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Welcome to “Should I Call a Doctor?” The podcast where we dive into trending health topics to separate fact from fiction. We bring in experts to talk about all things health, to empower you with knowledge and answer your questions hosted by Inova Health.
Welcome to should I call a doctor,
the podcast where we dive into the
questions you have about your health and
today's trending health topics
to separate fact from fiction.
I'm one of your hosts, Dr. Sam Elgawly,
an internal medicine physician at Inova.
I'm Tracey Schroeder. I lead
communications for Inova.
Dr. Sam will give you the clinical
perspective while I ask the questions that
keep patients up at night.
Joining us today is, uh, Jamie Gentille,
our system Director of Child Life Services
and Community Engagement at Inova.
We are excited to dive into a new
trending health topic today. Um,
really focusing on child
life services. Um, Tracey.
Jamie's been with Inova
for more than 22 years,
oversees a team of 32 child
life specialists who are
dedicated to helping young
patients in their family navigate the
often overwhelming experience of illness,
hospitalization, medical
treatments and procedures.
We're happy to have you with this
today, Jamie. Thanks for having you. Um,
just tell us a little bit about
yourself and your role at, uh, Inova.
Thank you for having me. It's, it's
amazing to have been here for that long.
It doesn't feel like that long 'cause
this time just goes by really fast. Um,
I started here at Inova as the child
life specialist in radiology and when I
first started there were five of us
and now we have a growing team of over
30 child life specialists.
So what we focus on is the psychosocial
needs of kids and families when they're
going through any kind
of medical experience.
Our goal is to decrease the trauma
associated with that experience and to
promote positive coping.
So that looks really different depending
on the unit where we're working.
So we could be doing a lot of procedure
preparation and support for kids in say
the or, or the er, um, or some of our
other procedural areas like the GE Lab,
um, up on the inpatient units.
We're helping a lot with
explaining what this diagnosis is.
What does it mean to a 4-year-old that
you now have cancer or diabetes or
Crohn's? How do you even begin
to explain that to a young child?
We also will work with siblings and family
members and help them cope with their
loved one being in the
hospital and explain to them
what that means for them and
how they can cope with it. Um,
the end result is to get kids
healed in a medical sense.
That's why they're here at the hospital.
We also want them to go
home psychologically safe
and feeling like they have
had a good experience and they,
we don't want them to bring
trauma home with them.
You know, you said something interesting.
Obviously you're helping navigate helping
children and their parents families
navigate the complexity
of a hospital stay.
Some of that entails talking
about the diagnosis itself.
And so obviously that's a very, there's
a majorly clinical nature to that.
How much time are you actually
having to spend on that?
Like explaining what diabetes
is or pneumonia or RSV
or something like that? Or is it sort
of peripheral to what you guys do?
It's,
it's definitely a significant part of
what we do and it just depends on the
child and the diagnosis. So for example,
we could spend a couple hours with
a family and the oncology unit
explaining what a new cancer
diagnosis is to the family,
to the siblings and what
that means for them.
We could also spend much less
time on a different diagnosis,
or if a child is older,
if they're a teenager cognitively they're
more able to understand these abstract
concepts. We would not
need to spend as much time,
but part of coping is knowing,
so that first piece is
explaining to whatever age child,
this is why you're here, this is why
you're going through all of these things.
This is so different. A
lot of it is really hard.
There has to be a reason for it.
We're gonna explain that to you.
So I'm just curious where you guys
draw that line between the pediatric
specialist and yourselves in
terms of that explanation role.
Right. It's such a good question.
'cause we can't do what we do in a
vacuum and we have to work alongside the
physicians and nurses and anyone
else involved in the care.
So it is a real fine line.
We aren't the ones disclosing a diagnosis
or saying, here's what you have.
We are the ones that come in after
that and say, this is what it means.
So what that means is that we do work
really closely with the physician,
providers, nurses,
everyone on the team to understand
what it is that we're working with,
what the family knows already,
how they've initially responded,
and then we can go in and help close
the loop with some child friendly
explanations and starting to get into
how do we cope with what we just heard.
And so tell me, does every child
that comes to the hospital,
whether they get admitted as an inpatient
or they're at our emergency room,
do they all get to interact with a
child specialist or not necessarily?
