What exactly is Child Life? Child life specialists are asked this question daily. Despite its decades-old presence, child life specialists regularly explain the basics of their practice to others, often provoking surprise and appreciation. The “wow” following the explanation is a shared experience, a moment where child life specialists themselves reflect on the remarkable, and sometimes hard-to-grasp, nature of their profession.

Child life, though rooted in 1920s “play programs,” gained formal recognition in hospitals during the 1960s. While the profession has evolved significantly since then, just as the world has, its foundations still guide and direct every interaction. Child life is an essential component of pediatric care, supporting children’s healing throughout their medical journeys.   

Play

The foundational principles of child life services include emotional support, preparation for medical procedures, parental involvement and play.

At the heart of child life lies play, a fundamental principle that guides all other aspects of the profession. While play can sound simple and unimportant to the world, it is the primary way to relate to children. Children communicate through play in many ways: parallel play, cooperative play, constructive play, physical play and more.

As Fred Rogers, a television host and author better known as Mister Rogers stated, “Play is a child’s most important means of communication. Children are not self-conscious about playing. They play out what they think is real. That’s the ultimate honesty. Children bring their whole inner drama to any relationship.”

He also said, “Play is the work of childhood,” highlighting its crucial role in learning and development. Play is the best framework for every interaction with children.

So when a child is experiencing something new, different, scary, or confusing like the hospital, play becomes the essential starting point. It remains central to normalizing the hospital environment and facilitating healing.  

In The Story of Child Life, authors Susan Wojtasik and Claire White state, “Preparation for medical encounters, supporting family centered care, pain management, coping with grief and loss are as fundamental to child life practice today as is play. Nevertheless, play continues as a central experience in the hospital lives of children. It is a mode of healing.”

In some ways play has evolved over time with the development of technology. However, it has not changed a child’s need for free play, dress-up, or face-to-face interaction over a good card game or Barbie playtime.

Medical play, a cornerstone of child life practice, empowers children to process their medical experiences. By taking on the roles of doctors or nurses, children gain control and express their emotions, allowing child life specialists to understand their interpretations of their diagnoses and treatments.

So while the landscape of play has expanded, its core purpose – to learn, express and cope – remains unchanged. Children still thrive through pretending, competing and building, both independently and with others.

Emotional Support

While play is the foundation for communication with children, another principle of child life is emotional support.

Over the years, child life specialists have become essential in providing this support to patients and families, occupying a unique position within the health care team.

They are not responsible for making medical decisions for the patients or carrying out medical procedures; however, they serve as a constant, empathetic presence, guiding patients and families through the emotional complexities of their medical journey.

While other professionals can provide emotional support, child life specialists have the unique role in a therapeutic relationship with patients and families that includes a lot of play and fun. This type of relationship breaks down emotional barriers and fosters trust.

From initial hospital admission to end-of-life care, child life specialists offer unwavering emotional support to patients, families and friends. Over the past century, their reach has expanded significantly, extending beyond inpatient settings to outpatient clinics, specialty clinics, emergency departments and many other spaces. Today, emotional safety is at the forefront of pediatric care, and child life specialists are leading the charge to ensure that the emotional well-being of children is protected within their health care experiences.

Preparation

Preparing and supporting patients for medical procedures and experiences is another foundational principal for child life. Since its inception, the profession has emphasized the value of preparing children for medical experiences.

There are many ways to prepare children, but we know that play is the foundation of communication with children; therefore, effective preparation incorporates play and demonstration, including medical play.  Preparation also includes sensory information for the patients – what they will feel, see, smell, and hear – before, during and after procedures. Child life specialists can prepare patients and families for a wide variety of medical experiences, from blood pressure cuff placement to an IV start, MRIs and end-of-life care.

Child life specialists are trained to use developmentally appropriate language with children, translating complex medical terms into understandable concepts, like describing a tourniquet as a “tight squeeze.” This language helps alleviate fear.

Child life specialists also educate patients about new diagnoses and collaborate with families to create personalized coping plans. Over time, this aspect of child life has become increasingly specialized, making child life specialists essential in helping patients navigate and cope with their medical environments and experiences.

