Coping with illness, injury and hospitalization is stressful for even adults. Imagine, for a minute, being a child faced with strange people, bright lights, loud noises and scary looking machines. For many kids and teens the hospital environment invokes a lot of stress and anxiety because they aren’t quite sure what to expect when they get here. Lucky for them Akron Children’s employs child life specialists like Betsy Cetnarowski to help break things down in a language they can understand.
“Since children process information differently than adults, they have distinct needs for managing the effects of stress and trauma,” said Betsy. “Child life specialists are trained professionals with expertise in child development who help children, families and siblings cope with the stress and uncertainty of illness, injury, disability and hospitalization.”
Helping kids cope
As the only child life specialist in the radiology department, Betsy spends her days calming kids who are visiting the hospital for imaging procedures like computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, interventional radiology, fluoroscopy, catheterizations and injections.
“Studies show by offering child life services hospitals can reduce lengths of stay, decrease sedation needs and improve family satisfaction and the overall hospital experience,” she said.
Betsy joined Children’s team in 1995 after having worked for 10 years as a child life specialist at another hospital. She routinely sees 15 to 20 patients a day.
“The most challenging part of my job is there is only 1 of me, and it can be hard when I get pulled in multiple directions,” she says. “Using knowledge of child development and assessment is how I prioritize where my help is needed most.”
Betsy is 1 of 27 child life specialists employed at Children’s. On the Akron campus, all inpatient floors as well as radiology, pediatric intensive care unit (PICU), emergency department, surgery, and palliative care have child life specialists. Three child life specialists cover the pediatrics unit, outpatient surgery and the emergency department on the Beeghly campus, while another provides service at Children’s pediatrics unit at Aultman Hospital.
Today, Betsy is seeing 5-year-old Brock Austin, who is in for a gastro-jejunal (G-J) tube change out with interventional radiologist Dr. Janice McDaniel. G-J tubes have separate ports to access both the stomach and the small intestine. Brock receives food and medicine through his tube.
“Even though this is a fairly routine procedure for Brock, he can still get anxious,” says Betsy. “He gets his tube changed every 3 to 4 months. I’ve gotten to know him and he’s a pro, having been through this procedure multiple times over the years.”
Betsy stays by Brock’s side during the interventional radiology procedure, providing support and distraction, holding an iPad for him to watch his favorite Thomas the Tank Engine cartoon. When he starts to show signs of agitation, Betsy distracts him with pictures of real trains blowing steam on her tablet and encourages him to use deep breathing exercises.
Teaching coping skills
“I try to have that engagement with my patients to help them get through the experience,” she said. “I hope to empower them by teaching them coping skills they may use at other times in their lives.”
Some of those skills involve strategies to use in the moment like deep breathing or preparing patients for what they might see, hear, feel or taste during their procedure or exam. Betsy also uses props and pictures to show kids what they can expect when they enter a room and the equipment that will be used during their procedure.
“I can show them photos of the various radiology machines they are going to be in or the mask that may be used for sedation,” she said. “It’s my job to prepare them using language they understand.”
Today, Betsy has a student – Julianne Blamble from The University of Akron – shadowing her. Julianne is completing a 15-week internship on her way to becoming a child life specialist.
“We have a big student presence in child life at Children’s,” Betsy explains. “I usually have a student with me every other semester. The child life staff feels strongly about continuing child life’s work and teaching the next generation.”
In addition to the hospital setting, child life specialists are employed in hospice programs, early intervention programs, courtrooms, support and bereavement programs, special needs camps and private medical and dental practices. Child life specialists are trained in both child development and psychosocial support. They not only work with patients, but also with siblings, parents and other family members.
Family centered approach to care
“We take a family centered approach,” said Betsy. “Kids can pick up on parental anxiety – if I can get a parent to relax, it will help the child relax as well.”
John Taylor and his 13-year-old daughter have made the all-too-familiar drive from Orrville for a MRI of Morgan’s brain. Diagnosed with a malignant brain tumor 4 years ago, Morgan has been through numerous rounds of chemotherapy and radiation that successfully shrunk her tumor. She now comes every 6 months to make sure the tumor hasn’t grown in size.
“The tumor is still there, it always will be,” explained John. “Dr. (Tsulee) Chen was able to get 85% of it, but Morgan will have to be monitored for the rest of her life.”
Morgan sits down with Betsy to review the MRI process and discuss what kind of music she’d like to listen to during the 45-minute procedure – she picks country. Because Morgan is getting a MRI with contrast, Betsy reminds her of the IV process and some of the options available for her during her MRI.
“Is there anything I can do to make you more comfortable?” she asks. “We can put a pillow under your legs to help relieve any pressure on your back.”
Morgan opts to have some numbing cream applied to her arm veins before getting her IV started.
“I’ve been poked so many times I should be used to it,” Morgan jokes.
When Betsy notices that Morgan’s leg is shaking, John admits she’s been a little more anxious and nervous lately.
“She went through all that chemo and radiation and didn’t miss a beat,” he said. “But lately she’s been having pain again.”
Betsy suggests John follow up with Morgan’s oncologist, Dr. Sarah Rush, who is familiar with the hospital’s Childhood Cancer Survivorship Clinic. The clinic’s staff works to help minimize or cure potential problems, or late effects, caused by childhood cancer and/or its treatments.
Although Betsy doesn’t work on an inpatient unit, where the child life specialists often develop a bond and rapport with their patients and families, she still sees patients like Morgan and Brock on a semi-regular basis.
“I thought by working with outpatients there wouldn’t be much continuity or chance to develop relationships, but that’s not the case,” she said. “We have quite a few patients we see regularly in radiology. It’s helpful to have the familiarity with patients and families to better support them during their exams.”
Betsy stresses it’s the expertise and empathy of the multidisciplinary team at Children’s that makes her job run smoothly.
“Thankfully I work with a team of people who are experts in the care of kids,” she says. “When I can’t be someplace, it’s comforting to know hospital staff is able to help support children as well.”