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Children's Palliative Care Foundation
Children's Palliative Care Foundation

Sunshine Kids

Sunshine Kids

Can Kids Sit through a Medical Examination?

What would medical toys, medical tools, photos, video clips and cloth dolls associate you with? These items may be common enough, but put together, they are important tools used by the child life specialists for preparing young patients to cope with various treatment procedures.


When a child falls sick and is hospitalised, a myriad of tests and check-ups such as blood work, X-ray, ultrasound or CT scan inevitably follow. These tests are no big deal to an adult but for a child, they could be intimidating. Take CT scan for example, the child has to lie flat on the bed, motionless, for five to ten minutes; any slight movement would affect the efficacy of the exam. Children do not understand how the exam process works and they don’t know how to cooperate with medical personnel, so they get anxious and afraid.


To enable examinations be carried out smoothly, doctors have no choice but to sedate them, so they can be examined in their sleep. Occasionally, the child cannot be sedated and might need a heavier dosage of medication in order to carry out the examination. In this case, it will increase the chance of the child getting sick from any side-effects. One of the functions of the child life specialists, within the paediatrics team, is to help children conquer their fears and anxieties, and boost their confidence so that they may keep calm without the aid of medicine, thus avoiding its potential side-effects.


Pre-check-up Preparation and Assessment

The child life specialists use age-specific teaching tools such as toys, puppets, story books, models, medical equipment, etc., to give step-by-step explanations to the child on the examination procedures. During the preparation, the child life specialists also observe the patients’ doubts and concerns on the procedures, and help them choose a method that will best suit their needs. They will also discuss with the medical team to determine if the child is suitable for an examination without sedation. Since parents’ support is critically important to the success of the treatment, the child life specialists always explain to them in great details on the treatment procedures and how they could help to support their child in completing the treatment.


The Story of Yan

Yan (pseudonym) is a four-year-old patient suffering from brain cancer. Before he was diagnosed, he had gone through umpteen tests and examinations, big and small, and developed a great fear for medical personnel in general. When the child life specialist first met Yan, he was reticent and resisted to any kind of contact with people. After many encounters, the specialist helped Yan to express his feelings about the treatment and he gradually understood what he had gone through. When it came time for Yan to receive radiotherapy, we focused on the procedure and further explore his anxieties and capabilities in withstanding the treatment. Yan indicated that he didn’t like wearing the head gear because it blocked his vision and coupled with the separation from his parents which made him really scared. Considering his concerns and after a series of assessments, the specialist decided to cut holes around the eyes of the head gear to allow him to see and his mother talked to him through a PA system to calm him down during the treatment. As a result, Yan was able to successfully complete 30 sessions of radiotherapy without any medication.


Cooperating and Communicating Closely with Medical Team

For a child patient to undergo examinations without any medication, it requires the concerted effort of a close-knit medical team. This is why the child life specialist always communicates and coordinates with medical personnel prior to the examination. During the treatment, the child life specialists will use the method chosen by the patients to help them cope with the process, accompany them and encourage them to cooperate with the medical staff to complete the examination. In the past few years, child life specialists have been proactive in communicating regularly with various departments such as radiotherapy and anaesthesiology to swap notes and viewpoints, and to further understand their work process so they may achieve the best result in their collaboration.


The Advantages of Reducing Sedations for Child Patients during Examinations

During 2016, CCF’s child life specialists supported 33 child patients in five public hospitals, aged 12 years and under, to go through radiotherapy. Out of those, 27 managed to cope with the treatment on their own – a most encouraging result. The youngest of them was only three years old. In the case of United Christian Hospital, in 2016, our child life specialists helped 49 child patients, aged between four and eleven, to do assessment and preparation for their MRI and ultimately 40 of them managed to complete it without sedation. The specialists also assisted 196 child patients, below the age of three, taking ultrasound; of those only 14 children needed sedation. These results show that with the appropriate support, majority of the children can quietly sit through any kind of medical examination.


The fact remains that there are many distinctive advantages to the treatment process when the child patient does not require medication for examination. The time for hospitalisation is reduced, which correspondingly reduces the demand on medical resources and the pressure on the medical team. More importantly, this minimises the discomfort that could result from the use of medication on the patient. And, most importantly, when child patients find their own way of coping with difficulties and building their trust in medical personnel, they are much more likely to succeed in dealing with future treatment.


CCF Newsletter Vol.52 (Jul 2017)