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POLICY STATEMENT Organizational Principles to Guide and Define the Child Health
Care System and/or Improve the Health of all Children
Child Life Services
Barbara Romito, MA, CCLS,a Jennifer Jewell, MD, FAAP,b Meredith Jackson, MD, FAAP,b AAP COMMITTEE ON HOSPITAL CARE;
ASSOCIATION OF CHILD LIFE PROFESSIONALS
Child life programs are an important component of pediatric hospital-based abstract
care; they address the psychosocial concerns that accompany hospitalization
and other health care experiences. Child life specialists focus on the optimal a
Child Life Program, The Bristol-Myers Squibb Children’s Hospital at
development and well-being of infants, children, adolescents, and young adults Robert Wood Johnson University Hospital, New Brunswick, New Jersey;
and bThe Barbara Bush Children’s Hospital at Maine Medical Center,
while promoting coping skills and minimizing the adverse effects of Portland, Maine
hospitalization, health care encounters, and/or other potentially stressful
Ms Romito provided the benchmarking data and the majority of the
experiences. In collaboration with the entire health care team and family, child writing; Dr Jewell designed the outline for the policy, noted and
life specialists provide interventions that include therapeutic play, expressive updated information that was irrelevant since the last revision,
provided assistance with the writing, and presented the content to the
modalities, and psychological preparation to facilitate coping and Committee on Hospital Care; Dr Jackson provided technical assistance,
draft review, and content expertise for the portions related to medical
normalization at times and under circumstances that might otherwise prove education; and all authors approved the final manuscript as
overwhelming for the child. Play and developmentally appropriate submitted.
communication are used to (1) promote optimal development, (2) educate Policy statements from the American Academy of Pediatrics benefit
from expertise and resources of liaisons and internal (AAP) and
children and families about health conditions, (3) prepare children and external reviewers. However, policy statements from the American
partner with families for medical events or procedures, (4) plan and rehearse Academy of Pediatrics may not reflect the views of the liaisons or the
organizations or government agencies that they represent.
useful coping and pain-management strategies with patients and families, (5)
The guidance in this statement does not indicate an exclusive course
help children work through feelings about past or impending experiences, and of treatment or serve as a standard of medical care. Variations, taking
(6) partner with families to establish therapeutic relationships between into account individual circumstances, may be appropriate.
patients, siblings, and caregivers. Child life specialists collaborate with the All policy statements from the American Academy of Pediatrics
automatically expire 5 years after publication unless reaffirmed,
entire interdisciplinary team to promote coping and enhance the overall revised, or retired at or before that time.
health care experience for patients and families.
DOI: https://doi.org/10.1542/peds.2020-040261
Address correspondence to Barbara Romito, MA, CCLS.
E-mail: Barbara.Romito@rwjbh.org
CHILD LIFE INTERVENTIONS: PSYCHOLOGICAL PREPARATION PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
This document is copyrighted and is property of the American
Preparing children for hospitalization, clinic visits, surgeries, and Academy of Pediatrics and its Board of Directors. All authors have filed
diagnostic and/or therapeutic procedures is essential during a child’s conflict of interest statements with the American Academy of
Pediatrics. Any conflicts have been resolved through a process
hospitalization and an important element of a child life program. It is approved by the Board of Directors. The American Academy of
estimated that 50% to 75% of children develop significant fear and Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
anxiety before surgery; recognized risk factors include age, temperament,
baseline anxiety, past medical encounters, and caregiver anxiety.1 FINANCIAL DISCLOSURE: The authors have indicated they have no
financial relationships relevant to this article to disclose.
Children’s anxiety in the perioperative environment is associated with
impaired postoperative behavioral and clinical recovery, including
increased analgesic requirements and delayed discharge from the To cite: Romito B, Jewell J, Jackson M, AAP COMMITTEE ON
recovery room.2,3 Preparation can reduce anxiety and distress before HOSPITAL CARE; ASSOCIATION OF CHILD LIFE PROFESSIONALS.
