Child-Centred Paediatric ER Helps Ease the Fear

Your daughter has been vomiting throughout the night. You take her temperature and discover it’s much higher than it should be. Her illness has gone on for too long. You decide to take her to the Emergency Department. Thoughts of going to Emergency as a child fill your head. You can still feel the cold, hard chairs, the antiseptic smell, and the depressing green walls. You remember the fear that gripped you when your turn came to see the doctor. You look over at your daughter and wish she didn’t have to go through this experience. When you arrive at the new ER at St. Joseph’s Health Centre in Toronto, you are pleasantly surprised…

Recognizing that a visit to the Emergency Department, although one of the most common experiences a child will have with a hospital, can also be a traumatic event, St. Joseph’s has created a separate Paediatric Emergency Department.

The Paediatric ER is part of the recently renovated and expanded department, which opened in April 2002. The new Emergency Department features four separate “mini” ERs for Paediatrics, Urgent Care, Ambulatory Fast Track and Mental Health. All four are separate, distinct areas, with their own treatment and waiting rooms. The mini ER concept allows for specialized staff and resources to stay in that particular area. It is a better functional work environment that allows them to spend more time and improve the quality of care for patients.

As a Regional Paediatric Centre, St. Joseph’s has a team of specialized physicians, nurses and child life specialists to meet the specific needs of children. With the new Paediatric ER, they now have a child-friendly space to provide their care. The separate space also protects children from the often-frightening situations that occur in general emergency departments. To a child the ER is a place where they go when they are hurt or very sick. It is filled with strangers wielding unfamiliar, possibly scary objects, who ask questions they don’t understand. At St. Joseph’s, the ER features a fish tank, plenty of toys and colourful walls to help children feel more comfortable. The walls are decorated with artwork appropriate for children to create an environment that is less clinical and more familiar. Since a child’s “job” is to play, there is an area devoted specifically to this, with many toys available. Families often accompany a child to the ER so there are larger waiting areas, exam and treatment rooms. Specialized suturing and casting rooms as well as a breastfeeding/family room have also been created.

More importantly, because St. Joseph’s understands a child’s emotional needs must be cared for as well as their physical condition, a Child Life Specialist is on-hand to provide psychosocial support to children and their families. The Child Life Specialist meets with families and explains to them in a child friendly manner what is going to happen, and prepares them for any tests or procedures they may have to undergo. Preparation often involves explaining and showing children and parents the medical equipment, how the procedure is completed and giving opportunities to ask questions. This educational process frequently eases fear and makes both the child and the adults accompanying them more comfortable.

One of the most important functions of the Child Life Specialist is to provide diversion. For example, bubble blowing, interactive play or looking at books are some of the tools used during procedures. While the child is distracted, he/she is more comfortable and more cooperative with medical staff. After a procedure the Child Life Specialist rewards children with stickers or certificates of courage so they can feel a sense of accomplishment.

By providing care in an atmosphere and manner that allows children to be children, we can hopefully make the hospital experience more positive.