Bittersweet announcement: Heal Play Love is growing up! We are turning from a baby blog into a grown-up company! In partnership with Jeanette Molineaux, MA, CCLS, CEIM, we have founded Baby in Mind– a company dedicated to the service of parents and children, and to supporting child life specialists everywhere.
Please check us out at: www.babyinmindparenting.com
And thank you all, so much, for all of your encouragement and support, for Heal Play Love, and for this new endeavor!
What’s your favorite book? If you’re anything like me, you’re mentally flipping through a bunch of beloved ones, unable to decide on your absolute favorite. And that’s a fantastic thing.
Stories are powerful– stories are connections, and they reinforce our bond to one another. Stories can help us share our life story with other people, and learn from theirs. Stories start debates, change minds and sometimes, long-held beliefs. Stories can comfort and inspire us; bring us to tears or anger; and stories can make us immortal.
Stories are told in all cultures, and by all people– they hold cultural significance, and some stories are told and then retold, generation after generation. Many stories start with, “Do you remember…?” and are shared stories, tying people together with a common memory.
Stories are critical to trauma recovery. Being able to share the story of a traumatic event with another person– to open one’s self up and recount a moment of desperation and intense vulnerability– this can be one of the greatest steps on the road to recovery. It allows the survivor to reach for and grab a rescuing hand– the hand of someone who will listen, empathize, and share the weight of this terrible story.
Lastly, stories can help us connect to other people, and to other traumas. These stories can be powerful, and the farther they spread, the more likely it is that the story can be changed. Here are a few trauma stories from around the world– watch, listen, and share.
Tell a story, change a mind, join the conversation.
UNICEF music video about the obscenely high rate of child marriage in Chad:
Tens of thousands of children, all under the age of 17, have been released, after being forced to fight for the South Sudan’s Democratic Army. The UN will be overseeing efforts to return these children to their families and ensure that they receive psychological and physical care, as well as schooling.
“I got to fall in love with him.” A mother is blind, but was able to see her newborn baby, with some amazing technology!
We are back, and focused on trauma– hard to know just where to begin with a topic as nuanced and as endemic as trauma, but here goes– a few things we learned during our research:
1. While the clinical definition of “trauma” refers to the body’s response to a life-threatening event, children’s interpretation of “life-threatening” can look a bit different. Even if the triggering event was not strictly life-threatening, if the event involved betrayal by someone on whom the child relies for survival, or an event that deeply frightened the child, the trauma can still exist– as can symptoms of PTSD.
2. There are many classifications within the larger topic of trauma– here are a few:
3. Unlike adults, many of whom instinctively respond to trauma by pushing away and denying thoughts of the event, young children can respond by re-creating the traumatic event in their play. This can frighten and worry parents and caregivers, but it can be a critical part of the child’s healing process. Supporting the child’s play and being close by to correct misconceptions or offer empathic responses can be an important way to help a child make sense of the event and begin to recover a sense of equilibrium.
4. If you’re reading this, chances are good that you are or you know someone in the field of pediatrics– guess what? Those people are at an elevated risk for PTSD as well, due to the secondary trauma (also called burn-out or compassion fatigue) experienced by those who are exposed to trauma on a regular basis. Symptoms of PTSD can include: flashbacks/ intrusive thoughts/ nightmares, insomnia, fatigue, avoidance, and an increased startle response or hyper-vigilance. To minimize the risk of PTSD due to secondary trauma, professionals in pediatrics (and other traumatic occupations) should stay involved with their social support network, practice self-care, and strongly consider working with a mentor for professional guidance and/ or a therapist for emotional support.
5. Recovery is absolutely possible! The three strategies that have been recommended most are:
For reasons that will become clearer over the next couple of months, I am moving healplaylove’s focus to trauma that affects children. The articles, resources, and posts will be dedicated to various types of trauma, and the responses that child life and other adults can take to prevent trauma and help children and families recover.
I’ll be spending the next couple of weeks doing research and celebrating the holidays with family and friends. I hope that all of you have a wonderful holiday season and enjoy some time off!
Happy Holidays from healplaylove!
1. The Child Life Council released a “December Child Life Survival Guide.” It offers tips for surviving the season, and while probably every adult could use some help during December (the malls! The company holiday parties! The pressure to find the right gifts! The total decimation of the monthly budget!), I think child life specialists may need a bit of additional support (all of the previously mentioned stressors plus: planning the pediatric unit’s holiday party! Planning the sixteen corporate events! Getting all of the donations sorted! Finding someone to cover the floor on December 25!).
2. PBS published a great article on ways to help children cope with angry feelings. It’s based on, and references, some of the great work that Fred Rogers did for children. Highly recommend!