Child Life Services. Pediatrics. 2021;147(1):e2020040261
surgery and/or during mask induction and may also decrease emergence
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PEDIATRICS Volume 147, number 1, January 2021:e2020040261 FROM THE AMERICAN ACADEMY OF PEDIATRICSdelirium after surgery.4–7 More than stay, a clearer understanding of Child life specialists can effectively
50 years of research and experience procedures, and a more positive provide developmentally appropriate
supports 3 key elements of the physical recovery as well as nonpharmacologic pain management
preparation process: (1) the provision posthospital adjustment for children and provide coaching and support to
of developmentally appropriate enrolled.16 Patients spent less time on patients and caregivers before,
information, (2) the encouragement narcotics, the length of stay was during, and after medical
of questions and emotional slightly reduced, and caregivers were procedures.40,41 They can also
expression, and (3) the formation of more satisfied. In other studies, provide valuable education and
a trusting relationship with a health researchers have found that child life training to nurses, physicians,
care professional.3 A recent interventions play a major role in students, and other personnel,
systematic review of preparation calming children’s fears and result in supporting health care team member
effectiveness evidence concluded that higher parent satisfaction ratings of competencies in the provision of
children who were psychologically the entire care experience.8,17,18 developmentally appropriate,
prepared for surgery experienced psychosocially sound care.42,43
fewer negative symptoms than did Multifaceted institution-wide
children who did not receive formal CHILD LIFE INTERVENTIONS: protocols, such as the Ouchless Place
preparation.3 Findings included PAIN-MANAGEMENT AND COPING and other similar programs,
a decrease in posttraumatic stress, STRATEGIES incorporate the standard use of both
lower levels of fear and anxiety, When combined with preparation and pharmacologic and
increased cooperative behaviors, and appropriate pharmacologic nonpharmacologic techniques,
better long-term coping and interventions, nonpharmacologic preparation of the patient and family,
adjustment to future medical pain- and distress-management environmental considerations, and
challenges. Research also strategies have proven successful in training of all health care team
demonstrates that preparation and terms of patient and family members.44,45
coping facilitation interventions experience, staff experience, and cost- Research has demonstrated that
decrease the need for sedation in effectiveness.17,19,20 Strategies such children are less fearful and
procedures such as MRI and as swaddling, oral sucrose, vibratory distressed when positioned for
radiotherapy, resulting in lower risks stimulation, breathing techniques, medical procedures in a sitting
for the child and cost savings in relaxation, and guided imagery have position rather than supine.46 Child
personnel, anesthesia, and been shown to decrease behavioral life specialists are often involved in
throughput-related expenses.8–12 distress and pain experience in facilitating the use of “comfort holds,”
Preparation techniques, materials, children during invasive medical techniques for positioning children in
and language must be adapted to the procedures.21–25 a parent or caregiver’s lap or other
developmental level, personality, and comforting position. In addition to
Distraction strategies have been reducing the child’s distress and
unique experiences of each child and
highly effective in reducing reported gaining cooperation, these techniques
family. Learning is enhanced with
and observed pain and distress in generally require fewer staff to be
hands-on methods versus exclusively
children in inpatient, emergency present in the room, facilitate safe
verbal explanations. Photographs,
department (ED), and clinic and effective accomplishment of the
diagrams, tours of surgical or
settings.26–32 The emergence of medical procedure, decrease parent
treatment areas, actual and pretend
virtual reality, Internet technology, anxiety, and increase parent
medical equipment, and various
and electronic and digital devices has satisfaction.47,48 With a goal to
models (dolls, puppets) are used to
been found to be an effective means severely limit the use of papoose
reinforce learning and actively engage
of distraction in reducing pain.7,33–38
the child.1,13 Caregivers should be boards and eliminate the practice of
Child life specialists may also multiple staff members holding
included in the preparation process
develop comfort kits for use in a child down, these techniques
because this can decrease parental
treatment areas to include age- provide a viable and more humane
anxiety and allow them to provide
appropriate distraction items, such alternative in most cases.
