Child Life

Background:

• The patient is a 1year-1month old, male, admitted for a level two trauma, rule out non accidental trauma.
• Prior to this medical emergency, the patient and his 4 sisters, lived with their biological mother and father.

Admitting Assessment:

• The patient was febrile and suffered from abdominal distention, respiratory distress, multiple skin abrasions to his lower extremities, multiple rib fx, left tibia and mid shaft spinal fx, chronic mid-to-distal left ulnar fx, chronic right olecranon fx, chronic right distal radial diaphysial fx, liver laceration and bilateral pulmonary contusions and effusions requiring left chest tube and intubation.

Health Care Variables:

• The patient was admitted to the Pediatric ICU due to his critical condition, he remained there for 10 days.
• Hospitalization posed a challenge to the patients physical, social/emotional and language development, such as, a full leg cast, 2 chest tubes, intubation, and sensitivity to the left side of his body.
• 18 day duration on General Pediatric floor.

Social Variables:

• Social vulnerability and severe injury impact throughout the patients upbringing have impeded his ability to meet developmental milestones.
• Suspected history of physical abuse and neglect by parents.
• The patient’s parents and siblings were unable to visit throughout the entirety of his 28 day admission.

Child Variables:

• Separation anxiety and fear of strangers, escalated on isolation
• Trust vs. Mistrust
• Insecure attachment formation throughout infancy due to inconsistencies of care throughout upbringing
• Unfamiliar and unnormalized environment
• Loss of twin

Trying to Connect:

The Child Life and Creative Arts Team provided emotional support through music therapy, reading and story telling, and positive encouragement while he was intubated. Therapeutic touch, was also utilized, i.e. playing with the patients hair and holding his hand to try and create a physical sense of comfort.

Connection Continuation...

• When extubated, the Child Life Team tried to engage the patient with developmentally appropriate stimulation.
• Normalizing play within a hospital setting to increase coping and a better sense of safety and security.

Purposeful Play & Intervention:

• Playing with toy drums to promote independently sitting up.
• Singing and clapping to encourage mirroring through example.
• Stacking blocks and manipulatives to facilitate gross and fine motor skills.
• Transferring toys from one hand to another to promote coordination and body awareness.

Purposeful Play & Intervention:

• Shape sorter to encourage problem solving.
• Peek-a-Boo to help assess object permanence.
• Puppet play to assess tracking and promote positive social/emotional interactions.
• Reading stories and creative story telling to enhance language.

Room for Improvement:

Transformation:

• Throughout admission, the Child Life and Creative Arts Team were able to see the patient go from extremely frightened, tearful, uncomfortable and physically retracted, to laughing, smiling, enhancing development and actively engaging in play and music with staff members.

Theory:

• Erikson's Stages of Psychosocial Development
• Ainsworth's Child Development of Attachment Theory
• Piaget's Cognitive Development Theory
• Bowlby's Attachment Theory

References:

• Thompson, R. H. (2009). The handbook of child life: A guide for pediatric psychosocial care. Springfield, Ill: Charles C. Thomas.
• Shute, RH & Slee, PT. Child Development Theories and Critical Perspectives, Second Edition. New York: Routledge; 2015.
• Berk, LE. Child Development. 8th ed. USA: Pearson Education, Inc; 2009.

Questions?

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