Heading to the hospital can be scary and overwhelming for both kids and their parents. According to Akron Children’s pediatric hospitalist Michael McCabe, it helps to keep the lines of communication open among all involved.
“We try to have some flexibility in how we initiate treatment plans,” Dr. McCabe said. “We don’t just say, this is how it’s going to be. We try to include the family so we are a team trying to get the child better.”
Dr. McCabe, who practices at Aultman Hospital, offered tips about pediatric hospitalization in a recent radio interview for “Health Matters with the Medicine Center Pharmacy” on WHBC AM.
WHBC: How can we help kids and their parents feel more comfortable if they have to have a hospital stay?
Dr. McCabe: You have to wonder how a child perceives the whole thing because it’s got to be weird. The environment is so different from what they are used to. They’re thinking, “I don’t want this IV in my arm,” “I don’t want this oxygen mask.”
We can’t be accommodating when it comes to basic treatment but the key is to create an atmosphere where the child and family feel their needs are being addressed. We try to create comfort when we can and allow for some decision-making by the child.
WHBC: What do hospitalists need to get familiar with the child’s medical background if you are seeing them for the first time?
Dr. McCabe: With electronic medical records, kids will sometimes be in our system so we can access that. For me, if someone knows the timeline, or what medications and dosages they were on, it can be so helpful. Also knowing if this is something that has happened before can make the real difference.
WHBC: Can parents bring comfort items from home like a child’s own pajamas, favorite blanket or stuffed animals? And is there anything you specifically recommend they bring?
Dr. McCabe: Comforts from home like the favorite binky, blanket or stuffed animal are always allowed and a good idea. However, it seems these things proliferate because any child who’s in the hospital for 2 days seems to go home with at least 7 stuffed animals and a couple of new blankets.
Things that give the child a sense of familiarity are helpful. When they wake up and can’t remember where they are, those give them a sense of comfort. We encourage families to do what they can to help their child feel more comfortable during their stay.
WHBC: Can you explain the role of a child life specialist and how they can help explain to a child what to expect during a hospital stay?
Dr. McCabe: Child life specialists are a very unique group and Aultman is one of the few community hospitals in the country that have them on staff. Usually you have to be in a children’s hospital to have them. Aultman’s emergency room has 2 child life specialists and our unit has one.
On our unit, Rachel is our “child whisperer.” She listens to rounds, follows treatment plans and helps explain them to families. She really helps distract the children in a creative way. For example, one little girl wouldn’t drink so Rachel devised a drinking game by drawing a line, coloring it and taking a drink, the girl would follow suit and before you knew it the girl drank the whole prescribed bottle.
Another patient who didn’t want to take deep breaths because it made him cough was given a straw with paint in it. His task was to blow on the straw on his paper to make a picture. His siblings and every one else joined in and his oxygen levels improved because now he was taking deep breaths.
Solutions like these take time, relationship and creativity. These specialists help families feel comfortable while allowing us to do what we do.
WHBC: Is a child life specialist trained as a nurse or some other specialty?
Dr. McCabe: No, they are a separate certified specialty, either bachelor or master’s prepared. They are trained in child development and pediatric health systems.
WHBC: As far as strategies to help parents juggle work, home and a hospitalized child, do you have any advice?
Dr. McCabe: The theme of our treatment plans is the same for us as the family – the hospitalized child takes precedent. They are No. 1 and we try to build what is needed around that.
Sometimes work situations may not allow the family to be there all the time so they’ll communicate that to us. Having someone familiar there, especially when procedures are done is extremely helpful. If someone can be there to help with the day-to-day things like reading a book, playing a game or watching a movie, this can help make the child feel more comfortable.
WHBC: What advice would you give parents to explain what’s going on for kids at home?
Dr. McCabe: Keep it simple and just explain the why. Things like, “Your sister is there because she needs medicine through an IV into their bloodstream because they can’t take it by mouth yet.” Or, “They’re on oxygen to help them breathe better because we don’t have that at home.”
Then really try to explain that the hospital is a place that offers a little different level of care than we can do at home versus focusing on the serious of the illness.
WHBC: Are siblings allowed to visit or are we experiencing a situation now where visits could be influenced by the flu?
Dr. McCabe: No, I don’t think that hospitals are on the influenza watch yet but once flu hits that does curb visitation. Besides that, we encourage visitation.
We offer a game room that is an oasis within our unit donated by a local family, the Seth’s, in memory of their daughter. Jayani’s Treasure Chest is where families can get together and get away from the hospital room or siblings can hang out while the doctors talk to the parents. We encourage siblings to come but they get bored too, so we try to be sensitive to that as well so it doesn’t get in the way of the care.
WHBC: What other precautions do you ask of visitors?
Dr. McCabe: For controlling communicable disease, washing your hands or using a hand sanitizer is very helpful as well as habits like sneezing into the elbow area. Families ask about what they should do about the home environment such as, should they spray Lysol in the air. Although these germs are air born, they drop, so spraying it in the air won’t do anything.
It’s smart to sanitize surface tops, toys, areas that are touched and handled. Educating families is important so that we all can be practicing proper hygiene especially when someone is ill.
WHBC: Can you explain some of the more common hospital diagnostic tests and what they are used for?
Dr. McCabe: Most commonly you have your standard screening tests, blood counts, and urine analyses, chest radiographs. We have the ability to do CAT scans and ultrasounds and all kinds of things but the big push in pediatrics has been less is more.
Oftentimes, I try to think whether a test would change what we are going to do right now for this child. Do I need to know what this is? Since it’s a poke, a dose of radiation, we think through it and often rely more on the clinical exam.
If it needs to be done, Aultman has certified phlebotomists trained to draw blood and nurses trained to catheterize children or start an IV.
WHBC: Talking about how lucky we are to have the Akron Children’s Hospital pediatric unit at Aultman, can you tell us more about it? How many things do they offer there that help us keep a child local?
Dr. McCabe: The goal for having this unit is to be able to offer care close to home. The vast majority of kids when they’re sick don’t need specialists, intensive care units and things like that. If things are more accessible and you can catch them early, oftentimes you can prevent things from worsening.
We have a 20-bed capacity and a full staff of pediatric trained nurses, medical assistants and additional staff from Aultman such as respiratory therapists who are trained in pediatrics. There are a core group of 3 hospitalists who work primarily in Canton and 6 other hospitalists from Akron Children’s who work with us in a similar setup in Wooster.
What makes our unit different is that we are a level 2 unit, which means we take care of sicker kids including those who are on oxygen, need careful monitoring, have bloodstream infections, have out of control diabetes. We manage children who don’t need intensive care but are close to that line because of our incredible team.
WHBC: Should a child up to the teenage years see their office-based pediatrician once a year?
Dr. McCabe: Yes. Every now and then something will pop up and to say that wasn’t there last year really helps us know how to go forward, as opposed to I saw you 5 years ago and the diagnosis could be anything.
WHBC: Any parting words for parents and caregivers on what they need to do to keep their child as healthy as possible to avoid hospitalization?
Dr. McCabe: There’s still nothing that works better than having a great home routine and to have clear air in the house. A lot of our respiratory kids are exposed to cigarette smoke and that makes a huge difference. Having good nutrition and regular care is important and leads to parents being educated on their child’s specific health care needs.