Being in the hospital is no bed of roses. Especially for kids.
"For many children, the hospital can be a scary place," said Linda Nicolotti, Ph.D., director of pediatric psychology at Brenner Children's Hospital, part of Wake Forest Baptist Medical Center.
"A lot depends on why they're here, how uncomfortable they are with their medical condition, how old they are, their developmental level, their personality characteristics, their coping skills and other factors. But all in all, hospitalization is often a very stressful experience for children."
That presents a challenge above and beyond providing medical care at children's hospitals, which generally serve patients from infancy to age 18 whose conditions range from minor to life-threatening and whose stays run from overnight to weeks or even months. And that challenge becomes more formidable during the holiday season.
"Holidays can be particularly hard for hospitalized kids and their families," Nicolotti said. "If a child is in the hospital, they're taken away from the annual routines and special activities of the season. Depression and anxiety are fairly common among children with health issues, particularly those that require them to be hospitalized, and the holidays are usually a more difficult time for children to be here."
"That's why we do all the things we do in December," said Cindy Mahan, manager of the Child Life Department at Brenner Children's, a 144-bed facility that covers six floors of a tower on Wake Forest Baptist's main campus and admits more than 5,000 young patients a year.
Mahan and her staff of five certified child life specialists and one assistant are dedicated to helping children and their families cope with all aspects of hospitalization and making their experiences at the hospital as positive as possible.
At this time of year, that includes decking the halls. Christmas trees and other seasonal decorations are placed in all of Brenner's inpatients units, activity rooms and common areas.
"We try to create an environment that, while it's not home, is as festive as it can be," Mahan said.
The holiday menu includes events, too.
"There are so many things happening in December at school, church and in the community that don't happen at any other time of year, and if you're in the hospital you're not able to participate," Mahan said. "So we try to provide opportunities that are similar to or maybe even more exciting than what the children would do normally."
Among these are three different visits from Santa Claus during the month. And on Christmas morning all patients wake up to find that Santa has visited and left each of them a large gift bag full of age- and gender-specific presents.
All the decorations, events and gifts are made possible by direct donations of items and funds to the Child Life Department and contributions to Friends of Brenner, a volunteer advocacy and fundraising organization that supports the children's hospital.
"We have an incredibly generous community," said Mahan, who joined Wake Forest Baptist in 1978. "This is definitely our busiest time of the year for donations, but what we receive around Christmas also supports what we do for the children throughout the year."
That list includes activities around Easter, Halloween and other holidays; birthday parties for individual patients; an off-site prom for teenagers in the Hematology/Oncology Unit; appearances by sanctioned "Star Wars" characters and window washers dressed in superhero costumes; and visits by members of Wake Forest University athletic teams.
The Child Life Department also maintains five age-appropriate activity rooms, an outdoor terrace with a garden and playground equipment, and a stockpile of toys, games, electronics and other items for patients' in-room use.
But it's not all about parties and playtime.
The child life program includes weekly visits by therapy dogs and other therapeutic activities, and the staff specialists have clinical responsibilities, including preparing children for medical procedures and treatments; conducting pre-surgery tours; teaching strategies to reduce anxiety and enhance cooperation with care providers; providing support and alternative focus before, during and after medical procedures; and offering information and support to patients' parents, siblings and other family members.
"It's really valuable to have a lot of psychosocial support for children while they're in the hospital," Nicolotti said. "Psychological issues can definitely exacerbate an ongoing medical problem, and relieving those problems can have positive effects on health."
Research studies have shown that child life programs and pediatric psychology services are associated with improved quality and outcomes in care, increased patient and family satisfaction, shorter hospital stays, decreased use of sedatives and pain relievers, greater adherence to "doctor's orders" and better overall health and well-being. The American Academy of Pediatrics has stated that child life services are "an important component of pediatric hospital-based care."
"If we have done our job well," Mahan said, "patients will have some positive memories of their hospitalization and will have learned that they can manage stressful situations both in the hospital and out."