Intro to Child Life
Final Exam Review:
How are Boundaries Established for Professionals?
Licensure or certification
Ethical standards for individual professions
Implied assumption that professional relationships are to be kept
professional, not personal.
Child Life Code of Ethics:
Individuals shall hold paramount the welfare of the children and families
whom they serve.
Individuals shall strive to maintain objectivity, integrity and competence in
fulfilling the mission, vision, values, and operating principles of their
Individuals shall have an obligation to serve children and families, regardless
of race, gender, religion, sexual orientation, economic status, values,
national origin, and disability.
Individuals shall respect the privacy of children and families and shall
maintain confidentiality of information concerning the children and their
families with who they work.
Individuals shall promote the effectiveness of the child life profession by
continuous efforts to improve professional services and practices provided in
the divers settings in which they work and in the community at large.
Individuals shall continually seek knowledge and skills that will update and
enhance their understanding of all relevant issues affecting the children and
families they serve.
Individuals engages in study and research shall be guided by the
conventions of scholarly inquiry and shall recognize their responsibility for
ethical practice in research.
Individuals have an obligation to engage in only those areas in which they
are qualifies and not represent themselves otherwise, but to make Intro to Child Life
appropriate referrals with due regard for the profession competencies of
other members of the health team or of the community in which they work.
Individuals shall act with respect for the duties, competencies and needs of
their profession colleagues and shall maintain the utmost integrity in all
interactions with the institutions or organization that employ them.
Individuals shall recognize that financial gain should never take precedence
over the delivery of services.
Individuals who are responsible for the supervision and training of others
(i.e. staff, students, and volunteers) shall assume responsibility for teaching
ethical profession values and providing optimal learning experiences.
Individuals shall refrain from illegal conduct in their profession practice of
The Importance of Play:
Universal right of childhood; necessary for development
Natural mode of communication (adults use words, children uses toys)
Definition of Play Therapy:
The systematic use of a theoretical model to establish an interpersonal
process wherein trained play therapists use the therapeutic powers of play to
help clients prevents or resolve psychosocial difficulties and achieve optimal
growth and development.
Definition of Play Therapist:
A licensed mental health professional who has earned a master’s or
doctorate degree in a mental health field with considerable general clinical
experience and supervision. To be a Registered Play Therapist (RPT), one
must have advanced, specialized training, experience, and supervision.
Axline’s Basic Principles:
1. Warm, friendly relationship with good rapport.
2. Accepts child
3. Feeling of permissiveness, which allows child to express self
4. Reflect feelings so child gains insight Intro to Child Life
5. Respect for the child-his/her responsibility to make choices and
6. Child leads the way; therapist follows
7. Does not attempt to hurry therapy along.
8. Limits only necessary to anchor the therapy to the world of reality and
make child aware of his/her responsibility in the relationship.
• Therapeutic play
• Short term
• More directive
• Inconsistent relationships
• Child developmental theory
• Immediate issues
• Developmental goals
• Developmental agenda
• Open format
• More preventative
• Focus: process of play to master developmental milestones and critical
• Play therapy
• Long term
• More non-directive
• Consistent relationships
• Counseling theory
• Larger dynamics
• Long-term coping
• Treatment agenda
• Closed format
• Pts in distress
• Focus: address basic and persistent psychological issues.
Pediatric Pain Management
History: Intro to Child Life
Pediatric pain has been undertreated.
Infants do not feel pain in same way as adults – pain response is reflexive
and no processed or remembered.
Pediatric pain gained focus in the 70’s – it was found that children got far
less analgesia than adults who were undergoing the same operative
Restraint or pappoosing, but no sedation was used for infants undergoing
International organization for the study of pain – www.iasp-pain.org.
3 Basic Ways to Measure Pain in Children:
Commonly Used Pain Scales:
Faces pain scale
• Recently revised – now shows more neutral faces. Dow not have that
final face with tears. More realistic.
Numeric Rating Scale
• Best used for children 8 years and above.
• “On a scale of 1-10 with 1 being no pain at all and 10 being the worst
pain you can feel, what does your pain feel like now.
• Face, legs, activity, cry, and consolibility.
• For infants
• Rates displays of distress – grimacing, crying, rigid limbs.
