Medical play eases kids' fears, helping procedures go smoothly

Facing an upcoming medical procedure can be frightening for child patients and their families. Tom Collins, a bilingual Child Life specialist at Children's Hospital, uses play techniques to help ease their fears.

Four-year-old Zaira clings to her mom's side in the waiting area of the outpatient surgery center at Children's Hospital. When senior child life specialist Tom Collins speaks to her in her native Spanish, she smiles back shyly but doesn't reply.

Zaira watches as Tom pulls out a toy syringe and a practice doll, and "gives" the doll oral medicine. When coaxed, she darts over, gives the dolly oral medicine too and then retreats to safety by mom's side.

Their interaction is playful, but it is more than a game. Tom, a member of the pre-operative surgery team, is preparing Zaira and her family for a scheduled surgery.

"There's no minor procedure when it's your child," says Tom. "Everything is important and frightening. We can't take away the discomfort of the procedures or the anxiety, but we help kids and families get a sense of mastery over what is happening to them. We go in where the dragon of fear is, and meet that dragon."

During their consultation, Tom takes the family through a complete timeline of operation day, using pictures of the gurney and operating room to illustrate. He also pulls out a breathing mask and an intravenous bag to show them what to expect. He uses props, like the doll and child-sized play equipment, so children can mimic the procedure that awaits them. Kids begin to feel more like participants in the process.

The 15 to 20 minutes Tom spends with each family preparing for surgery can have a dramatic impact. At age 2, Mary Gaston's son William has already had three surgeries.

"Before we met Tom, Will didn't let anyone touch him," says Mary. "He was clingy and resistant. Tom worked with him and made some suggestions for us that made a world of difference."

Tom suggested giving Will his own doctor's kit so he could practice on stuffed animals. At his next visit, Will knew what was coming and it helped tremendously. "It's at the point now that he is really good with his healthcare provider," Mary adds.

Tom also encouraged the family to make a storybook of Will's hospital experiences.

"Now we talk to him in story form about what is happening and he gets it, he knows it's about him, but it's also a story," says Mary.

Tom's work did more than help William. "It had a big impact on us, too," Mary acknowledges. "It's taught us how to relate to Will and how to deal with him now and in the future. Tom gave us a framework and tools to use, and we're very thankful."

The psychological benefits of Tom's work translate into medical advantages.

"I noticed early on that when Tom spent time with a family the kid had an easier time going to sleep," says anesthesiologist Jonathan Clarke, MD. "If the kid has an easier time, I have an easier time. A crying child's tears can get in his airway, impairing breathing. If a child has been prepared by a child life specialist, these incidents are greatly reduced."