Only 6/44 EDs (14%) had at least one full-time CLS, with three of those having two full-time workers. In these EDs the CLS prepared children for painful or anxiety-provoking procedures and provided developmentally appropriate activities in the ED. Another 6/44 (14%) had CL services available by consult. There were no CLS available in 32/44 (72%) EDs, where nursing staff prepared children for painful procedures. EDs with a higher census were more likely to have a full-time CLS (P = 0.02). Hospitals with certified pediatric trauma centers were less likely to have any CL services available in the ED (P = 0.04). A review of the records of the ED at Arkansas Children's Hospital revealed that 32% of patient contacts by the CLS were for invasive procedure teaching and support. Another 22% of interventions were for developmental stimulation. Family support (21.5%) and therapeutic intervention (17.5%) were the next most common contacts. Admission teaching accounted for 4%, while preoperative teaching and support accounted for only 3% of the total. There were more patient contacts made by the worker on evening shift. CL programs, while common in the inpatient setting, are currently underutilized in most pediatric EDs. CLS can provide a variety of services in the pediatric ED.