Parent Involvement

Lastly, child life specialists foundationally believe in parent involvement. A century ago, parental presence was not a given in hospital settings.

One of my favorite books is Curious George goes to the Hospital by H.A. and Margaret Rey. It was originally published in 1966, and the Man with the Yellow Hat was not allowed to stay at the hospital with George. While this book is chalked full of the foundations of child life, it is clear that family-centered care was not yet a standard practice.

It wasn’t until 1980s that family-centered care was introduced to hospitals and not until 2003 that the American Academy of Pediatrics added family-centered care to their policies. Child life specialists were instrumental in advocating for parental inclusion in a child’s hospital stay and care. They were guided by family systems theory, which recognizes that a child’s medical experience affects the entire family.

Today, family-centered care is essential to medical care, especially pediatric care, with child life specialists championing parental presence and involvement in all aspects of care, from comfort positioning to education about procedures and diagnoses.

So, what is child life? Child life is the foundation of caring for children in the medical setting. Child life specialists exist to bring comfort and understanding to children within the medical environment and ensure their emotional safety through play, emotional support, preparation and parent involvement. A century later, child life specialists still play – first and foremost – provide emotional support, prepare, support and educate patient families, and advocate for family-centered care. As we celebrate child life month, we celebrate the incredible role that child life specialists play within the health care team.

References

Gaynard, L., Association for the Care of Children’s Health., & ACCH Child Life Research Project. (1990). Psychosocial care of children in hospitals : a clinical practice manual from the ACCH Child Life Research Project. Association for the Care of Children’s Health.

Wojtasik, S. P., & White, C. L. A. I. R. E. (2009). The story of child life. The handbook of child life: A guide for pediatric psychosocial care, 3-22.

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A Look Back: Celebrating 45 Years of Cook Children's Child Life Department

By Baylee Simmons, CCLS, Child Life Specialist at Cook Children’s Neonatal Intensive Care Unit

A child life specialist is commonly known as someone who can help a child understand and cope with his or her hospitalization, diagnosis or medical experience.

That being said, I am often asked what role a child life specialist plays in the Cook Children's Neonatal Intensive Care Unit (NICU) where patients are far too young to talk, comprehend preparation for procedures, diagnosis education or participate in play and therapeutic activities typically provided by child life. 

Great question! Child life in the NICU looks very different than in other areas of the hospital. Still, our goal is the same -- to provide support and interventions that promote emotional safety, improve patients' and families’ ability to cope, and reduce the negative effects of unavoidable stress and trauma they endure.

Stress and coping in the NICU

When an infant is born prematurely or with medical needs leading to a NICU admission, the whole family is affected. Most parents expect to take their baby home to a quiet, calm environment where they can heal, bond with this new baby and begin adjusting to life with a new member of their family.

A NICU admission can turn all of those expectations upside down. For the first few days, the mother is often still admitted to another hospital, the delivery hospital. While this is necessary for moms to heal and recover, it creates a lot of stress for the family. The baby’s father and/or other family members have to navigate where to spend their time, who will care for any children at home and so much more.

Patients admit to the NICU for many, many different reasons and these admissions range from a few days to many months depending on the severity of their condition and medical needs. Over the course of a patient’s admission, the stress may change but continues to bring new challenges.

Some parents grieve their first days or months with this baby not looking how they thought, some struggle to feel connected with their baby amidst the restrictions and treatments needed to grow or heal, or wonder how to support, explain things to and include the baby’s siblings without overwhelming them.

Other families find themselves unable to understand/process their baby’s diagnosis and care, juggling time between work and the hospital to maintain income, or processing a tragic situation where their baby might die and making decisions about how to honor their child’s memory or explain that to their siblings. All of that stress impacts a family’s ability to cope with the hospitalization and ultimately provide a secure, nurturing environment for their baby, which plays a critical role in their development and health.

Child Life in the NICU

As a NICU child life specialist, I can often be found hanging a name banner in a new patient’s room, making ink prints of tiny feet or seated on the couch next to an overwhelmed parent listening to whatever troubles their mind that day. These are a few ways I begin getting to know a family, what is meaningful to them, and what individual stressors or challenges they bring to the NICU experience.

