Child Life Professionals

Child life specialists (CLS) have extensive training in child development, family systems, and evidence-based supportive interventions for children and families facing pediatric illness or injury. CLS play a pivotal role in recognizing and decreasing medical traumatic stress, providing trauma-informed pediatric care, and collaborating with the rest of the multidisciplinary medical team.

Medical Traumatic Stress

Pediatric medical traumatic stress is a set of psychological and emotional responses that children and families may have to medical experiences. Learn more.

Many medical events or treatment procedures are scary or stressful for children and their families. Children and families may come into a given healthcare interaction with their own concerns and fears related to:

their current medical situation, diagnosis, procedures, prognosis
past medical interactions
past trauma or challenging experiences
experiences of discrimination or bias

A trauma-informed healthcare system incorporates awareness of trauma across all aspects of care, with the goals of:

decreasing the potentially traumatic effects of new and unfolding illness, injury, and treatment experiences, and
minimizing distress related to pre-existing trauma exposure.

Child life professionals who work directly within a healthcare setting can help to educate the healthcare team about trauma-informed care and consult on specific cases to assist in the development of appropriate plans of care. Addressing and preventing medical traumatic stress also translates to the work of community-based child life professionals, who may find themselves collaborating with child welfare and other systems in their work.

Trauma-informed care: Child Life’s Role

CLS are integral to providing trauma-informed care and mitigating the potential impacts of medical traumatic stress on patients and families. According to the American Academy of Pediatrics, “Certified Child Life Specialists are primely positioned to assess for, prevent, and alleviate PMTS symptoms in infants, children, youth, and families through play-based, relationship reliant, and individualized psychosocial care,” (AAP, Value of Child Life).

Trauma-informed child life services include:

Realizing the potentially traumatic impact of illness, injury, and medical treatment experiences as well as the impact of prior trauma exposure
Recognizing reactions and behaviors that may indicate pediatric medical traumatic stress, and factors that might place some children at higher risk
Responding by taking action to reduce Distress, promote Emotional support, and address Family immediate needs (See more about the "D-E-F" framework)

The AAP’s official statement on child life highlights several key elements of child life services: procedural preparation, pain-management and coping strategies, the therapeutic value of play, and family support. Speaking to the effectiveness of procedural preparation on traumatic stress, they cite a recent systematic review (Koller, D. 2020) that “concluded that children who were psychologically prepared for surgery experienced fewer negative symptoms than did children who did not receive formal preparation. Findings included a decrease in posttraumatic stress, lower levels of fear and anxiety, increased cooperative behaviors, and better long-term coping and adjustment to future medical challenges” (Romito, B., Jewell, J., Jackson, M., 2021).

The D-E-F framework offers guidance for specific ways to address pediatric medical traumatic stress in the course of medical treatment and provider-patient interactions.

DEF Protocol for Trauma-Informed Pediatric Care

Some examples of the D-E-F framework within the role of Child Life:

Reducing Distress by optimizing pain management, asking about fears and worries, and attending to loss or grief
- For example, regarding pain management: CLS will work with patients to help identify nonpharmacological pain management techniques.
- Provide age appropriate / developmentally appropriate teaching and information pertaining to the hospital, treatment, etc.
- Encourage the child to be given choices, when possible.
- Ask and listen to fears, worries and answer any questions the child may have.
Promoting Emotional support of the child via family members and the healthcare team
- CLS may help child identify coping mechanisms and to adapt to the current situation.
- May engage the child or give caregivers tools to provide distraction during procedures or times of acute pain.
- Help identify barriers to mobilizing the child’s existing emotional support.
Addressing Family needs that can impact child health outcomes
- CLS may help facilitate connection to family, friends, schools and identify ways for siblings to remain connected to caregivers and the sibling receiving medical care.
- Support caregivers and family members so that they can best support their child.

Modulating distress, providing emotional support, encouraging positive coping, and explaining typical developmental recovery processes, Certified Child Life Specialists buffer patients and families against the longterm psychological deficits that can result from hospitalization, alongside the lingering trauma that accompanies it. - The Value of Certified Child Life Specialists, ACLP.

Resources and Trainings for CLS on Trauma Informed Care:

Take our free online courses on PMTS and D-E-F

Child Life and Secondary Traumatic Stress

CLS may also be affected by what they experience while caring for children with illnesses and injuries and their families in the form of secondary traumatic stress, which may affect their lives outside of work. CLS often accompanying them during some of the most difficult moments in their medical journey. It is important to support yourself and your colleagues in identifying and treating STS.

Some resources to help with STS:

Download a slide set on secondary traumatic stress to share with your team
Take a 1 hour online course on secondary traumatic stress
Learn about quick tools for coping with stress related to COVID-19

More Information and Resources

Trauma-Informed Care and Relationship Building in the Pediatric Intensive Care Unit

The Value of Certified Child Life Specialists: Direct and Downstream Optimization of Pediatric Patient and Family Outcomes – ACLP

Romito, B., Jewell, J., Jackson, M. Child Life Services: AAP COMMITTEE ON HOSPITAL CARE; ASSOCIATION OF CHILD LIFE PROFESSIONALS. Pediatrics Jan 2021, 147 (1); DOI: 10.1542/peds.2020-040261

Emotional Safety Initiative

Child Life On Call Podcast

Pediatric Medical Traumatic Stress

Patient Education

Screening & Assessment

Intervention

Trauma-Informed Care

COVID-19

Resources