Playing down fears

On a midsummer Tuesday morning at the Roberts Proton Therapy Center at Penn Medicine, the children's waiting room is bustling. Preteens punch up basketball video games while younger children squash Play-Doh through a plastic mold or check doll heart rates with toy stethoscopes.

At a round table in the center of the waiting room sits Carlin Beasley, a delicate 3-year-old in a pink tutu whose mischievous eyes gaze out above a wide sterile mask.

Chemotherapy for a brain tumor has compromised her immune system, but it hasn't stopped Carlin from pulling out the pieces of a real-life prep kit designed to deliver anesthesia.

With small practiced fingers, she accurately fits the injection kit over a surgically implanted port located in the chest of a stuffed animal called Chemo Duck, and with a confident push, starts the imaginary drip.

In the midst of the action roams Allison Tappon, 34, a child-life specialist who gently directs these activities. As she walks among tables, Tappon leans down to ask a question, suggest a different mode of play, or quietly observe as her charges wait for or return from their radiation treatments.

As one of 45 child-life specialists at Children's Hospital of Philadelphia, Tappon helps to prepare these young patients for care, assess their coping skills, and provide developmentally appropriate play to help them deal with the anxiety and stress of their condition.

Lowering their anxiety can also lead to a reduced need for anesthesia during their time on the proton machine. Many of the children receive treatments five days a week, from five minutes to an hour, often involving the sedating drug propofol.

"Every day is unpredictable," says Tappon. "We try to give sisters and brothers an understanding of what their sibling is going through and to keep the information consistent with what the family is telling them."

Child-life specialists at Children's work in all inpatient and emergency areas, radiology, day surgery, dialysis, and outpatient oncology, and at satellite locations in King of Prussia and Voorhees. Internationally, there are 4,625 certified child-life specialists, most of them in North America.

Tappon uses a number of "toys" that help her explain difficult and scary concepts to her young charges. In a private room decked with colorful murals, she works with children one on one, using real-life anesthesia prep kits and a mock scanner that can stand in for a CT scan, the proton machine, or an MRI. Patients, who need to don masks for the proton machine, practice with Spider-Man or Hello Kitty masks. And for kids who require anesthesia, Tappon has a prep-port-access doll and Chemo Duck.

"Child life is a win-win, for each child, family, and for anesthesia," says Joe Denham Jr., an anesthesiologist at Children's. "Even if a child still needs anesthesia, Ali helps allay and minimize stresses that each child brings."

Play can be a serious help, concludes a recent review of studies on using therapeutic play for children in hospital settings from the Hospital for Sick Children in Toronto. The paper notes that "re-enactments of experiences through doll play and instructional play . . . can alleviate a child's emotional distress, help them cope with difficult medical experiences, diminish their anxiety and fear, and increase their willingness to revisit the hospital." Physiological benefits include a reduction in palm sweating, excessive body movement, escalating pulse rate, and high blood pressure.

Child-life specialists are not covered by insurance. At Children's, services are paid out of operating capital and donor contributions.

Byung Lee, 33, of Broomall, whose active son Shane, 4, has a brain tumor, said that at first he didn't think a child-life specialist was a great idea. "It came out of nowhere," he says.

But he has since been converted. Shane, who receives treatment five days a week, has his anesthesia port removed every Friday, which means it has to be put back in on Monday mornings.

"Mondays were really tough for us," says Lee, a Stephen Starr restaurant manager. "But Ali meets Shane with toys and an iPad to ease the pain."

Tappon also helps families who transition to Children's for proton therapy from other hospitals, which can be as far away as Europe and Asia.

Wendy Schofield, 40, mother of Carlin, watches over the playroom with her husband, Rick Beasley, 43.

"Allison did a wonderful job when we moved Carlin from Kentucky to Philadelphia for treatments," says Schofield. "The staff went out of their way to make the transition easy and kid-friendly."

She glances at her two daughters happily playing at the table. "I can't imagine if it were a more sterile situation."

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