This careful assessment allows me to identify what support, education or therapeutic intervention they might benefit from on any given day. I strive to give families the tools they need to be successful in the NICU environment and overcome the stress they inevitably encounter here. That could be using my knowledge of child development to help validate or explain why their 4-year-old daughter is regressing and acting out uncharacteristically or offering a more simplified explanation of new medical equipment being used on their baby using a teaching doll or other resources to strengthen the family and siblings’ understanding. 

I make ink prints or take photos of big moments and milestones babies meet to help encourage their parents and foster that connection throughout their stay. We celebrate holidays and “firsts” throughout the unit to bring a little bit of joy or normalcy into a place where most families feel that they are missing them. And on the darkest days when families are told their baby will not be coming home with them, I offer bereavement support and the opportunity for families to choose how they will honor and memorialize their child’s last moments of life.

Child Life exists in the NICU to support the WHOLE family so that they can better care for and support their baby both in our unit and as they transition home.

, a Twisted X Global Brands company, have joined together to create the Cook Children’s by Twisted X Collection. Twisted X will donate 100 percent of wholesale proceeds from every pair of shoes sold from this collection directly to Cook Children’s.  

“The partnership between Cook Children’s and Twisted X furthers our commitment to providing patients and families with a one-of-a-kind resource tailored around their health care needs to enhance the overall experience,” said Cook Children's Health Foundation Senior Vice President and Chief Development Officer Grant Harris. “We are constantly looking for new ways to provide compassionate care and we are proud to come together with Twisted X who shares this passion and embraces creativity as a therapeutic outlet.” 

From factory to retailer, the entire supply chain has come together in support of the collection to deliver the footwear at a reduced cost to maximize the donation. The collection includes four unique designs made by patients at Cook Children’s with the help of Twisted X Designer, Tuan Lee. Each pair is named after the artist and embodies their dream pair of footwear to achieve a perfect balance of style and comfort in the form of a slip-on kick.  

• The Alex: Alex is a 6-year-old with Ketotic Hypoglycemia. She loves math, enjoys riding her bike and uses her imagination to go on adventures as colorful as her bright shoe design.  
• The Rowan: Rowan is a 9-year-old with Sigmoid Sinus Vein Thrombosis. She loves riding horses and is a member of 4H, which is highlighted by the western vibes of her cactus green design.  
• The Brianna: Brianna is a 14-year-old with Epidermolysis Bullosa. She has painted several canvases displayed inside Cook Children’s Media Center and especially loves to paint butterflies, which are prominently featured in her sky-blue design.  
• The Isaac: Isaac is a 15-year-old with Spina Bifida. He enjoys art, video games and Marvel movies, using Iron Man as the inspiration behind his sleek silver design. 

"Twisted X is dedicated to making a positive impact on the community we serve, and Cook Children’s is a perfect partner for us,” said Twisted X CEO Prasad Reddy. “We know that little steps can make a big impact and our hope is to raise awareness within the western industry for the amazing care provided at Cook Children’s in order to give back to those who need it most. This collection is a true embodiment of comfort that gives back and brings so much joy to footwear design.”  

"I like my shoe and my favorite part about it is that it’s rainbow colored and I love rainbows. And I love this shoe the best because I painted it and I got to make it however I want,” said Alex. “Art helps me relax and calm down my nerves from the pain that I get from my skin condition. I usually paint butterflies because it represents my illness. It’s like butterfly skin because it’s fragile,” said Brianna.  

Cook Children’s and Twisted X will celebrate the collection with a launch event today at Cook Children’s Fort Worth Campus. The collection is now available online at twistedx.com/pages/cook-childrens and in-store at select retailers nationwide. To learn more about the collection and the shoe’s young designers, visit cookchildrens.org/twistedx.    

As a child life specialist my job is help provide normalization during stressful and traumatic medical experiences. We educate, prepare and support children through tests and procedures, as well as coping with any life challenges children and their families face.