essential family-centered
as bubbles, pop-up and sound books,
support.14,15
light-up toys, and other visual or
An experimental evaluation of one auditory tools.39 Distraction CHILD LIFE INTERVENTIONS: THE
child life program model revealed techniques have also been shown to THERAPEUTIC VALUE OF PLAY
that child life interventions resulted be successful in lowering a parent’s Therapeutic play during health care
in less emotional distress, better fear and distress during an invasive experiences is essential and a major
overall coping during the hospital procedure.27 component of a child life program and
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2 FROM THE AMERICAN ACADEMY OF PEDIATRICSof the child life professional’s role. reason video games are so popular is easily transmitted to the patient.64
Play is crucial to a child’s social, with this age group56). Patients in this Child life specialists help facilitate the
emotional, and cognitive age group also benefit from activities family’s adjustment to the child’s
development and is even more that allow them to maintain illness and health care experience by
critical during adversity or stress relationships with peers and establish providing psychosocial support and
points in a child’s life.49 In addition to new connections through, for coping strategies for caregivers. They
its developmentally supportive example, online networking and the can help family members understand
benefits and as a normalizing activity availability of teen-aged activity their child’s response to treatment
for children and youth of all ages, play rooms in the hospital setting.57 and support caregiving roles by
is particularly valuable for children promoting parent-child play sessions
Auxiliary programs, such as animal-
who are anxious or struggling to cope and sharing strategies for comforting
assisted therapy, infant massage
with stressful circumstances of or coaching their children during
instruction, therapeutic clowning,
hospitalization, illness, or grief.50 Erik medical procedures. In addition, child
performing arts, and artist-in-
Erikson51 writes, “To play out is the life specialists play a pivotal role in
residence programs, often used in
most natural auto-therapeutic encouraging and facilitating family
conjunction with child life services and
measure childhood affords. Whatever involvement in the patient’s care as
incorporated into child life
other roles play may have in the well as promoting communication
departments, provide additional
child’s development…the child uses it between family members, providers,
outlets for patients of all ages and
to make up for defeats, sufferings, and and the interdisciplinary team.
their families.58–60 Live, interactive
frustrations.” Play in the health care
programming using closed-circuit
setting is adapted to address unique Siblings of pediatric patients present
television systems and studios can be
needs on the basis of developmental with their own unique anxieties and
a particularly effective way to engage
level, self-directed interests, medical psychosocial needs, not often
patients restricted to their rooms for
condition and physical abilities, assessed or addressed. Siblings, much
infection-control or medical reasons.
psychosocial vulnerabilities, and like children of adult patients, can be
Other interactive technology, such as
setting (eg, bedside, playroom, clinic). helped to comprehend a family
video conferencing, can help patients
Play as a therapeutic modality, member’s illness via therapeutic play
engage with people outside the
including health care play or “medical and educational interventions or by
hospital, including their peers, the
play,” has been found to reduce offering support during hospital
community, and their schools. The
children’s emotional distress and help visits, including diagnoses, critical
ability to connect with a child’s school,
them cope with medical care, and end-of-life situations.65,66
community, and home helps normalize
experiences.52 Research has revealed Although sibling support is essential
the experience by minimizing
that physiologic responses, such as in all areas, a critical care
disruption of usual routines.
