Extended hospital stays aren’t fun for anyone, especially young patients. But child life services programs can help children break free from the hospital and just be kids again.
Like Brinley Jungnitsch, a 6-year-old patient with acute myeloid leukemia who is receiving treatment at University of Michigan C.S. Mott Children’s Hospital in Ann Arbor. Sitting on the floor with music therapists Meredith Schlabig and Susan Smiddy, Brinley plays a violin, ukulele, and drum with ease. Known around the hospital as “Brinley the Brave,” she serenades the group with “Twinkle, Twinkle Little Star.”
Music therapy sessions such as Brinley’s are provided by board-certified music therapists who are part of the Child and Family Life Department, which encompasses child life specialists; music, art, activity, and recreational therapists; and educational specialists who work with children and their families to make their hospital stay more comfortable. It aims to alleviate pain and stress by addressing emotional needs.
Brinley has a 30- to 45-minute music therapy session two to three times per week. Her favorite song to play is Rachel Platten’s “Fight Song,” fittingly about never giving up. Schlabig, who has worked with Brinley for a year and a half, says the child’s evolution has been remarkable.
“We gave her control for empowerment and normalized what she shared,” she says. “I’ve seen Brinley blossom from someone who was originally shy and scared of her environment.”
Through active interventions, such as playing music or songwriting, and passive interventions, like listening to or discussing music, patients are provided outlets for safe release of emotion. Songwriting can be especially helpful with self-expression.
“I like to describe music therapy as taking music to achieve a non-musical goal,” Smiddy says. These goals can be emotional, such as in Brinley’s case, or physical, motor, cognitive, or speech-related. But it’s all about being creative.
“There’ve been multiple times where we’ve seen blood pressure decrease or agitated kids go to sleep when nothing else reaches them,” Smiddy says.
The Benefits of Creative Therapies
Through art, music, virtual reality, and pet therapy, along with educational programs and curated events and visits, children are given the childhood they’re otherwise missing out on. Integration into the hospital becomes less complicated and scary because of special socialization therapies that teach children about their diagnosis and treatment.
“In the hospital setting, I think we forget that kids are first and foremost kids,” says Divna Wheelwright, DMC’s Children’s Hospital of Michigan child life services manager. “They become a child with cancer, or a child who has been in a devastating car accident.”
Instead of fusing with those identities, children have spaces where they can be themselves, a crucial component because they’re still developing. At DMC, they’ve added an art therapist and will have a music therapist soon. In an atmosphere that often creates an overwhelming loss of control for families, child life services can help give it back.
It’s a relatively new field, with it beginning to grow in the 1960s (first programs date back to 1920s) with significant research taking place in the last decade on child life intervention as a mediating factor in patient’s perceptions of pain and control.
“Child life services is on the rise because we know those relationships are there,” Wheelwright says.
In the oncology and hematology floor activity room at Mott (as well as in playrooms and bedside on several floors), patients are immersed in gaming and virtual reality. There are five different VR rigs here, including two HTC Vives donated by charity GameChanger and an Oculus Rift and MSI computer donated by the Eric Hartwell Foundation. The VR program launched in November 2015 and has grown to become one of the hospital’s most celebrated nontraditional outlets.
Three times a week, three employees from Game Start, a local school that teaches kids to code their own games, go to patients’ bedsides to provide them VR experiences, and they also visit the activity rooms. Large gaming parties are held in the Family Center.
“We want to make sure when we set them up with the video, it’s exploratory but not too intense,” says Antonio Perez, Game Start project manager.
Sessions typically last 45 minutes, and patients will usually play for about 10-20 minutes before taking a break and trying a different program. Some VR experiences encourage upper and lower body movements that can have therapeutic benefits, but some do not. “Patients have to be active; they have to engage their cores,” Perez says. He recalls a patient in mobility recovery whose goal of being out of his wheelchair for 10 minutes was beat by 45 minutes playing a VR game.
Game Start teaches patients how to program their own video games and VR worlds using a program called Unity. Mott also uses an app called SpellBound that uses a technology called Augmented Reality. The app allows the user to focus their phone on cards that have pictures of animals, which makes digital animals appear to be walking around in the real world.
“It takes them out of the room entirely,” Perez says. “They’re no longer a patient; they just get to be a kid again.”
Kids also benefit from art therapy, such as the weekly sewing group where children create pillowcases with the help of art therapists and fellows. “It really gives them a sense of control,” says art therapy fellow Raja Aossey, while she helps 5-year-old Addysen “Addie” Johns make a pillowcase. “They gain a new ability they can be proud of.”
“I’m a champ at this,” says Addie with a big smile on her face. She recently made a reindeer pillowcase, but today she’s working on a puppy one. The art therapy program also includes drawing, painting, photography, and sculpting. There are daily art programs, art galleries, and pop-up shows that are often done to provide patients with the opportunity to share artwork they created during their stay at the hospital.
“It’s good for the kids because it takes their mind off of why they’re here in the hospital,” says Candace Cobb, whose 2-year-old son, Steven, is being treated at Mott for neuroblastoma cancer. It doesn’t just help the patient but the whole family as well.