3. Light Spinner Quarterly released a YouTube short about the important work of play and imagination for kids in the hospital. It’s very sweet, and inspiring!
4. Someone came up with a great event for typically-developing kids: a “drive-in” movie night! How awesome would this be to plan for a hospital unit’s playroom??
5. LASIK. It’s like magic– and I’ll be getting my very own laser eyes this week, so during that day and the recovery day afterwards, I may be absent from the internets. I will miss you! And will see you very soon!
(I wrote this for another site, Sidelines (https://sidelinesapp.com/item/thankful/), but I wanted to share it with all of you as well! Thanks, as always, for reading!)
So, I could be cynical and sarcastic, and open this article by talking about how over-used the phrase, “thankful for” is, at this time of year. For example:
“I just wanted to say how thankful I am for my lovely children, caring husband, and new Lexus. Also our health. Of course, our health!”
“I’m thankful for two days off work! LOLOLOL! jk”
“#thankful #sleep”
But I won’t. Whatever the outcome is, the spirit is correct– it’s a lovely idea, to take some time and think about the people, things, and experiences that make our lives rich and joyful and meaningful. As we head into the holiday season, I hope with all of my heart that you are surrounded by loved ones, that you are healthy and safe, and that you lead a happy, happy life, and that you enjoy celebrating all of it over the next few weeks!
Not everyone is as lucky– we all know this– and in the spirit of gratitude and appreciation, many people give to charities, especially during the month of December. If you are able, and open to that idea, here are some organizations to consider:
Check out Give Well (http://www.givewell.org/). It’s an organization that researches charities, and is able to give an open and transparent report on many of them, so that you, the donor, know exactly where your dollars are going.
Doctors Without Borders/ Medecins Sans Frontiers (https://donate.doctorswithoutborders.org/monthly.cfm?source=AZD140001D56&utm_source=google&utm_medium=ppc&utm_term=msf). Less than 15% of donations go to management costs and fundraising– the rest of the donations go straight into providing emergency medical services for countries in desperate need of assistance. MSF won the Nobel Peace Prize in 1999 and is one of my favorite charities.
Your local children’s hospital. When I helped run the pediatrics and child life departments at Harlem Hospital, the holidays were the best time of year– every year, without fail, I was moved to tears by people’s generosity towards our patients. People from all walks of life– hedge funders to local churches and schools to the exhausted med students and residents– gave. Generously. They gave toys, books, wrapping paper, stuffed animals, baby blankets, cozy socks, electronics for the teens, and gift cards. (Almost all of our population was Christian/ observed Christmas. Those that did not were given Hannukah or Kwanzaa gifts, of course!) When kids, literally tethered to their hospital beds, saw a wrapped, bow-bedecked box headed their way, their faces lit up in a way that I can’t describe, but will never forget.
It’s a wonderful time of year. Have a fantastic Thanksgiving, everyone!
Here are five things I’m loving this week:
Wonderful quote from the president of the American Academy of Pediatrics, in response to President Obama’s address on immigration: “Children are not a political problem, they are a national treasure.” So true! https://twitter.com/AmerAcadPeds/status/535605200154005504
One of the search-and-rescue dogs who worked with teams on 9/11 is now working as a therapy animal and helping elementary school children learn to read. What an incredibly selfless life– and what a powerful statement about the impact an animal can have on healing! http://www.cnn.com/2014/11/19/us/disaster-city-911-dog-search-and-rescue/
I’ve loved Life is Good Playmakers, ever since Steve Gross gave the keynote presentation at the Child Life Conference a few years ago. Here’s another reason to love them: their phenomenal perspective on how to build relationships and foster connection between people– children and adults. Inspiring stuff! http://www.inc.com/bert-jacobs/what-for-profits-can-learn-from-non-profits.html
Partnerships are always a give-and-take, and a constant lesson in communication– it can be especially hard for parents, as the stakes (their child’s life and happiness!) are so high. Here’s one parent’s take on how to find balance between parenting styles: http://www.dirtandboogers.com/when-mom-and-dad-have-different-parenting-styles-2/
If your family celebrates Christmas, here’s a creative way to get little kids involved in decorating in an age-appropriate and safe way: http://www.icanteachmychild.com/kid-friendly-christmas-tree/ How can you imagine this activity being adapted for a hospital environment? For other holidays and events?
Meet Shani Thornton, my co-author this week!
Shani Thornton is a Certified Child Life Specialist and parent of two young children. She provides valuable information to child life specialists, parents and professionals working with kids. She is the author of a children’s book, It’s Time For Your Checkup What To Expect When Going To a Doctor Visit. To learn more about Shani, you can follow her blog at ChildLifeMommy.com or contact her at ChildLifeMommy@gmail.com
She is also on Twitter, Facebook, Pinterest and Instagram
We co-wrote pieces on adolescence this week. After you’ve read all about teens’ cognitive development here, head on over to Child Life Mommy for some practical tips and tricks for working with adolescents!