• Each of the five categories is scored from 0-2, then all points added for
a total score of 0-10
Challenges to Rating Children’s Pain:
Children and teens have trouble describing pain due to limited vocabulary
and experience. Intro to Child Life
Children may see pain as a consequence of bad behavior or something they
did wrong – punishment.
Children may under report pain if they are unsure of how pain will be
Adult modeling of pain management – stoic attitude, “just get it done,”
“walk it off,” dramatic responses.
Considerations for Child Life Assessment and Intervention:
Past medical experiences
Perceives parental anxiety and coping ability
Can we reduce sensory overload – less people, voices, lighting, silence
• Facial expression
• Furrowing brow
• Open squared mouth
• Robust crying
• Generalized ridgitiy and thrashing
• Pushing away stimulus (older adults)
• Withdrawal of area in pain
• Verbal cues
• Lowered distractibility
• Focus on pain sensation
School-age/adolescent: Intro to Child Life
• Verbal cues
• Facial expressions
• Change in affect
Pharmacological Pain Management:
Medications prescribed by medical professionals
Child life may advocate for:
• EMLA/LMX – topical analgesia creams
• LET Gel – topical analgesia cream used in open wounds
• Cold spray – VapoCoolant
• Lidocaine – J-Tip
• Sweet Ease – Sucrose for infants
Non-Pharmacological Pain Management:
Preparation – stress point identification
Positioning for comfort
Swaddling – infants
Breastfeeding – infants
Gate theory techniques – buzzy, magic glove, switch
Things That Effect How Child Life Specialists Treat and Work with
• How many staff members are there
• how much time is allowed before procedure and after
• You cannot always be in charge
• important if time allows Intro to Child Life
• good to know what went well
• what didn’t go well
• clearing up any misconceptions
• trying things out that they may see, such as tape and masks
• smelling the things they will smell during the procedure, such as
• sensory is important
• things have to be age appropriate
• building rapport with children and family
Preparation for Families:
• Parents are just unfamiliar as children
• Praising the patient work well
• Give them suggestions for next time
Not a lot of research has been done one specific types of preparation.
A lot of preparation is explaining and describing things.
Teaching coping skills is an important part of child life.
• Coping skills and self-care are important aspects of working as a child
life specialist as well.
• Coping skills are important not only for children that are patients but
siblings and parents.
Child life works with children with developmental and intellectual disabilities
as well as their families.
There is no minimum age for a child to be able to receive child life care.
Child life is a non-billable service.
Child life can be expanded to many very different aspects of family-centered
You have to be able to recognize what parents are bringing into the
Child Life in the ER:
Many times, child life specialist is part of phase one care for children who
come into the hospital in an emergency or trauma situation. Intro to Child Life
Child life specialist is with the child from the moment they get to the hospital
until treatment is provided.
“ducking and dodging”
Child life specialist tag team with social workers often in emergency room
Talk through what happened when the dust of the emergency settles.
Knowing protocol is important especially in the emergency room
Modeling is very important to child life.
People make primary and secondary appraisals.
• Primary appraisal: am I in trouble? What is happening?
• Secondary appraisal: can I do anything about this? What can I do
Assess the situation, assess the room, assess the people, etc.
Comfort positioning – making something as comfortable as possible utilizing
family and child life specialist.
• Hasn’t always been practiced
• Has come a long way
• Used in most hospitals
• Big with children’s hospitals
• Leads to more positive experience
• Empowering families
• Parents involved in the decision making process
• Peer to peer support
• Parent to parent support
• 24-48-hour post-discharge phone call
• Respite care
• Care to siblings
• Referral services
9 Elements of Family-Centered Care:
• Recognize that the family is the constant in a child’s life while
healthcare professionals and service systems change. Intro to Child Life
o Ask parents daily for their priorities and their assessment of the
plan of care
o As how they want to be involved in their child’s care
o Encourage parent/child to relay information to the healthcare
o Situational awareness – parental concerns are escalated for
assessment of a higher level of care.
• Facilitate parent and professional collaboration at all levels of care.
o Nurture mutual respect for skills, knowledge, and care
o Partner daily in delivery of service.
• Honor the racial, ethnic, cultural and socioeconomic diversity of
o Be aware of personal values, beliefs, biases that may impact