Somedays are full of amazing moments, like sending patients home after a long stay, or watching a hospital therapy dog light up a room.

But sometimes life is full of hard moments; moments that feel like mountains that kids can’t ever imagine overcoming. My job as a child life specialist gives me the opportunity to help families during those hard moments.

Sometimes it is giving a small child, afraid of the hospital and the people in it, the chance to play in the midst of all the new things happening around them.

Other times it's being there when a patient needs a poke, to help them learn coping skills that will help them right then, as well as in the future. One of my favorite moments was witnessing a 4 year old exclaim, “That wasn’t as hard as I thought it would be!” after getting a poke he had been very nervous about. Through preparation in terms he could understand and support using distraction, he was able to feel successful in the moment and hopefully be a little less nervous in the future.

From time to time my job includes supporting kids and their families when they get difficult news they didn't want to hear. Sometimes that looks like providing a developmentally appropriate explanation of a new diagnosis to a patient and their siblings, or standing at a parent's side to help them explain things that feel too heavy to find the words for on their own.

Every day is different and not every moment is full of bubbles and sunshine, but I feel so lucky to work as a child life specialist. It is an honor to walk alongside kids and their families during hard moments and so encouraging to celebrate with them during the good ones.

About the author

Zoe Growald is a Child Life specialist at Cook Children's on 4P and the Epilepsy Monitoring Unit. Our Child Life specialist work with kids and families to make their visit to the medical center easier and more comfortable. Our Child Life specialists offer your child and your family an opportunity to express and work through any fears and concerns you may have. We’ll provide an explanation about what’s going to happen during your visit and work with parents, brothers and sisters and other family members who may be involved in your child’s daily care. As a part of our commitment to family-centered care, Child Life specialists work with your child's medical team to advocate for and ensure your child’s and your family's needs are addressed in the most nurturing atmosphere possible. Click to learn more.

When I came to work here, I was in an as-needed position that required me to work anywhere and everywhere in patient care. One morning I was working in outpatient surgery when, to my surprise, an anesthesiologist asked me to help walk his patient back to the operating room due to high anxiety. What was even more surprising was when a second anesthesiologist made the same request just a few minutes later. I was in the middle of trying to make a decision about whose patient to help when the second doctor let me know he would wait for me to bring his patient back. Anyone in child life can tell you how huge that is; the recognition that the services provided by child life are so vital that they are worth waiting for, even in the fast-paced world of surgery.

Though to an outsider our work may look like many of the things that people innocuously comment (you have the best job ever; all you do is play all day; I wish I got paid to blow bubbles and play on an iPad), it is important to clarify that in all things a child life specialist does, there is a therapeutic value. I remember when I was a student in child life and my preceptor was referred to as a “glorified babysitter.” Though it may have stung her to hear that, it sparked an important conversation about what child life specialists aren’t, and more importantly, what they are.

Child life specialists are educated in child and human development; they have at least a bachelor’s degree, and in many cases, a master’s. They complete a semester of practicum, a 480-hour highly selective clinical internship, and must demonstrate theoretical and practical knowledge to pass a certification exam. Once certified, they are required to maintain certification by participating in professional development and continuing education. The knowledge gained on the way to becoming a certified child life specialist is used to build therapeutic relationships that help patients and their families master the health care experience.

With a child life specialist on the health care team, patients gain an understanding of their diagnosis and treatment in a way that meets their needs. The patient’s specialist may use medical dolls, messy activities and other forms of play to help the patient and any siblings clearly understand what they are going through. It is the work of child life specialists to assess the patient’s development, needs, and psychosocial goals. They then help to equip the whole family with knowledge and coping skills; they normalize a very abnormal environment, and perhaps most importantly, they make sure that kids have every possible opportunity to still be kids while they are here.

And yes, child life specialists do have the best job ever.

About the author 

Kizzy Marco is the Child Life Zone Program Coordinator at Cook Children's and the primary handler of Ralph Lauren, a therapy dog at Cook Children's. Cook Children's Child Life specialists work with kids and families to make their visit to the medical center easier and more comfortable.