High school! Teenage years! Best years ever, am I right?
If you answered “yes,” I can only assume that you were one of the socially-gifted and confident high-schoolers that I could only admire from afar. If you, like me, answered with a big “h*** no!”, well, then, you and I have something in common.
Teenage years can be intensely difficult, and one of the reasons they can be is due to the massive changes occurring in the brain and endocrine system (which produces those famous teenage hormone surges). Let’s take a look at some of those changes:
There are physical changes to both the grey and white matter in the brain, starting just before puberty and continuing throughout adolescence.
The brain circuitry necessary to process emotions is undergoing major change during adolescence. To complicate matters, the parts of the brain that involve the reward system (i.e. how we learn to motivate ourselves to make decisions) are tightly linked to this emotional response center. To sum up: most teens shouldn’t be expected to maturely process emotions, or respond in a positive or healthy way all the time, without lots of loving support and guidance.
There are enormous, uncontrollable hormonal changes, which, as we know, fuel sexual impulses, but also strongly influence social behavior and reactions to stress. This can help explain those lovely teen behaviors like (mild) bullying, clique formations, and sullenness towards parents and adults. Unless you’re seeing some major red flags (serious bullying, signs of depression, big changes in eating and/or sleeping, big changes in school performance, loss of interest in extracurricular activities), just know that these behaviors will run their course and this too, shall pass.
From a developmental perspective, i.e. combining the physical, social, cultural, and emotional changes during this period of life, most teenagers go through an intense identity crisis. Erik Erikson, one of the godfathers of developmental theory, called this stage “Identity versus Role Confusion,” and the big take-away from this part of his theory is that during the teenage years, most kids question who they are and what their role is in the world. No surprises there, right? Teens are transforming, in all ways, at a relatively high speed: there are new expectations placed on them, new responsibilities, and new pressures emerging in every domain of their lives, at the same time that their bodies are subjecting them to unprecedented change. It’s only natural that their previous sense of self falls apart, and leaves them feeling confused!
On a more encouraging note, a person’s ability to learn will never be higher than in their teenage years. Teens have an enormous capacity to take in new, diverse, and abstract information, and to process it with the speed of an adult brain. The teenage years can be difficult, but they are a wonderful, never-to-be-surpassed time of learning, wonder, curiosity, and growth!
Check out Child Life Mommy’s post for tips and tricks for working with teens!
Resources
Lightfoot, C., Cole, S., Cole M. (2008). Development of Children – Sixth Edition. Worth Publishers, Inc.: NY, NY.
National Institute of Mental Health. (2011). “The teen brain: still under construction.” NIH Publication No. 11-4929. Retrieved from http://www.nimh.nih.gov/health/publications/the-teen-brain-still-under-construction/index.shtml on November 13, 2014.
Emily Schuman, of “Cupcakes and Cashmere,” has a series on her blog that I like very much- the concept is simple, just five things that caught her eye during the week. I’m going to adopt it, and post five things– five ideas, or resources, or pieces of inspiration that I find and want to share with you!
Five Things on November 17
An uplifting and inspiring music video from Akron Children’s Hospital
PBS Kids rounded up some of the best books on adoption
Be the Match reminds us why it’s so important to encourage a diverse donor registry
An article on how virtual reality can help reduce pain
Enjoy!
There are some cases that stay with me– some because I felt a strong connection with the patient, and some because something particularly memorable brought them to the hospital. At least in this case, both are true.
(All identifying details have been omitted or changed.)
She didn’t come in on a gurney, like most of the patients brought into the emergency department. She stumbled in, held upright by a police officer. At first, I figured she must be drunk or high, but when I looked more carefully, I saw the leg irons that made it so difficult for her to walk. Another police officer came in behind her, with a tight look on her face that I didn’t understand yet. I looked at my patient, who was plaintively complaining about the discomfort of the handcuffs around her wrists. She looked about 12 years old. I said hello and introduced myself, and then asked why she was here today. She looked at the floor. The officer holding her arm responded for her: “She was raped.”
I’d like to say that I did what I was supposed to do- go to the attending physician on duty, calmly talk through the case presentation, and request that the handcuffs and leg irons be removed. I didn’t. Instead, I glared at the officer and demanded to know why a child, following a serious trauma, was being treated like a criminal and put in restraints. As you, my wiser Reader, may have already guessed, this caused the officer to bristle onto the defensive and snap at me, “Lady, this is my job.” At this, his partner came over, and after a whispered conference with her, the officer agreed to remove the restraints, as long as a police officer remained with the child at all times. (Knowing that there’s no way I’d tolerate anyone forcing their presence in the exam room during a rape kit, I thought, “Fat chance;” but decided to cross that bridge when we came to it.)