Not necessarily. So we have a
ton of patients , um,
and all of the needs of those patients
vary. And you know, in a perfect world,
we would have a child life specialist
for every single patient. We don't.
So we have to prioritize and we
factor in a lot of different things.
The age of the patient, what they're
here for, the diagnosis, if we have,
if they have any known trauma in the
past, um, lots of different things.
If we know that they're gonna come back,
if they've had any medical
experiences in the past.
So we're doing this on the spot quick
assessment all of the time with every
patient on the census
in the inpatient world,
every patient on the track board in the
ED and kind of determining this kiddo
is, okay, this is a pretty big diagnosis.
We know that they didn't cope
well with this procedure.
We're gonna be spending some more time
with this patient. Mm-hmm .
Versus this other family. Okay.
They seem to be really coping well.
They understand what's
happening. The family is engaged.
They have good coping strategies
already that we're seeing.
So we can let them kind of handle things
on their own and we don't have to be as
engaged. And one of
the goals of, you know,
I always say the a great
child life specialist is
able to work with families to
the point that they don't need them
anymore. Right. Right. So that's,
that's our goal. You know, if
we can get kids who come in,
they're so anxious and they really
are having a hard time coping Yeah.
We want to teach them and build these
skills and empower them so that they can
help themselves without
us there at the bedside.
'cause the truth is we're not there 24 7.
Right. You're right.
You're trying to give them the skills
to do it on their own. Exactly. Exactly.
And are you, so can a family request to
have a child life specialist come by?
Absolutely. Okay. That's great to know.
And what I, what struck me earlier,
what you said was it's not
just the patient, it's the
family, it's the siblings.
And so there could be sort of issues
with coping or understanding at
any part of that family. Absolutely.
And so I could see you not always just
even focusing just on the patient,
but just on the, you know, whole family
because you don't want the siblings.
Right. Sort of getting the
patient wound up that, you know,
this is really bad or whatever, you
know, I could see the benefit of that.
Talk a little more about
your experience there.
Absolutely. It's, it's a really good
example of that is our work in the nicu.
So if you think about NICU babies,
you might not automatically think, oh,
we don't really need to explain
things to these babies. Okay, sure,
that's true , but there are a
whole lot of other factors happening.
So what our work looks like in the
NICU are several different things. One,
we're certainly working
with pain management, um,
to help support non-pharmacological pain
management during test and procedures.
But a huge other part of what
we do is with that sibling,
any sibling involved and the parents.
So imagine a mom comes in for an
emergent birth, wasn't expected.
Their baby's now in the nicu.
They have a four year-old
or a five year-old at home.
They don't know where mom is. They
don't know what happened to the baby.
They've been decorating the nursery,
but what's going on? But there's.
No baby in it. , but there's.
No baby and, and mom's not here. And I,
I'm a smart kid so I know
something's happening, right.
So we step in and we'll meet with the,
with a sibling and we'll go
over exactly what's happening.
We'll use a teaching doll with a tiny
little baby with tubes in it that will
explain, this is the tube that helps,
is helping your brother breathe. Mm.
This is the tube that's helping
giving your brother some medicine.
And we'll go through all of
that. And if appropriate,
we'll even facilitate a visit so that
they can see their baby and actually say,
this is this, this exists. Right? Yes.
The babys getting ready to
come home to you .
Exactly. And, and supporting
that separation because, um,
a huge stressor for families in the
NICU in any intensive care situation
is separation. Yeah. So we can
do things to, um, and promote,
um, connection between sibling and
baby, between mom and the child at home.
You know, their routine is all
thrown off mm-hmm .
So how can we support them to still
maintain that relationship with sibling at
home? Right.
That's so important. Even siblings
that don't have a, you know,
a a baby that is in the NICU sometimes
have a difficult ti time with that
transition. So this must be even harder.
It's absolutely, and we've
had some beautiful stories of,
of kids who've come in and met
their baby brother, sister,
and it just makes it real for
them and it makes it concrete.
And one of the sweetest things was, uh,
family did a, a beautiful sibling visit.
They went home and the older brother,
I think he was like eight or nine,
he sent flowers to the
child life specialist. Aw.
And.
They, and was say, thank you for
letting me meet my, my baby sister. Aw.
