CCLS cheat sheet

Piaget stages guide explanation depth: sensorimotor (birth-2), preoperational (2-7), concrete operational (7-11), formal operational (11+).

Preschoolers in the preoperational stage often interpret illness as punishment or the result of a bad thought or wish; school-age children can grasp contagion and simple cause-and-effect.

Separation anxiety peaks between 6 and 30 months; Bowlby's sequence is protest, then despair, then detachment, and is buffered by caregiver presence and consistent routines.

Pain measures by developmental level: FLACC for preverbal or nonverbal children roughly 2 months to 7 years, Wong-Baker FACES for about 3 years and older, numeric rating scale for about 8 years and older.

Coping style is categorized as approach (information-seeking, active participation) or avoidance (withdrawal, distraction-seeking); interventions are matched to the observed style.

High psychosocial risk indicators include prior negative healthcare experiences, developmental delay, multiple invasive procedures, caregiver distress, and limited social support.

Assessment data sources include direct observation, play-based assessment, child and caregiver interview, medical record review, and standardized measures.

Reassessment is triggered at transitions: admission, new diagnosis, surgery, transfer between units, and discharge planning.

Play is grouped into three intervention categories: normative play (normalizes the setting), therapeutic play (emotional expression and mastery), and medical play (exploration of equipment and experiences).

Preparation content combines procedural information (sequence of events), sensory information (what is seen, heard, felt, smelled, tasted), and a rehearsed coping plan.

Timing rule: toddlers and preschoolers receive preparation immediately before the event; school-age children and adolescents benefit from roughly one to two days of lead time to process.

Statements promising no pain (for example, "it won't hurt") are avoided; the child is told the expected sensation and which coping options are available.

Distraction is most effective for brief, acute painful procedures; breathing, counting, imagery, and choice-making build generalizable coping skills for repeated procedures.

Comfort positioning, with caregiver participation, replaces forceful restraint and supports the child's dignity, security, and sense of control.

Medical play is used to surface and correct misconceptions, because children's fantasies about procedures are frequently more distressing than the actual events.

Documentation of an intervention records the assessment, the intervention delivered, the child's response, and the evaluation or plan.

Normalization maintains age-typical routines, schoolwork, play, and choices during hospitalization to support ongoing development.

Assent is the child's developmentally appropriate agreement; it accompanies but never replaces the legal informed consent of the parent or guardian.

Confidentiality is protected by HIPAA, with recognized limits including suspected abuse or neglect, imminent danger to self or others, and legal requirement.

Mandatory reporting is triggered by reasonable suspicion of abuse or neglect, not by proof or by the specialist's own investigation.

Scope of practice: child life provides psychosocial and developmental support through play, preparation, and coping; psychotherapy and diagnostic assessment belong to licensed mental health disciplines.

Boundary rules prohibit dual relationships, require minimal personal self-disclosure, follow institutional gift policies, and keep contact within professional channels.

Core ethical principles applied to child life decisions are beneficence, nonmaleficence, autonomy, justice, fidelity, and veracity.

Recertification as a CCLS is administered by the Child Life Certification Commission and requires documented continuing professional development units within a defined cycle.

Evidence-based practice integrates the best available research evidence, the specialist's clinical expertise, and the family's values and preferences.

Reflective supervision and deliberate self-care are used to maintain competence and reduce burnout and compassion fatigue.

Family-centered care treats the family as the constant in the child's life and as a partner in assessment, planning, and decisions, including presence during procedures.

Typical interdisciplinary team members include physicians, nurses, child life specialists, social workers, psychologists, chaplains, and physical, occupational, and speech therapists.

Interdisciplinary or bedside rounds are the primary forum where child life shares psychosocial assessment findings and advocates for developmental and emotional needs.

HIPAA governs protected health information; information is shared on a minimum-necessary basis with those involved in the patient's care.

Joint Commission accreditation standards address patient rights, safety, pain management, and psychosocial and spiritual care, which child life supports through practice and documentation.

Discharge planning begins at admission and addresses family education, follow-up appointments, medications, equipment, and community resources.

Unresolved clinical or safety concerns are escalated through the chain of command, typically from charge nurse to unit manager to physician leadership.

Child life practice settings include inpatient units, emergency departments, ambulatory clinics, perioperative areas, NICUs, and community or home programs.

Social determinants of health, including housing, food security, transportation, insurance, and language, influence access, adherence, and health outcomes.