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Kid-Friendly Medicine

Children’s hospitals have learned to treat their patients like children

There is nothing like a children’s hospital to make you wonder whether the universe has a major design flaw. No one who has ever tended to a child who is very sick, or seriously injured, or newly arrived in the E.R. with signs of child abuse, can escape the question: Shouldn’t someone have planned better so that children would be spared suffering and pain? Over the years, children’s hospitals have learned to at least make the best of a bad situation. Once scary and cold, they have risen to the special challenges of providing child-friendly and parent-friendly health care.

First, the hospitals have invited parents to help out—something that did not happen until the 1950s. Before then, parents were considered irrelevant, a nuisance, and even a threat to the well-being of their hospitalized child. Visiting hours were kept to a minimum. In my home town of Baltimore, around the time I was born, Johns Hopkins Hospital told parents they could visit only from seven to eight P.M. on Wednesdays and from one to two P.M. on Sundays. Two hours a week.

Now, hospitals recognize that parents can be a calming presence. They can even help children tolerate medical procedures and pain. To do so, parents must coach, not fuss. As the pediatric psychologist and author Leora Kuttner explains, a “fussing” parent is someone who is apt not to be managing his or her own anxiety, who asks unnecessary questions, and who provides help that is neither requested nor needed. A “coaching” parent remains outwardly calm, listens to the child, offers encouragement, provides helpful guidance—such as getting a child to remember a time when he or she successfully fought through pain—and uses sensitive touch (patting for very young children, stroking for older children).

Parents can also catch mistakes or oversights that sometimes occur when busy hospital personnel don’t understand the quirks of a particular child. One mother I knew was the only person to notice that a neck cast had been fitted improperly for her teenage son. Another mother responded—after a physician said her son looked fine—by correctly diagnosing her child’s illness: only she could detect her son’s way of expressing discomfort.

Medical language has also become more kid friendly. Some confusion over terminology may be inevitable: Why did my cat scram? What am I supposed to do with an ivy? And who is this Anna Stesia they keep talking about? But today’s pediatric professionals will soften the lingo wherever they can. They’ll say “sleepy air” for anesthesia gas, “a poke” for what the needle does, and “a hug” for what a blood pressure cuff gives you. Anything to make the child less anxious.

The physical environment is another thing that has changed. Young patients used to be kept in wards filled with children of different ages. Now, they often have their own room, or at least a private space where parents can hang out and where one crying child doesn’t set off another. Nor do older kids have to suffer the embarrassment of sharing a room with a preschooler. Walls are now brightly colored and often decorated with cartoon characters, and there are Barbie Band-Aids for boo-boos.

Perhaps most important, pediatricians and other care providers have learned to enter the child’s world. My favorite example occurred recently in an operating room at Tufts Medical Center’s Floating Hospital for Children. The chief anesthesiologist led his medical team in a round of “Wheels on the Bus,” the young patient’s favorite song. Not much anxiety in the OR that day—more like it should be for children.

W. George Scarlett is a senior lecturer and deputy chair in the Eliot-Pearson Department of Child Development. He is also a former chaplain at Boston Children’s Hospital.

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