Child Life in the Adult ICU: Including the Youngest Members of the Family

Abstract

The profession of child life is one of the newest providers of direct clinical services in adult intensive care units. Through their philosophy and training, child life specialists make available a wide range of interventions to children and families who are facing the very serious or life-ending illness or injury of an adult patient. These certified experts also provide specific tools to assist other professionals in meeting the needs of the expanded family, including any infants, children, and adolescents who are impacted by the hospitalization of an adult in the challenging environment of an intensive care unit.

Appendices

Appendix A: Tips for Helping Hospital Professionals Help Children of Adult ICU Patients

When talking to parents or family members about children:

• Determine what children in the life of the patient might be impacted by hospitalization.

• Ask open-ended questions about the children, their knowledge, emotional status , etc.

• Find out exactly what concerns the adult has about the children in the family.

• Stress the importance of honesty and age-appropriate information to children.

• Teach parents signs to watch for that may indicate problematic reactions of children.

• Offer visitation and other services as available at your hospital.

• Identify resources for children beyond the hospital and provide written material.

When interacting with children directly:

• Use language that is appropriate for the age and developmental level of the child.

• Find out from the child what he/she knows and thinks about the medical situation.

• Talk about emotions and reactions as much as about facts.

• Help the child to talk! Ask him or her about themselves, their friends, school, pets, etc.

• Use play and art to illustrate information or to allow expression of emotion.

• Explain what will be happening in the most immediate time frame, and plan to add additional information as the medical situation evolves and changes. Avoid overwhelming children with too many facts at one time.

• Provide opportunities for diversional play and art. Have simple materials like markers and paper, small toys, something for building, and something for hugging.

• Assure the child that the parent is being well cared for and you are all doing everything you can to help with recovery. However, be very careful about saying anything that could be construed later by the child as a lie.

Appendix B: Preparing Children for a Visit to a Seriously Ill Adult in ICU

From: How to Help Children Through a Parent’s Serious Illness

Kathleen McCue, MA, LSW, CCLS

General Rule:

If the child wants to visit a sick adult, and the hospital staff says it is allowed, it usually can be a positive event for both the child and the adult, with appropriate preparation and support.

Considerations to decide if the visit is appropriate:

• 1. Does the child want to go?

• 2. Does the sick adult want a visit from the child?

• 3. Can the sick adult tolerate a visit medically?

• 4. Will the hospital permit a visit by a minor child? Check the hospital rules and. then talk to the doctors and nurses about special arrangements.

• A. Why should the child visit?

  • (a) Opportunity to see that the adult is alive and being cared for.

  • (b) Opportunity to achieve closure.

  • (c) Reduce the fearful magical thinking and misunderstandings a child may have.

  • (d) Reduce post-hospitalization anger and regret, especially in situations that are life-threatening.

• B. Preparation at home for the visit.

  • (a) Allows child to have first reactions in a safe place, away from the ICU.

  • (b) Share pictures or drawings and/or describe in detail what the child will see, smell, feel, and hear.

  • (c) Emphasize the emotions the child may experience: anxiety, fear, caution, and sadness.

  • (d) Practice the visit: what can the child take for the adult, what can be said, can a hand be held, will the person be able to respond, what exactly will the child do when the actual visit takes place?

  • (e) Things the child can do at the hospital: tell sick adult about his/her life, school, friends, activities, pets, etc.; give the adult a picture, drawing, poem, or something else created by the child; arrange the adult’s cards on the wall and table or in a book; bring and distribute cookies or candy to the hospital staff; and create a communication book so that visitors can leave messages for the sick adult.

• C. The visit itself.

  • (a) Keep the focus of the visit on the child.

  • (b) Keep the visit short so the child doesn’t sit around worrying or imagining.

  • (c) Help facilitate the conversation with open-ended questions to the child or prompt about the conversation or activities.

  • (d) If the child is old enough, give him/her some private time with the adult.

  • (e) Help the child say “good-bye,” either for this visit or as a final good-bye.

• D. After the visit.

  • (a) Review with the child how the visit went. Help the child to feel good about anything he said or did that might have been helpful to the sick adult.

  • (b) Have a picture of the adult looking healthy, to remind the child of the adult he/she will want to hold in mind.

  • (c) Make a plan for any future visits or activities.

• E. If the child doesn’t want to visit.

  • (a) Do not force a child to visit an adult in ICU.

  • (b) Help the child to create something that can be sent to the hospital, a letter, poem, or picture.

  • (c) Assure the child that the decision not to visit is OK, no need for guilt.