Children and their families often feel scared, overwhelmed and confused by a medical experience. When a child is first admitted to the hospital or diagnosed with an illness, parents are initially focused on doing whatever it takes to get their child physically better, which is understandable. It can be easy to overlook how to keep young patients emotionally safe in the process. The National Child Traumatic Stress Network reports that up to 80% of children and their families experience at least some traumatic stress reactions following medical treatment for life-threatening illnesses or injuries. When these reactions persist, they can impair a child’s day-to-day functioning, affect adherence to medical treatment and impede optimal recovery.

In our roles at Johns Hopkins Children’s Center, we know how important it is to provide emotionally safe care to young patients and their families. The Association of Child Life Professionals defines emotional safety as “an intentional, interdisciplinary practice to promote resiliency, healing, and trust for pediatric patients and their families during medical experiences.” 

Emotionally safe care is built around four pillars: proactive screening, individualized coping plans, environmental enhancements, and staff communication and education. In practice, our strategies to emotionally support children and families run the gamut, from explaining each step of a procedure in advance to reduce fear and helplessness, to teaching coping skills such as deep breathing or holding a comfort item. We believe that by centering the emotional needs of children and families in every aspect of care — from their environment to staff communication — we will help to eliminate the experience of stress and medical trauma that that can have a lifelong impact on health. 

To highlight emotional safety at The Johns Hopkins Hospital, the Department of Child Life hosted an all-day Emotional Safety Summit last fall, organized around the 80th anniversary of the Child Life Department at Johns Hopkins. Leaders from across the Children’s Center came together to create a shared vision of how to implement emotionally safe care for all our patients and families. Additionally, “emotional safety taskforces”— including both inpatient and ambulatory care — were formed as part of a five-year strategic planning process for the Children’s Center. These groups were tasked with mapping strategies and concrete deliverables to achieve emotionally safe care for every patient, in every instance.

Furthermore, members of our Pediatric Patient and Family Advisory Council provided in-person feedback on what makes them feel emotionally safe when they seek care for their child: in the emergency room, during a procedure, at bedside rounds or during discharge. From these discussions emerged several well-established patient- and family-centered themes, including the importance of information-sharing; building trust and rapport; participation; and providing a caring environment.

We look forward to continuing this work to ensure that the practice of emotionally safe care becomes as much a part of our safety and quality culture as the practices we have in place to provide physical safety. Creating an emotionally safe environment helps to reduce patients’ medical trauma and distress, and it fosters trust, paving the way for positive health care encounters in the future and improving health care-related quality of life for young patients and their families. Physical safety and emotional safety go hand in hand.

Sue Mead is a parent adviser on the staff of Johns Hopkins Children’s Center and co-chair of the Pediatric Family Advisory Council. Patrice Brylske is director of the Child Life Department.