Healthcare News & Insights

Keys to improving the ED experience for children

Your hospital should be doing all it can to make children feel at ease when they’re visiting the emergency department for an illness – particularly those with autism and other related developmental disorders. 

Doctor vaccinating small redhead girl.Even if your facility doesn’t specialize in pediatrics, it’s a given that your ED will treat children and adolescents. And some of them will have autism.

In fact, according to the Centers for Disease Control and Prevention (CDC), one of every 68 children is on the autism spectrum.

As discussed in a report from the American Academy of Pediatrics, young patients’ pain is often underestimated in the ED because children can’t always let doctors know how serious their symptoms are. This is especially true with young patients who have autism.

If that wasn’t enough, the general anxiety of the ER experience only heightens children’s pain, the report said. Children may be confused about why they’re being prodded and poked by doctors, and this may make them even more uncomfortable.

The experience is often worse for children with autism, as the bright lights, numerous staff members and unfamiliar setting can make them extremely anxious, which can have negative effects on their treatment.

Easing kids’ anxiety

To make ED visits less stressful for children in general, clinical staff should be trained on how to best interact with them to reduce their anxiety.

Training should focus on techniques such as:

  • showing children the medical supplies staff will use
  • offering them choices, when appropriate
  • telling children what to expect during treatment
  • encouraging them to ask questions, and
  • giving them a special role or job with a medical procedure.

Along with specialized training, here are some other tactics your hospital can try to improve the ED experience for children:

  • Create child-friendly spaces. Use a small section of the ED as a place just for children, with colorful walls and furniture, along with games and toys. Televisions can display children’s programming, and exam rooms can play child-friendly music.
  • Hire a child-life specialist. A child-life specialist is trained to talk to children on their level, offering them techniques to reduce their stress and explaining treatment plans to them in a developmentally appropriate manner.
  • Allow family members to be present during procedures. Children, and even adolescents, may feel more at ease during uncomfortable procedures if parents or other family members are with them to “coach” and reassure them.

Better EDs for children with autism

As a way of going the extra mile, some hospitals have created specific initiatives to make the ED experience less upsetting for autistic children

In these facilities, staff are trained to identify specific behavior patterns often associated with autism. Then, they learn about techniques to put young autistic patients at ease in the ED.

One hospital that’s created an autism-friendly ED for children is Capital Health Medical Center in Hopewell, NJ. According to an article from, besides extensive staff training, the facility has taken steps such as:

  • dimming harsh fluorescent lights in waiting areas
  • making “sensory boxes” with comforting objects of different textures (e.g., “soft,” “hard,” “squishy”), and
  • allowing young patients with limited verbal skills to communicate with nurses using iPads.

Nemours Children’s Hospital in Orlando also offers sensory boxes and iPads to autistic children in its ED, but, as discussed in the Orlando Sentinel, the facility goes a step further with its Respecting Each Awesome Child Here (REACH) program.

As part of the REACH program, autistic patients and their families are offered the chance to wait for treatment in a separate ED waiting room. The area is quieter and less chaotic than the standard waiting room.

Once the child is called back for treatment, a small sign on the exam room lets staff members know the patient has special needs so they can be prepared.

Taking similar measures could help your hospital better meet the needs of young autistic patients in the ED.

Listen & learn

Above all, when clinicians evaluate children in the ED, especially those with autism or special needs, don’t forget to remind staff about the importance of feedback from the patient’s parents or guardians.

Parents are the first to know when something’s off with their child. So if a parent or guardian states a concern about a child’s treatment, or offers a suggestion to calm a young patient’s anxiety, providers should listen closely and respond appropriately.

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