Over the course of the next few hours, I learned a lot more about this patient: She was 14, and had run away from home two weeks previously. She wanted to be with her boyfriend, whom her mother didn’t approve of. I silently agreed with the mother when I learned that the boyfriend was 23 years old, and had broken up with the patient’s adult aunt to start “dating” my patient. She told me, tearfully, that he was really nice to her, and that she loved him.
At first, she did not want to have an exam. The attending physician, along with the female officer, who was really a very kind and gentle presence, and I, all sat with her in the exam room. I had listened to this child’s story in an agony of confusion and sadness– what to say? I believed that she should have the rape kit, because I believed there was enough evidence to suggest that a rape, statutory or otherwise, had occurred. But I also believed that a gynecology exam, done against someone’s will, is tantamount to sexual assault. I would not have any part of talking her into an exam that she didn’t really want.
My shift had ended at 8pm. It was now 10:30pm. I left the room to call my husband and explain that I would be coming home late– I didn’t know when I’d be leaving the hospital tonight. When I went back to the exam room, the attending was coming out– she relayed that the patient had consented to the rape kit and exam, and that she was calling the forensic team now. I don’t know what was said in that room, when I was on the phone, but when I went back inside, my patient was calm and sitting next to the police officer, her head on the officer’s shoulder. (Note: we called the patient’s mother, as we are required to, and the mother refused to come in. This was reported to child protective services, which was, unfortunately, all we could do.)
The forensic team, who have to perform the rape kits, was tied up in another case and took about 90 minutes to arrive. During that time, I sat with my patient. We made a beaded bracelet while she ate a sandwich, and then I prepped her for the upcoming exam, telling her that it would take about an hour, and she wouldn’t have any clothes on, below her waist. I showed her the stirrups that her feet would go in, and assured her that we could give her a sheet, so that she’d be able to cover up, and only the doctor would see her private parts. I explained that there were some parts of the exam that would seem strange: combing her pubic hair, scraping under her nails, and the rectal exam. I showed her a swab, the lubricant, the exam light, and the speculum. I told her that the underwear she was wearing would be kept by the forensic team for evidence. During all of this, as my voice shook and I fought back tears, my patient was quiet. She touched the stirrups and picked up the swab, sweeping it over her cheek. “Will it hurt?” she asked me.
I hesitated. “The exam may feel…uncomfortable,” I stammered.
“Uncomfortable how?” she pushed.
“Well, it may feel strange and…uncomfortable, when the doctor uses her tools to check you out. Down there.” I continued to stutter out these vague phrases, and was ashamed of myself.
“OK. Here’s the deal,” I finally said. “It may hurt. It may not hurt at all. Everyone is different. I can promise you a few things: 1) I will ask the doctor to be as gentle as she can possibly be, and I am sure that she will be; 2) I will work with you to figure out how to make the exam as easy and fast as possible; and 3) you can take as many breaks during the exam as you need to.”
“OK,” she said. “How are you going to make it easier?”
I went through all the options that seemed possible during this particular exam: distraction with an iPad game or movie, deep breathing, guided imagery, and I Spy. She chose to watch a movie, and picked “13 Going On 30.” We started watching it right away, still waiting for the forensic team.
They arrived at last, midway through the movie. I spoke briefly with the doctor and told her of my patient’s nervousness. She immediately responded with kindness, and assured me that she would be very gentle. I went back into the exam room, and told my patient that she could have anyone she wanted in the room with her, and she could also have no one in the room, if she’d rather. She asked me to stay with her, and to hold her hand. In this moment, when I looked at her, she looked younger than 14– younger than the 12 years I thought she was when I met her– she looked about six years old, scared and lonely and lost. I grabbed her hand, and stood next to her head while the doctor and the examiner set up.
I asked my patient if she’d like for me to narrate what the doctor was doing, and she said yes. I told her when the doctor was about to touch her, when the speculum was coming, and when a swab would be going in. She was brave, and she cried– she never asked for a break, and when I suggested one, she refused, saying that she just wanted to finish the exam and get it over with. I held her hand while she cried, and Reader, I cried too.
When it was over, a social worker arrived to take her to a group home for the night. After everything this girl had been through, she was also going to be sent from her family and friends and enter the state foster care system. She would spend her night in an unfamiliar, hard bed, in an unfamiliar, far away place, and my heart hurt, just thinking about it. I said goodbye, and she hugged me tight, both of us crying hard. I left the hospital at 2am, gratefully heading home, but haunted by my patient’s face and that I could not do more.
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