The Hidden Resource: How Child Life Services Helps Families Cope at Shriners Children's

Hazel was 8 months old when an accident changed the course of her life. In March 2017, she was in her walker in the family barn when a fire sparked from a torpedo heater, and Hazel was stuck in the flames.

She was rushed to a local hospital and then transported by ambulance to another before ultimately being transferred to Shriners Children's Ohio, where doctors found that Hazel had suffered second- and third-degree burns to her hands and face.

Since then, the 8-year-old has undergone numerous procedures, including skin grafts, releases and laser treatments, and she'll likely need more surgeries until she's finished growing. But one thing that has made those years of treatment much easier to bear is the child life services team.

"I was one of those parents who had no idea child life services even existed, but they have been huge for our family," her mother, Ashlee, said. "They can completely change a child's appointment or surgery for the better."

Every Shriners Children's location has team members trained to help kids and families cope with injury, illness and hospitalization as patients move through clinic visits, inpatient stays and surgery.

"Child life specialists work in pediatric healthcare settings to promote positive coping and adjustment with injuries, illness and hospitalization," said Rebecca Wildes, MS, CCLS, lead child life specialist at Shriners Children's Boston, who also leads the hospital's Team Brave program, a partnership with the Boston Firefighters Burn Foundation. "My day-to-day work varies greatly because of our ability to see patients in clinic, on our inpatient unit and in the OR."

Ask a specialist to define the job in plain terms, and the answer often comes back to one idea: making the hospital feel less like a hospital.

"Our overarching goal is to help minimize the trauma that kids experience in the hospital," said Alexandra Rogers, MS, CCLS, manager of therapeutic recreation and child life at Shriners Children's Northern California. "We want to make the hospital environment feel a little less scary and a little more normal for kids and their families."

Built for Children Who Return Again and Again

Shriners Children's patients often come back for years, sometimes into adulthood, for the same condition. That pattern shapes how child life teams do their jobs.

"Because we're so specialized here, we're able to do the full spectrum of child life work," Rogers said. "We get to see kids during their hardest moments – their first dressing changes, their first surgeries – when it feels like an insurmountable thing. And then we get to see that growth. We get to see these kids build coping skills and learn to advocate for themselves."

Rogers said her team's caseload ratio tends to run smaller than at a larger children's hospital, which lets specialists check in with every surgical patient rather than triaging to the highest-need cases.

"I want a kid to tell me, 'I think I can do this today by myself,'" she said. "If they tell me that, it means they've built up enough coping skills and they feel secure enough to know what's happening and how to handle it."

At Shriners Children's Greenville, Nikki Buchanan, CCLS, CTRS, has watched that pattern play out for more than three decades. She started as a Clemson University intern in 1992 and was hired full-time at Shriners Children’s the following year, making her one of the longest-serving child life specialists in the international nonprofit healthcare system.

"I love the patient population. I love the staff here," she said. "This place is just amazing. It's like we're a family."

Meeting Children Where They Are

Procedural prep, medical play and distraction are the tools child life specialists reach for most, but which one gets used – and how – depends on an assessment made in the moment.

"Truly, at the end of the day, what we focus on is an assessment. We're trained to walk into a room and quickly assess what that patient and that family need," Rogers said. "I can walk in with a plan to prep a kid for surgery tomorrow, and that kid is in tears and inconsolable. I'm not doing a prep. We're going to pause and figure out where those tears are coming from."

That flexibility extends to parents, too. Rogers recalled a 4-year-old in clinic who was terrified of the hospital environment, including something as simple as stepping on a scale.

"I brought her a teddy bear and some medical play items, and I told her mom how she could use those tools at home to start talking about the hospital in a non-threatening way," Rogers said.

When a medical assistant asked to try the scale again, Rogers put the teddy bear on it first.

"I said, 'Well, why don't we measure teddy bear first?' She hopped on holding her teddy bear, and we got her weight. It allowed Mom to see that it's possible. We just have to change how we're doing it."

At Shriners Children's Greenville, child life specialists respond quickly to patient needs thanks to the hospital’s electronic health record system.

"There were times when labs would be drawn on kids, and we'd have no idea," Buchanan said. “Now, when a lab order comes through, the lab team reaches out to child life with a five-minute lead time so a specialist can prepare the patient first.”

Inside the Operating Room

For patients and their families, the operating room and the moments leading up to it are filled with anxiety. At Shriners Children's Boston, Wildes works with patients to personalize equipment like their anesthesia mask before they're wheeled in.

"The operating room can be an unfamiliar and intimidating environment for children, so having child life there helps patients feel supported and at ease," she said. "Engaging a young child in decorating their anesthesia mask, then practicing with it on a doll or stuffed animal, gives them control and mastery when they don't have many choices during their admission."

Wildes described meeting a young international patient in clinic for her first surgical evaluation. The girl, about 2 years old, had spent three months at an outside hospital after a burn injury in her home country and had been discharged only a month earlier.

"When I entered, staff were attempting vitals, and she was completely inconsolable, almost to the point of making herself sick," Wildes said.

