Child Life: Tom Collins

TOM COLLINS

Tom shows Zaira how to listen to dolly's heart while her parents look on.

Pre-Op with Tom: Meeting the Dragon

Medical play eases kids' fears and makes procedures go smoothly.

When Zaira, 4, came in to the outpatient surgery center at Children’s Hospital & Research Center at Oakland for a minor surgical procedure, she wasn’t rushed off on a gurney and put to sleep. Instead Zaira and her parents met with senior child life specialist Tom Collins a few days before the surgery so he could help her understand, at her level, what would be happening to her during the operation.

At first, Zaira clung to her mom’s side until Tom engaged her in her native Spanish. Zaira then watched Tom pull out a toy syringe and a practice doll, and gave the doll oral medicine. When coaxed, she darted over, giving the dolly oral medicine too, then retreated to safety by mom’s side. Tom pulled out a stethoscope and listened to dolly’s heart. Zaira darted in again to listen, then quickly back. Their interaction was playful, but it was more than a game.

“There’s no minor procedure when it’s your child,” Tom says. “Everything is important and frightening. We can’t take away the discomfort of the procedures or the anxiety, but we offer methods that help kids and families get a sense of mastery over what is happening to them. We go in where the dragon of fear is, and meet that dragon.”

During the consultation, Tom took the family through a complete timeline of operation day, using pictures of the gurney and operating room to illustrate. He also pulled out a breathing mask and an intravenous bag to show them what to expect. He uses props, such as the doll and play equipment, so children can mimic performing the procedure that awaits them. Kids begin to feel more like participants in the process, not objects.

The 15 to 20 minutes Tom spends with each family preparing for surgery can have a dramatic impact.

At age 2, Mary Gaston’s son William has already had three surgeries.

“Before we met Tom, Will didn’t let anyone touch him,” Mary says. “He was clingy and resistant. Tom worked with him and made some suggestions for us that made a world of difference.”

Tom suggested giving Will his own doctor’s kit so he could practice on stuffed animals. At his next visit, Will knew what was coming and it helped tremendously.

“It’s at the point now that he is really good with his healthcare provider,” Mary adds.

Tom’s work did more than help William. “It had a big impact on us, too,” Mary acknowledges. “It’s taught us how to relate to Will and how to deal with him now and in the future. Tom gave us a framework and tools to use, and we’re very thankful.”

The psychological benefits of Tom’s work translate into medical advantages.

“I noticed early on that when Tom spent time with a family the kid had an easier time going to sleep,” says anesthesiologist Jonathan Clarke, MD. “If the kid has an easier time, I have an easier time as well. A crying child’s tears can get in his airway, impairing breathing. If a child has been prepared by a child life specialist, these incidents are greatly reduced.”