And it was just the sweetest
thing. And that right there,
that eased the tension and and
stress on the parents. Right.
So then the parents were able to be more
present and cope for the baby and the,
and the sibling at home. So it's, it's
the entire unit that we're working with.
And it also really helps because parents
are a huge part of the medical team.
And if their stress is controlled
and we are meeting their needs,
they're better partners. That's right.
So it's a win-win all around. So.
How did you get into this
line of work? Because I,
I wouldn't have even known to if I had
a child in the hospital to ask for a
child life specialist.
Absolutely. So I kind of learned about
child life almost too late in the game.
So I am not that, not the youngest
child life specialist at a nova.
So I've got some years under
my belt back in the day, um,
it wasn't super well known.
And I went to school for Biobehavioral
Health and I wanted to go into public
health and something having to do
with the medical world and kids.
And I happened to be working at a summer
camp for kids with significant medical,
um, conditions.
And one of my favorite parts was going
to the infirmary with them and helping
them through their treatments.
And that just spoke to me
and that filled up my soul.
And one of the other counselors who worked
there was a child life specialist and
she said, Hey, this is like a thing
you can do this , you ,
this could be a job.
This is not just Camp . Exactly.
I was like, tell me more .
So once I learned about it was the
perfect combination of one-on-one.
I wanted that one-on-one interaction.
I wanted to be able to
impact the medical setting,
and I wanted to be able to support that
and to meet kids and families in that
vulnerable, um, part of their lives,
which is truly an honor and not something
that everyone gets to say that they
can do. So it was a perfect mix
for me. I really lucked out.
I got an internship, um, up at Dartmouth,
and then I found this position
down here in Virginia at Inova.
And 22 years later. 22 years later.
Exactly. Yeah. That's amazing. Yeah.
So now it's, there's a,
it's background in training to be
a child life specialist. You have,
did you have to have an undergrad
degree in child life or related field,
and then you do your practical internship
experience, which is about, um,
a semester full-time, and then you
sit for the certification exams, you.
Know, what are some of the ways that
specifically that you guys can help?
What are the tools that you give them?
The tool patients or physicians.
Patients?
So, yes. Um, we,
there are a lot of different tools
that we can provide for patients and
families. It's really depending
on where they are. So it could,
our goal could be teaching about
a procedure or a diagnosis.
So we're gonna bring teaching
tools and pictures and recordings
of when an MRI sounds like, um,
we could be dealing with patients who are
just at the hospital for treatment for
a really long time.
And our goal for them is to
decrease any developmental
setbacks. So we're gonna bring age
appropriate things into the room,
make sure they have activities,
lean on our volunteers pretty heavily
for that to make sure kids are,
have what they need in the hospital.
Um, some kids who are, you know,
coping with something traumatic,
they may need some, uh,
more specific therapeutic intervention.
It could be through writing,
it could be through music,
it could be through art. Um,
we're also reaching out to our, um,
partners in music therapy for that. Um,
we also will, a, a lot of the work
that we do is around the sensory, um,
and environment piece of
the patient's experience.
So imagine a patient in the
picu, they are laying down,
they may or may not be awake and
alert, but they're, they're flat,
they're not able to move. And their
sensory environment is very limited.
And usually it's limited to harsh things
like lights and procedures and tests.
Mm-hmm .
So what we can do is we can go in there
and try to mitigate that by creating a
calming environment, soothing lights,
making sure that they've got good, um,
uh, visual things that they can look at.
Even if we don't know
if they're taking it in,
if we can put something in their line
of sight, it's something pleasant.
It's positive sensory input
so we can even soft blankets.
Mm-hmm . Or pictures
of family, something comforting.
Mm-hmm . Positive touch,
like coming in and just touching a hand.
Mm. Um, bringing our fish tank in.
We will sometimes do overnights and
sleepovers with our fish, fish tank,
which is so incredible. 'cause
it helps with self-regulation.
And that's one of the things
that's so incredibly hard for kids,
particularly in the
ICU, is self-regulation.
They're in such a crazy
state of dysregulation.
And the longer they hear, the harder
it is for them to self-regulate. Yeah.
So we can kind of come in and co-regulate
with a fish tank where how does the
soothing bubbles, the noises, the sounds,
the movement of the fish, the nature,
it's proven to be soothing.
It's very peaceful. Yeah.