palm sweating, excessive body hospitalization in the neonatal or
Expressive therapies, such as those
movement, tachycardia, and pediatric ICU presents additional
provided by distinctly certified play
hypertension, can be reduced with stressors for the entire family, and
therapists, music therapists, and art
therapeutic play interventions.53 child life interventions are often
therapists, can be offered to
focused on the siblings’ psychosocial
Play can be adapted to address the complement child life programs and to
needs. Sibling support may include
developmental and psychosocial needs provide support for particularly
preparing the sibling(s) for an initial
of patients in every pediatric age vulnerable patients.26,61,62
visit and providing ongoing emotional
group. For example, infants and
support throughout the patient’s
toddlers benefit from exploratory and CHILD LIFE INTERVENTIONS: hospital stay. Child life specialists are
sensorimotor play, and preschoolers PARTNERING WITH FAMILIES TO often involved in providing
enjoy fantasy play and creative art PROVIDE SUPPORT bereavement support to patients as
activities.54 Opportunities for parents
The presence and participation of and well as siblings and other family
to engage in play activities with their
partnership with family members is members. Grief support and legacy
young children are beneficial to both
a fundamental component of patient- activities, such as hand molds or
the patient and family, alleviating some
and family-centered care and has memory boxes for siblings and family
feelings of helplessness that can be
a significant positive effect on members, are often provided at the
common in caregivers and assisting in
a child’s adjustment to the health care end of life for both pediatric and adult
the child’s adjustment to the hospital.55
experience.63 When parents or other patients throughout the hospital. In
School-aged children and adolescents family members are highly anxious conjunction with the interdisciplinary
seek play that contributes to feelings about the child’s illness or diagnostic team, child life specialists are critical
of mastery and achievement (one and treatment regimens, such anxiety in helping all family members
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PEDIATRICS Volume 147, number 1, January 2021 3understand how to support children using the shift length as the The remaining 3 areas, inpatient acute
in age-appropriate ways during end- denominator, additional nonpatient care, outpatient ambulatory clinics,
of-life events. care responsibilities are accounted for and critical care units, all have similar
in the productivity calculation, productivity, with approximately 1
including such things as meetings, patient encounter per hour, or 8 in an
RECENT BENCHMARKING DATA committee work, student and staff 8-hour shift.
In 2016, the Association of Child Life education, and donor events.67
The productivity data allow
Professionals (ACLP) constructed the
Figure 1 identifies the total number of participating hospitals to clearly
Child Life Professional Data Center
individual patient and family identify how their program compares
(CLPDC), an online database to house
encounters an individual child life to the national average or similar
comprehensive child life program data
specialist provides in an 8-hour shift hospitals on the basis of median
and metrics, including staffing models,
in each of the 6 service areas. In scores. The data also serve as a tool to
staffing ratios, budget allocation data,
support appropriate staffing during
and hospital descriptors.67 Using radiology, the median productivity is
0.74 patient encounters per hour, or hospital program growth by offering
a systematic and evidence-based
approximately 6 encounters in an 8- a benchmark to adjust staffing
approach to measure the impact of
hour day. Of all 6 areas of service, depending on changes in patient
psychosocial services provided to
radiology encounters trend the longest volumes.
pediatric patients and families, this
database has synthesized information because radiologic procedures often Although these ratios establish
from more than 160 child life require significant preparation and national benchmarking and staffing
programs. In addition, the ACLP support during the procedures, which trends, other factors should influence
established a productivity metric may be lengthy. Child life specialists in staffing allocations. Child life services
measuring the number of patient and presurgery and the ED have the should be available to meet identified
family encounters a child life specialist highest median productivity, with an patient and family needs 7 days per
provides in a specified setting within average of 1.2 patient encounters week. Staffing plans should be
the hospital during a shift. Currently, every hour, roughly 10 patients seen sufficient to meet fluctuations in
more than 50 programs have per 8-hour shift in each of these areas. anticipated and unanticipated staff
participated in the productivity data absences, seasonal swings in the
collection. The productivity metric is patient census, and nonclinical
a numerical indicator of the number of Radiology community activities (such as school
patient and family encounters that can Presurgery programming, outreach events, and
be expected during the child life increased visits and in-kind donations
specialist’s shift. This measure of ED during the holiday season). Child
productivity is collected for 6 distinct Inpaent variables (such as age, temperament,
areas of service: (1) inpatient acute coping style, and cognitive abilities),
care units, (2) critical care, (3)
Outpaent family variables (such as caregiver
radiology, (4) presurgery, (5) Crical care anxiety, presence, and involvement)
outpatient ambulatory care, and (6) and diagnosis and treatment variables
the ED. These 6 distinct areas are (acute versus chronic, repeat
being used to collect and segment data
10 admissions, number of invasive