Given how upset the girl was, the surgeon proposed that she return home to heal from the trauma, and the surgery was postponed. She returned months later, and the team brought her to Boston a week ahead of the rescheduled procedure so she could meet with child life and psychology first.

"Intense fear is usually based on uncertainty or on previous negative experiences," Wildes said. "During medical play, she was able to gain control, and we were able to clarify misconceptions and provide explanations. She was able to process her experience through play, which was really empowering for her and for her mother."

The surgery went smoothly, with her mother present during induction and called back to recovery as soon as the patient woke up.

A Mother's Perspective

For Ashlee, one of the clearest examples of the power of child life services came during a recent laser treatment for Hazel, who has grown more anxious about procedures as she's gotten older.

"They decorated her anesthesia mask with stickers Hazel got to pick herself, and she chose the scent she wanted to smell," Ashlee said.

The team even showed her a trick, turning her mask into a bubble maker. Before long, her hospital room was filled with bubbles, and her nervousness turned into laughter.

"What could have been a scary and stressful moment became something fun that Hazel could participate in and control," she said. "That's what child life has meant to our family. They find ways to help her feel like a kid, even in moments when she has to be a patient."

Marie-Line has watched a similar relationship take shape for her son at Shriners Hospitals for Children Canada. Alex was diagnosed with severe scoliosis at birth and had his first surgery at 20 months old in Halifax, Nova Scotia. When his condition didn't improve, Marie-Line sought a second opinion and contacted Shriners Hospitals for Children Canada in December 2024.

Since then, Alex has undergone four additional spinal surgeries and completed nine weeks of halo traction, a treatment that uses a ring anchored around the skull to gradually straighten the spine before surgery.

In January 2025, Alex's surgeon told Marie-Line that the two of them would need to relocate to Montréal for three months for the treatment. The prospect of keeping a toddler occupied in a hospital setting for that long felt overwhelming until a social worker brought them to the playroom and introduced them to Angie, the hospital's child life specialist.

"Before every surgery, we tell Alex we're going to find Angie," Marie-Line said. "That simple tradition eases his pre-operative anxiety and gives him something positive to focus on and look forward to when he wakes up."

She added: "Even today, whenever we mention flying to Montréal, the first thing Alex talks about is seeing Angie again. To him, she is much more than a child life specialist. She is a friend."

Support for the Whole Family

Just as much of a child life specialist’s work happens with parents as with patients, particularly around how and when to talk to their child about what's ahead.

"A lot of times, parents just don't have the words. They want to talk to their kid about what's happening, but they don't know how to say it, or it's too hard to be the one to share that information," Rogers said. "I'll ask a parent, 'If I give you the words, do you want to share that with your child, or would you rather I share it with your child with you here?'"

At Shriners Children's Greenville, that support is especially visible around amputation decisions, which often fall to parents of children too young to weigh in themselves.

"That's big when you're an adult, much less when you're a child," Buchanan said. "We want them to know what we've seen. We have the luxury of watching these kids thrive. It might be a tough road for some of these surgeries, but at the end, they're amazed."

That anxiety extends to siblings, too, and families are welcome to bring them into child life activities. Buchanan said the alternative – going through a hospitalization without that support – is something she's experienced firsthand as a parent.

"We're a hidden resource that people don't know about," Buchanan said. "I have a 19-year-old son who's asthmatic, and we made several trips to the ER, but we never had the chance to meet child life. No one ever came in and prepared him for the injections he needed in his legs. Just knowing there's someone there for your child, and for the parent and siblings, too – that’s the full package."

Relationships That Last

Because many Shriners Children's patients return for years, specialists often watch a single relationship stretch from a child's first admission into their teens.

Buchanan's tenure has given her a front-row seat to what that looks like over time. In 1996, she accompanied patients to the Paralympic Games in Atlanta, including a teen with a limb deficiency who watched the athletes compete with visible intensity. Eight years later, that same patient was competing for Team USA at the 2004 Paralympic Games in Athens.

At Shriners Children's Northern California, Rogers described a patient who came from another country for a halo placement ahead of spinal fusion surgery.

"You could see him grow in confidence, even with the halo on," Rogers said. "He started coming out of his room more, coming to our events. We called him the mayor because he'd come down but make sure he brought other kids with him, too."

The patient was discharged about a year ago. When he returned for a checkup, he and his family visited a friend he'd made during his stay.

"We're able to create joy and happiness in a space that, especially in the adult world, we don't always think of that way," Rogers said. "It can last with these kids for a very long time."

Buchanan described a similar bond forming among the hospital's international families, some of whom stay in Greenville for months at a time.

"Our international families right now are from five different countries, but you'd never know they just met each other here," she said. "I was playing cards one night, and at the table, we had five languages: Mongolian, Arabic, Dutch, Spanish and English. But you'd never know it, watching us play. Everybody was just having a blast."

For Ashlee, Hazel’s years of visits to Shriners Children's have added up to something she still finds hard to put into words.

"I couldn't say this without crying: Thank you," she said to the team. "Every child is different, yet you have an incredible ability to connect with each one and meet them exactly where they are. That takes an incredibly special person."