So a lot of it is just the
environment mm-hmm . And,
and really just setting the tone for the
kids to heal in a place where they can
be more like kids. That's
great. I will say when, um,
we do have two child life specialists
who work with our adult population.
They're working with
children of adult patients.
So imagine a mom or dad coming in,
they've had a traumatic brain injury
and they're in the hospital. They may,
may or may not go home. If they go home,
they may or may not be the same
person that they were. Mm-hmm.
So we're working with those kids to
help explain what happened. Yeah.
What does this mean for, you know, and
for your life from here on in. Yeah. Um,
if there's an end of life
is there, if there's a loss,
we're working with kids through
that to, um, support them.
And inherently we're working with the
entire family and that does take a lot of
the pressure off of the family.
'cause that is such an immensely
difficult thing to go through. Yeah. Um,
but having someone there to just help
facilitate those conversations with the
kids. Yeah. But truly even just the base,
the baseline interventions
that we're doing with kids,
we could be doing with adults.
As well. Yeah. They, well they
would work with everybody. Yeah.
As you were talking, I saw the, I'm a
big, big dog lover and I see the dog say,
Bart Bartley Bartley on your badge
holder. It just triggered a thought. Like,
do,
do you guys leverage or use pet therapy
a lot in what you do with families and
children? We.
Do. We have a facility dog, his name
is Bartley. He's the cutest thing.
He's a black lab. Um, and he,
we have one of the child life
specialists is his actual owner.
And then there are about six of
us that are trained handlers.
So we will use Bartley in
so many different ways.
He's the best he can get
through to kids like no other,
like no human can really, it's amazing.
So we will, um, there's a very, um,
strict process. We need
physician's orders, we'd go
through the medical record,
make sure that they're okay to be seen.
And then it could be that we're going
and just bringing Bartley in and they're
taking, he's taking a nap on
the bed with the kiddo. Oh.
And that is like heart rate
goes down pain, you see.
It scores.
Yeah. Yeah. Pain score,
like first time. Wow.
The number of times that we've had
parents say this is the first time they've
smiled and the first time they've
stopped like wincing or crying because
it just bartley was there. And just
that soothing . Yeah. We also,
we'll use him with, um, uh,
kiddos who need to get out of bed and do
PT and walk around the hallway. Mm-hmm.
How much better is it if you
can walk around with a dog? He.
Is, well he's got a very
unique title, doesn't he?
He is, uh, one of the
chief comfort officers. I.
Love that. He's.
Pretty distinguished. Gentleman
. Yes. But he and the staff are,
I mean, it makes an immense difference
for the difference for the staff too.
It just, again, blood pressure, just,
we'll bring Bartley into a staff
meeting or a debriefing session after
something really difficult
has happens. Yeah.
And it's such a privilege and it's
such a great part of what we do. Um,
but he's the best. He really is.
Yeah. That's wonderful.
He's employee of the month
every month. .
. I believe it. I believe it.
What are the kind of one or two things
that you always feel like this is what I
would love people to know
about Child Life services?
First and foremost is a lot of times it's
a very common misconception to see the
very, the most visible part of what
we do is in the tools that we use.
And those are a lot of times choice.
So a lot of times people will say, oh,
your job is so much fun.
, what a great.
Job you get to play and get paid for
it. . Yeah. And we're like,
thank you for that validation of my worth.
. But.
Truly it's, uh, it's so much
more than that. And it, there's,
there's science behind it,
there's evidence behind it,
there's training behind it. Um, and yes,
we use play as a tool. Um, but it's,
it's just so much more. It's
not gonna say, yes, it is fun,
but it's also really hard when we're
working with a family who's just lost a
child. Yeah. Um, but we.
But that's the kind of stuff
that you're dealing with. Yeah.
Yeah. So we're, you know, the tip
of the iceberg is what people see.
And there's so much underneath
that. The other thing I would say,
and this is pertains to child life
and anyone who works with kids,
is the experience that these
kids are having for us,
we'd come to the, to the hospital every
day. We work, you know, 12 hour shifts,
eight hour shifts.
It's so natural for us to do IVs
or pokes or some kind of test
or diagnosis for these
kids. A lot of them,
it is one of the most traumatic
moments of their life. Yeah.