For Steven’s two siblings, who are three hours from their home in St. Joseph, the children can socialize with other siblings: child life services holds family nights complete with pizza, movies, and art.
Along with helping young patients be kids again, special socialization therapies can also help children learn about their diagnosis and treatment, easing some of the stress and anxiety.
The DMC is researching the relationship between child life intervention and the need for patient sedation in MRI. Through the MRI Can Do It program, they saw a significant reduction in sedation rates, down 30 percent from 2015-16.
“Our patients are going through MRI without drugs and coping,” says Wheelwright of the DMC.
The program provides a tailored approach that educates patients on what they’re going to experience. “When patients are sedated, it comes with a host of stressors: They’re cranky, they can’t eat, they’re nauseous,” she explains. “We have a knee-jerk reaction to sedate children because how can a 5-year-old lie still for an hour?”
It’s possible, Wheelwright says. MRI Can Do It is a family-centered initiative that aims to maintain the connection between patient and caregiver throughout the health care experience and approaches MRIs from a non-sedate perspective, with preparation and support from a child life specialist during the scan, Wheelwright says.
One socialization concept, called “medical play,” is used to clear up misconceptions about health care experiences as well as get a better understanding of what the patient’s fears may be. One form allows patients to act out their misconceptions on a doll.
“What emerges through this play are a lot of questions that the patient might not know how to express,” Wheelwright says. “Often what you’ll see is clear confusion.” For example, a child might place an IV between the doll’s eyes instead of its arm.
Little actions make huge differences, too. Blowing bubbles with patients promotes deep breathing, which has been shown to decrease perceptions of pain. However minuscule these actions seem, they can be invaluable.
Specialists also provide guided imagery, an intervention that focuses and directs the patient’s imagination. Guided imagery engages the patient’s physical body, emotions, and senses to promote healthy coping. One example is prompting the patient to visualize a beach and then discussing the patient’s perception of sounds, smell, and emotional response, Wheelwright says.
Still, it can be hard for children in hospitals to verbalize their feelings. One method to explain without words and release pent-up emotion is through syringe painting, where patients fill syringes with different colors and squirt them against sheets on the wall.
“As the experience of hospitalization often evokes feelings of loss of control, allowing patients the agency to release their feelings in this way can be cathartic,” Wheelwright says.
Another method for self-expression is through art therapy, such as filling outlines of the human body with different colors for different emotions. One child, Wheelwright recalls, colored the hurting part of his body yellow because being with caregivers made him happy.
“We don’t give kids enough credit for what they understand,” she says. “I think because of the poignancy of the hospital setting, children and families are actually forced to deal with life. The quality of joy and laughter and happiness, all of those are heightened here.
Nonprofit Aims to Improve Hospital Life for Families
By Isabella Hinojosa
Ten-year-old Jonny Hendricks likes to paint, participate in the science Olympiad, and attend school dances. However, for the past four years, Jonny has been in and out of the hospital for chemotherapy, making it difficult to do his favorite things.
When Jonny was 6, his mother, Samantha Hendricks, discovered a rash on his leg and took him to the Clarkston emergency room from their home in Holly. After examining Jonny, their doctor called an ambulance to take him to Beaumont Children’s Hospital in Royal Oak.
The next morning, Jonny was diagnosed with acute lymphocytic leukemia and spent 11 days in the hospital undergoing testing and treatment. During his stay, he did arts and crafts at the front desk. When he asked where the supplies came from, he was told the Children’s Miracle Network had donated them.
The Beaumont Children’s Hospital in Royal Oak is the only Children’s Miracle Network hospital in southeast Michigan. The nonprofit network, which consists of 170 partner hospitals in the U.S. and Canada, helps raise money to fund treatment, services, and pediatric care equipment. Since 1983, Children’s Miracle Network Hospitals has raised more than $5 billion.
Jonny first met network specialists in The Child Life Garden, which was donated to the hospital by CMN. The space was designed to give children in the hospital a place to play video games, watch movies, make arts and crafts, read books, and play with other children and toys.
Two years into Jonny’s treatment, the family met Kayla Rezmer, one of Beaumont’s seven child life specialists, who holds special events for patients as well as helps children and their families understand the treatment process in an effort to reduce anxiety and trauma.
Jonny’s treatment required regular chemotherapy, clinic visits, and “back pokes,” the name he gave his spinal taps. Nurses told Rezmer that Jonny was anxious about his intravenous chemotherapy. “Jonny is a very, very smart kid, so I had to trick him a little bit at first,” says Rezmer. She built upon Jonny’s interests in science with word games to distract him from the uncomfortable IV placement. “Eventually he would just put his arm out,” Rezmer says.
CMN has helped Samantha, too. “Having someone else to talk to was wonderful,” she says. “They showed different ways to cope and relax.” There were times that Samantha was unable to be at the hospital with Jonny. She says having someone to keep him company while she was away helped, even if it was only so she could go for a walk or pick up food.
Jonny finished his treatments in December and is back in school. When Jonny has to come in for occasional clinic visits, Samantha says she and Jonny still get to see Rezmer and the rest of Beaumont’s CMN staff. “They make you feel like family,” she says.