because the type and length of child 8 procedures) are known to affect
life intervention can depend on which psychosocial vulnerability and, thus,
medical service is being provided. A 6 influence the child’s particular child
patient encounter is defined as a child life needs.68 A combination of
life specialist–provided interaction 4 psychosocial risk assessment, medical
with a patient, sibling, or caregiver, and/or treatment variables (eg, the
and this serves as the numerator of 2 proportion of patients on isolation
the productivity metric. The precautions and the volume of patient
denominator is the length of the child 0 and family teaching needs), and the
life specialist’s shift (eg, 8 hours). The Paent Encounters per 8-Hour time requirements associated with
final metric given is the measure of Shi particular interventions directly affect
patient and family encounters per operational staff-to-patient ratios in
hour. These metrics account for FIGURE 1 both inpatient and outpatient settings
Average patient/family encounters per 8-hour
nondirect patient care activities and shift for child life specialists in various hospital and could necessitate a lower ratio of
direct patient care interventions. By settings. patients to child life specialist.69,70
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4 FROM THE AMERICAN ACADEMY OF PEDIATRICSIn addition to establishing a CCLS; and passing a standardized The scope of child life programs has
a benchmarking standard for child certification examination.71 Ongoing developed beyond pediatric inpatient
life specialist and patient encounters, and future requirements for the CCLS acute care settings to include
the CLPDC houses multifaceted credential are determined by the Child outpatient and other areas in which
information, such as types of Life Certification Commission of child life expertise can be effectively
organizations in which child life the ACLP. applied to support children and
specialists work, staffing, program families in stressful situations. Child
funding, reporting structure, services In some settings, child life services are life specialists provide services to
provided, and special services. The augmented by child life assistants (or presurgery and surgical centers,
CLPDC should be used as a resource activity coordinators, child life radiology and imaging departments,
for programs and hospitals in technicians, etc). Child life assistants dialysis centers, ambulatory clinics,
evaluation and continuous are typically required to have core NICUs, urgent care centers,
performance improvement of child college coursework, such as an psychiatric units, hospice programs,
life programming. associate degree in child development, camps for children with chronic
and experience with children in group illness, rehabilitation settings, and
settings. They generally focus on the some outpatient dental and physician
CHILD LIFE STAFFING AND ROLES normalization of the health care offices.76 Because the majority of
experience, providing play activities, children with medical complexities
Child life specialists are part of an coordinating special events
interdisciplinary, patient- and family- are being treated on an outpatient
(community visitors, holiday basis, child life services are
centered model of care, collaborating celebrations, etc), and maintaining the
with the family, physicians, advanced increasingly common outside the
playroom environment. Both child life hospital.77 Increasingly, CCLSs are
practice providers, nurses, social specialists and assistants actively
workers, and other members of the also part of interdisciplinary health
participate in the orientation, training, care teams, including palliative care,
health care team to develop and supervision of volunteers, thereby
a comprehensive plan of care. Child behavioral health, trauma, and child
contributing to volunteer effectiveness, protective services. In cases of
life contributions to this plan are satisfaction, and retention. This
based on the patient’s and family’s hospitalized or ill adults, child life
collaboration enables the child life specialists may be consulted to work
psychosocial needs, cultural heritage, specialist to conduct an assessment
and responses to the health care with children of adult patients,
and delegate as appropriate, allowing particularly in end-of-life, trauma,
experience. Child life specialists can patients with varying degrees of
participate in the care plan by, for and critical care situations.
psychosocial vulnerability and activity
example, teaching a child coping levels to be supported by the team Child life programs continue to evolve
strategies for adjusting to a life- member whose skills and knowledge and adapt to meet the changing health
changing injury, promoting coping are most closely aligned with patient care needs of patients and families.
with examinations for alleged abuse, and family needs. Although volunteers Children with special health care
assisting families in talking to their are a valuable supplement, they can needs now represent 18.8% of all
children about death, facilitating never be considered an adequate children, up from 12.8% in 2001.78
nonpharmacologic pain-management replacement for CCLSs. Specifically, the increase in patients
techniques, preparing and educating
with a diagnosis of autism spectrum
children about their medical care in
disorder presents opportunities for
age-appropriate ways, and EVOLUTION OF CHILD LIFE SERVICES child life specialization in supporting
communicating the child’s
The provision of child life services is this population in medical
developmental and individual needs
a quality benchmark of an integrated settings.36,79,80 In addition, the
and perspective to others. These
patient- and family-centered health number of children with mental health
interventions are most effective when
care system, a recommended and developmental disabilities
delivered in collaboration with the
component of medical education, and conditions is increasing, either alone
entire health care team.