Mm-hmm . And the,
the thought of it's really quick,
we'll just get it done fast,
is so damaging because when
you're thinking about these kids,
they, the experience that
they're getting as children,
they are gonna guide their healthcare
behaviors as adults. Mm-hmm .
So it's gonna have an,
a lost lasting impact in not only when
they have to come back for treatment
as a kid, they're gonna be freaked
out. And that's no fun for anyone.
But if you grow up, I mean,
every one of us can think of a friend
who just doesn't do needles or doesn't
like the doctor or isn't gonna go get
this checked out because they're not
comfortable and nine times outta hand.
That's because of a traumatic
experience as a child.
And that traumatic experience
can be as simple as,
I had one injection where they had to
hold me down and I wasn't able to sit
comfortably with my parent.
Yeah. That's all it takes.
So these moments that are truly
moments to us are setting lifetime.
They're lifetime. And they're,
they're for our neonates,
they're actually changed, speaks.
To their trust.
A hundred percent. Oh yeah. And it's easy
to say, we'll just do it really quick.
We'll get in.
Well then what about the next person
that has to come in and do something?
What if it's not even that uncomfortable?
That child now has no trust in us.
Right. And they're not gonna
allow us to do anything.
Even the simplest of things. And our tiny,
tiny babies who are neonates who are
born and their brains have not finished
cooking, they're literally
what we're doing.
Their pain experiences are changing
the neural pathways in their brains,
and it's making them
more susceptible to pain.
So it is having lifelong impacts. Um, so.
Beyond taking your time with it,
how do you get a child comfortable
with a needle stick or a blood pressure
cuff? You know, is it just walking them
through, this is what's going to happen,
or letting them do the countdown
before it starts? Or what's your,
what's your thought? It's.
A lot about giving them control
back. Mm-hmm .
So we are taking time and it's key to
do it in the non-stress point part,
right.
So we're not trying to do this when
we're trying to get the blood pressure or
trying to do an iv. We're doing
this when nothing else is happening.
It's just us. We're just quote
unquote playing. And, um,
when we're just playing,
and a lot of times we'll bring in medical
equipment or play medical equipment
and just let kids be the
boss mm-hmm .
And let them do the blood pressure
cuff on their doll or on themselves
if they wanna try it. And, uh,
just get experience being in,
in charge and in control of that. Um,
and giving them as many options as
possible. You know, do you wanna sit up?
Do you wanna lay down? It's not an option
to not do this right now, but here,
when it comes time to do it,
what do you, what do you do?
What do you wanna look
at? Something do you.
Want, are your choices, want.
To close your eyes? Yeah. Um,
and so some of that is just a
little bit of desensitization,
but also putting them back in control
and say, you're in charge of this.
Tell me what this feels like. And
we'll learn a lot from them too.
Mm-hmm . When we see them
be the nurse or them be the doctor, um,
we'll kinda get a really good insight
into what is stressful for them.
And then we can, some, some of it is, uh,
just demystifying some things.
Right. Perfect example is IVs.
A lot of kids and adults think
that the needle stays in.
And so the simple act of just explaining,
let's actually go through this,
you can see exactly what happens.
You can see that the needle came out and
it's just a plastic little tiny straw.
And that moment right there is,
it can flip a switch for a kiddo.
So making sure they understand,
making sure they have the facts, um,
getting to them when they're
in a non-stress point, um,
and giving them as much control as we can.
That's amazing. I feel like
that's just some a good,
that's like speaks to kids even if
they're not in the hospital. Exactly.
They wanna have more control over their
own day to day and their own lives.
So Absolutely. That makes,
that makes a lot of sense.
Thank you for, for being open and, um,
with us about what you're doing and,
and helping illuminate, um, something
I didn't understand very well.
And hopefully our listeners
understand better. So thank you.
Thank you really for what you do.
I mean, children are, you know,
I don't need to say it, but like,
they're everything and the families and
what they need in that time period and
what you do for them, I think is
truly remarkable. So thank you.
Keep doing what you're doing and
we love hearing about it. Thank.
You so much. We,
we love what we do and thanks for letting
me talk about this amazing thing we
do. Thank.
You, Jamie. Thanks Jamie. Thanks.
Guys.
Thanks for tuning in. We hope
you enjoyed this episode.
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