Authors: Jo Anderson, Laura Burton / Editor: Charlotte Davies, Liz Herrieven / Artwork: Seb and Alexander Burton / Codes: / Published: 01/06/2021
Visiting hospital can be scary at any age. Facilitating a positive hospital experience for children is also important because many of them will require further attendances and treatments in their lifetime. We dont want this to be a frightening place for them. 
The application and use of enjoyable physical and mental activities (play), enables us to engage children’s interests and distract children from what is happening around them. “Play can offer many health benefits enhancing physical, social, emotional and mental well being.” Play Therapy is a non-pharmacological method of helping reduce pain and anxiety.
The RCPCH suggests that “Every department for children should have access to a play therapist”.
Do you work in a child friendly department and a child friendly environment?
Does your department encourage play? Does it offer a range of recreational activities for different ages eg. books, magazines, toys? Have you painted some colourful walls or ceiling murals or put up posters, and ceiling mobiles? Older children may prefer a more sophisticated environment -have you put up some age-appropriate posters and decorations? Can you create different colour lighting or different levels of brightness? Do you have appropriate furniture? 
What if they ask “Is it going to hurt?” Be honest but don’t frighten them. That means don’t say you won’t feel a thing, when you know they’ll feel pushing as you pull the sutures through. Phrases like “some children say they feel can something but some children don’t feel anything at all. Why dont you tell me what it felt like after we have finished?”. Whether this is an examination or a procedure, tell them what is going to happen and if you can, show them. Some pictures might be useful. Demonstrate using the unaffected limb, or on a toy. You can tell a story to help explain. Involve them and make your examination fun for them, play a game. Let preschool children show you what to do with the stethoscope – ask them to guess where it goes: “where is your heart?”. Gain their trust by examining the uninjured limb first. Leave the more distressing parts till last. Be adaptive and flexible in your approach. 
Alongside distraction, reduce childrens discomfort during procedures with use of localised analgesia with distraction with analgesia (Emla or Ametop, tetracaine cold spray, sucrose). They may not even know you are doing the procedure!
Adolescents are often referred to as “the forgotten tribe”. They are different from young children but they are not adults. Neither the children or adult area may be appropriate for some of them. Can you provide a quiet, more private area for them? Similarly, do you have less stimulating areas appropriate for children with sensory processing disorders?
Distraction
Distraction is a form of play therapy. Distraction can help children and young people manage their emotions and stress. Distraction can alleviate anxiety, which in turn helps you to complete your clinical assessment, perform investigations and provide optimal treatment. Although initially you may think it means, “distract yourself with this, so that I can do this”, it actually is much more than that. It’s more about focusing your energy on something else to redirect away from upsetting emotions. Think about how children work themselves up when you are going to put in a cannula, if you leave them steam with those upsetting feelings, they reach a peak and it is difficult to return from them. But if you are able to get them to think of something else, then the only true pain, is that fraction of a second when the cannula goes in, if even that. 
Hopefully you now recognise that there are many different ways in which you can help to improve a child’s experience in your emergency department. Whether this is on a departmental level improving the environment by offering visual, auditory and physical distractions, or on a personal level engaging the child in play or discussion.
Don’t forget, little things can make a big impact.
And by making things easier for the child, you are actually making things much easier for yourself too! 
Editor’s Note: You all have probably noticed by now that I quite like hypnosis. And guess what… children are VERY hypnotisable, and most distraction probably has hypnosis elements. A lets pretend story with fantasies about the future cam be useful. Children can use magical thinking in early childhood. If you’re interested in this, I’d recommend attending the POEMS course, joining BSCAH to access the hypnosis and children webinair, and checking out this dentist surgery designed with children in mind.
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Further Reading
References
- RCPCH, Facing the Future: Together for Child Health, 2015.
- National Association of Hospital Play Staff; Guidelines for Professional Practice: Number 7. Sept 2002. NAHPS Reg. C. 1042.
- Hubbuck, C; 2009. Play for Sick Children: Play Specialists in Hospitals and Beyond. MPG books Ltd.