an indicator of excellence in pediatric or comorbid with a physical health
The credentials of a certified child life care.72–74 There are more than 430 condition.81,82 Hospitals are also
specialist (CCLS) currently include the child life programs in operation in admitting children with more complex
minimum of a bachelor’s degree in North America75; most are located in medical conditions, with rates
child life, child development, or freestanding children’s hospitals, doubling between 1991 and 2005, and
a closely related field; the successful children’s hospitals within hospitals, may need greater individualization of
completion of a 600-hour child life community hospitals with pediatric care from the CCLS.83,84 The numbers
internship under the supervision of units, and EDs. of children with disabilities and
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PEDIATRICS Volume 147, number 1, January 2021 5medical complexities are increasing, Although evidence supports the value from the hospital to the home setting
likely because of the increases in of child life services, financial less disruptive. Child life specialists
technology that ensures the survival of pressures in many health care also provide services outside
patients with previously lethal settings have threatened the growth hospital-based settings, including
conditions.85 Given the increasing and sustainability of child life private practice, community agencies,
survival rate of patients with cystic services. In addition to contributions and hospice care, and are becoming
fibrosis, cardiac conditions, spina to the patient experience, the increasingly involved in providing
bifida, short gut, cancer, and other literature has also demonstrated support to children and families
chronic illnesses, more teenagers and financial benefits of child life during catastrophic events.
young adults face the challenging interventions, including reduced
transition to adult health care.86 sedation-related costs, and increased For hospitals or other health care
Acknowledging team goals to compliance during procedures, settings considering the initiation or
normalize the transition process and resulting in procedure expansion of child life services, the
address patient and family anxieties or completion.8–12 A child life program ACLP offers a consultation service to
questions, child life specialists can improves quality and decreases costs support existing program review and
assist in this transition by providing and, therefore, should be included in development, new program startup,
education and helping patients to the value-added equation and interdisciplinary education, and
communicate their needs, fears, hopes, discussion of health care cost, written practice guidelines.94 In
and expectations.87–89 including with payers. community hospital settings with few
pediatric beds and minimal pediatric
In recent years, patient experience outpatient or ED visits, the provision
and/or patient satisfaction has ADDITIONAL CONSIDERATIONS of full-time child life services may not
become a key quality and Child life services contribute to an be financially feasible. In such cases,
performance indicator. Although the organization’s efforts to meet the part-time or consultative services of
definition of patient experience standards set forth by The Joint a CCLS may be obtained to assist in
continues to be explored and honed Commission and other accreditation the ongoing education of staff,
by health care leaders, there is agencies, including effective students, and volunteers as well as to
common agreement that when communication, patient- and family- advise on a psychosocially sound,
evaluating health care quality, patient centered care, age-specific developmentally appropriate patient-
satisfaction is an important metric competencies, and cultural and family-centered approach to care.
that translates to health care ratings competence.92 Child life specialists’ The advancement of telemedicine
and payment.90 Family-centered care psychosocial and developmental also presents an opportunity for child
is a core principle for child life expertise and their keen awareness of life specialists to intervene when they
specialists; the recent emergence of the benefits of patient- and family- cannot be on-site. Advocating for
the patient experience as a key centered care provide a useful child life services as an essential part
quality indicator has resulted in child perspective at a systems level. Child of the interdisciplinary team is
life specialists often taking the lead in life input is often incorporated into a responsibility of health care
family-centered care and patient hospital committees, such as ethics, organizations to ensure it is
experience initiatives. Research family-centered care, patient a standard of pediatric care and
studies have demonstrated the experience, safety, environmental should occur on local and national
positive impact of child life design, bereavement, and strategic levels as well as in regulatory and
intervention on patient and parent planning. Child life expertise has accrediting organizations.
