To Stay Still
Child Life Specialists Help Children Cope With Lengthy Imaging Procedures

BY KATHARINE MILLER

Using dolls and miniature equipment, child life specialist Ellen Vanderwilt shows 8-year-old Brittany Thompson what will happen during her MRI scan.

FALL 2002 - The patient is Sally, a redheaded doll. The technician is 8-year-old Brittany Thompson, who is learning to give an MRI scan, with the help of Ellen Vanderwilt, a child life specialist in the new pediatric MRI/CT suite at Lucile Packard Children's Hospital.

Brittany places the doll on the sliding table of a miniature MRI machine.

"Let's put the seat belt on Sally," says Vanderwilt. "It keeps her nice and safe." Brittany pulls the Velcro belt across the doll's belly, fastens it snugly, and slides the table into the wooden MRI.

"Do you know what Sally's job is during the MRI?" asks Vanderwilt.

"To stay still," Brittany says.

Only At a Children's Hospital

About 20 times a week, Sally and a variety of similar dolls receive MRI and CT scans under the direction of pediatric patients and a child life specialist. Packard's team of child life specialists have an extensive background in child development and recreation therapy and are trained to ease children through a variety of medical procedures. By putting children like Brittany in charge of a doll's scan, the specialists help children cope with stressful imaging sessions that can last up to one hour.

Packard's pediatric MRI/CT suite is the first imaging facility in Northern California dedicated exclusively to children, and child life training is an integral part of the program. The facility was funded, in part, by a corporate gift from Advanced Micro Devices, Inc. (AMD). An anonymous donor made an additional gift to support the work of child life specialists in the suite.

Child life specialists play an especially important role in the MRI/CT suite because they often can eliminate the need for children to be sedated during an MRI procedure. The specialists also help parents by modeling ways to talk about the scans to their children. And they teach technicians to explain the procedures in ways kids can understand. It is the kind of service only a hospital dedicated to children can offer.

"Our goal is to empower the child," says Kirsten Cotten, a child life specialist who works with MRI and CT patients. "We want them to understand what they're going through."

With advances in medical imaging, physicians have come to rely more and more on MRI and CT scans. Indeed, requests for these imaging services have nearly doubled in the last five years because the tests' diagnostic capabilities have increased. The tests now can image many different parts of the body, more easily identify problems early in the course of an illness, and help determine if treatments are working.

According to Pat Barnes, M.D., chief of Pediatric Neuroradiology at Packard, child life specialists make all the difference for children undergoing imaging procedures. "We get diagnostic quality scans without sedation. And the kids go away feeling comfortable with the hospital environment," he says.

Tailoring Needs To Fit Each Child

Brittany gets ready to enter the MRI machine. The scan will last approximately an hour.

Vanderwilt explains to Brittany that the MRI takes pictures sort of like an X-ray machine does. In Brittany's case, the radiologists will take pictures of her head to determine why she suffers from migraines. The procedure will last about an hour.

"This camera makes really loud noises," Vanderwilt says. As she describes what will happen in the MRI room, she tries to determine whether any aspect of it bothers Brittany.

Although painless, MRI and CT scans can be scary. According to Cotten, "Kids tell you pretty quickly what their fear is. You can tell what their trigger point is by their reaction to the equipment or their willingness to play."

Brittany's concerns aren't obvious at first. She's confident that she can lie still, declining the opportunity to practice by lying on the floor. And she is unperturbed by the tape of the MRI's hammering noises, an annoying racket that disturbs some kids. But she nods vigorously when Vanderwilt asks if she'd like her mom to touch her during the scan. Some youngsters just don't like the feeling of being alone inside a machine.

"We tailor our efforts to fit each child," says Cotten. "We're both support person and distracter. If they need bubbles, we've got bubbles."

To Brittany and many others, Vanderwilt suggests that the child picture her favorite place while breathing slowly. Older kids might prefer listening to music on headphones.

Occasionally Cotton and Vanderwilt offer playful ways to get through an hour on the scanning table. They might suggest that the child pretend to be a statue, or Snow White sleeping. Some children have ideas of their own -- like being frozen by a Sorcerer in the Harry Potter books.

"Sometimes I'll start a story with them and say I'll finish it when they come out," says Cotten. "That way they have something to think about while they're in the machine."

Replacing Fear With Understanding

While keeping things fun, the child life specialists' primary goal is to make sure youngsters understand the experience.

"Children have a right to know what's happening in an appropriate language for them so that they can feel in control," Cotten says. "We're factual but not scary factual.We explain the truth: The machine is not going to hurt you. If you move, they just have to take the pictures over again," she says.

The staff in the MRI/CT unit say that Vanderwilt and Cotten work wonders.

"They're honest and up front, and when they're finished, the kids know exactly what's going on," says Allan White, a radiologic technologist and supervisor of Packard's MRI/CT unit.

The child life specialists assess which kids can make it through the scans without sedation. Almost all children under age 4 need to be sedated, but many over that age can stay awake during the experience. Less use of sedation means less risk to the child. It also saves time and money.

White estimates that child life services reduce the use of sedation by about 20 percent. "To see what the child life counselors do and how well they work with these kids is phenomenal," he says. "They can work with kids who need sedation and take them to where they don't need it at all."

Support For Parents

Child life specialists not only assist the child, but the family as well. Before an appointment, Vanderwilt often calls the parents. She'll explain how to describe the scans to their child and suggest practicing by having the youngster lie still under a table.

Often, parents are worried about the test results, and they need support to get through seeing their little one strapped to the MRI table. Brittany's mom, Cyndie Thompson, is one of them. "I think I'm more nervous than she is," she says.When Vanderwilt offers to go into the MRI room with her, Cyndie accepts.

During Brittany's MRI scan, the child life training pays off. Brittany is so relaxed that she falls asleep for a short while. As she dozes, her leg twitches. When the scan is over, Brittany asks to see the pictures.

"The technician showed her the picture of when her leg twitched," said her mom. "It was a little blurry, so she got to know why she had to be so still."

Afterward, Brittany chooses a prize from the treasure chest, a suitcase painted gold and covered with jewels. She opts for a Barbie.

Brittany's mom will get the scan results in about a week. Regardless of whether the tests explain Brittany's migraines, the child life specialists hope children like Brittany come away from the experience knowing they have the tools to deal with future hospital experiences.

"We want them to feel that this is a safe place," says Cotton. "And that it's a place for children where they feel their questions will be answered in a way they can understand."