perception and evaluation of the applications beyond conventional
hospital experience, which is hospital care. Interventions can help
increasingly important for incentive- children transition back to their CONCLUSIONS
based reimbursement, accreditation, homes, schools, communities, and Child life services are associated with
marketing, and public reporting of medical homes.11,93 Child life improved quality, outcomes, and
outcomes.8,17,34,67,91 Health care specialists often collaborate with patient and family experiences as well
professionals and organizations local school districts to arrange as decrease costs in pediatric care.
acknowledge the significant impact hospital or homebound education, There is evidence that child life
child life specialists have on the and hospital-based teachers may be services help to contain costs by
patient experience as well as the role incorporated into child life program reducing the length of stay,
child life plays in helping the concept administration. These interventions decreasing the need for sedation and
of patient experience continue to help provide continued normalization analgesics, and increasing patient
evolve and grow.80 and help make the transition to and satisfaction ratings. Patient
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6 FROM THE AMERICAN ACADEMY OF PEDIATRICSexperience data and interdisciplinary 4. Child life services staffing must be AAP COMMITTEE ON HOSPITAL CARE,
team member feedback further individualized to address the 2018–2019
confirm the positive effects of child needs of specific inpatient and Jennifer Jewell, MD, FAAP, Chairperson
life programs on children, families, outpatient areas. The ratio of child Kimberly Ernst, MD, MSMI, FAAP
and staff. It remains essential for life specialist to patient should be Vanessa Hill, MD, FAAP
Benson Hsu, MD, FAAP – Section on
child life services to adapt and grow adjusted to account for the
Critical Care
with the changing health care patient’s medical, psychosocial, Vinh Lam, MD, FAAP
delivery system in support of the and developmental complexity and Melissa Mauro-Small, MD, FAAP – Section on
highest possible quality of care for vulnerability as well as family Hospital Medicine
children and their families. needs and preferences. Child life Charles Vinocur, MD, FAAP
services need to continuously
RECOMMENDATIONS evolve to meet the changing needs FORMER COMMITTEE ON HOSPITAL CARE
in pediatric health care, including MEMBER, 2017–2018
1. Child life collaboration with the
the significant increases in Daniel A. Rauch, MD, FAAP
entire interdisciplinary team is
children with disabilities and
essential to meeting the overall
medical complexity.
health care needs of children and LIAISONS
families. 5. Child life services optimize
Karen Castleberry – Family Representative
pediatric health care and, Nancy Hanson – Children’s Hospital
2. Child life services are part of an
therefore, should be included in Association
integrated patient- and family-
the hospital operating budget; they Kristin Hittle Gigli, PhD, RN, CPNP-AC, CCRN
centered model of care and can be – National Association of Pediatric Nurse
cannot solely rely on contingency
used as a quality measure in the Practitioners
or philanthropic funding.
delivery of health care services for Michael S. Leonard, MD, MS, FAAP –
children and families. 6. Legislative advocacy of child life Representative to The Joint Commission
services by pediatricians and other Barbara Romito, MA, CCLS – Association of
3. Child life services, provided directly Child Life Professionals
stakeholders is recommended at
by CCLSs, are recommended in
the state and federal levels.
pediatric inpatient units, EDs,
7. Additional research is needed to STAFF
chronic care centers, and other
diagnostic and treatment areas to further identify the impact of child S. Niccole Alexander, MPP
the extent appropriate for the life services on patient care
population served. In hospitals outcomes, including patient
with a small number of inpatient or experience, cost-effectiveness, and ABBREVIATIONS
outpatient pediatric visits, ongoing quality and safety measures.
ACLP: Association of Child Life
consultation with a CCLS is needed Professionals
to educate health care team CCLS: certified child life specialist
members and support LEAD AUTHORS CLPDC: Child Life Professional
developmentally appropriate Barbara Romito, MA, CCLS Data Center
patient- and family-centered Jennifer Jewell, MD, FAAP ED: emergency department
practice. Meredith Jackson, MD, FAAP
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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10 FROM THE AMERICAN ACADEMY OF PEDIATRICSChild Life Services
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