Painting Sick Children by Louise Lear


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I decided to write this 18 months into my sons 3-year course of chemotherapy.  I have painted in the hospital, at the clinic, and at events for the children, after working as a face and body artist for far more years than I remember....  Adams treatment has been an education in more ways than one, and I hope I can share some face-painting-related aspects of that with you here.  Strangely, perhaps, I left how to get started till the last.   If you read all the way through and decide that painting sick children is for you, that's where you'll find the last vital bit of info!
Painting in Hospital
Hospitals today are very very different from the WW2 barracks block where I had my appendix out in 1972!  They usually have a play area where you can set up and the kids who are not in isolation and allowed to mix freely will be able to come to you, just like any normal gig.
I use my normal kit, as is, on these children.  For kids who are in for surgery, who have no infection/contagion and are not a source of a budding plague, you need take only a little more than your usual health and safety precautions.
In a nutshell, these are basic requirements for anyone hoping to paint other peoples children.  Keep your kit clean and neat.  Wash your brushes and sponges thoroughly after every job.  Don't paint anyone with an open cut or sore on their face, or a runny nose/eyes or any other sniffy / dribbly / runny symptoms - offer to paint a hand, arm, or  a leg instead.  Because you are in a hospital, you may be bringing infection in, however, so keep a hand sanitizer gel with you and remember to clean your hands thoroughly before and after every child you paint.  Discuss all this with the nursing staff first so that everyone is reading off the same sheet.
Painting Cancer Patients and Other Vulnerable Groups
Some children are so ill they have hardly any immune system left, and they need to be protected from infection.  These kids are not on a main ward, but are kept in isolation - either to protect a weakened immune system from infection by other patients, or because they already have some form of infection and are a risk to other patients.  A surprising number of these kids will be allowed to be painted however, just so long as you take necessary precautions.
I still use my normal kit for these kids, but I only ever use one set of sponges per child, and never put a sponge back in the paint once it has touched the child so as not to transfer bugs to the paint.  Disposable sponge swabs are available in our hospital, but I notice the 'pound shop' often has cheap disposable eye-shadow applicators and these do very well for adding detail.  If you have enough brushes, and only a few children in isolation, it is possible to use brushes and just wash them well after the job. I would not normally use anything other than baby shampoo and warm water to clean my brushes, but for the hospitals I am happy to use baby bottle sterilizer in the rinse water after the shampoo.  Then  they are rinsed exceedingly well in clear, cool, previously boiled water to get rid of the sterilizer from your bristles as I can think of no other instance when I would ever recommend adding anything to your water.  I prepare my brushes this way before going onto the ward or into clinic too, just to make sure they are really clean.  You certainly should not add anything to the water you use while painting.
You - not the other children/paints - are the main source of possible contamination for these kids.  You must wash your hands or use sanitizer gel on entry to every isolation room and again before you leave...and read the section on Precautions, which comes along in a minute...
Discuss with the staff in which order the kids should be painted.  If I am painting at the weekly clinic we attend with Adam, then I will usually set up in the play area and paint all the kids who present themselves to me, then wash, take a fresh set of brushes and sponges and work my way along the isolation rooms.  The ones whose resistance is so low they cannot be allowed to mix, I paint first, followed by the ones who are not allowed to mix because they caught a cold or have been in contact with a virus such as chicken pox.  (If I get a cold-sore, Adam still needs to go to clinic, and on arrival we are all segregated into the “lepers quarters”.  A visit from a kids entertainer really makes a difference as three hours shut in a side room makes for a very dull morning for Adam, who might be otherwise perfectly fit!)
If you were taking notice, you would have spotted a glaring discrepancy there!  The fact is, that while on a normal job I would not paint anyone with cold symptoms, in the case of the clinic kids, I do paint them.  I use each sponge or swab only once, and dispose of it in the hospital orange bins if it's disposable, or pop it in my laundry bag (kept away from the clean kit and inside a clean polythene bag for good measure) for washing as soon as we hit home if it's not.   Of course I don't paint runny noses - they need a lot of blowing, after all and would mess up your work (yuk!) -  but a mask can look good, or else try a cheek motif; arms and legs can be painted too.
Outdoor Events
There have been many times over the years when an outdoor event, arranged for the benefit of sick/disabled children and their families has been the subject of much discussion on the list.  Many painters express their nervousness at painting these kids, or make helpful suggestions about ways to make them feel special.
Fact it, these kids are already special, and what they would really like is to be made to feel normal!  Treat them as you would do other kids. Help those who need a bit of physical help to climb into your chair, or be prepared to sit to paint a child in a wheelchair if you normally stand to paint, but don't go overboard with extra attention and small gifts as some people have suggested when this topic has come up previously.   In the main, as a parent of a sick child, I can honestly say that the extras and the gifts feel a bit like someone is saying “I pity you”  and pity isn't what we've gone out for the day to get...  What we have gone out for is to be able to do all the things normal families do, that we mostly can't, and to 'feel' normal.  Also, after enough months on chemo, most kids hair stops falling out - their bodies have had so much chemotherapy that they got used to it!  If you only give the extra prize to the bald kid, how does his friend who is further down the line in his treatment, but still just as sick feel?   Leaning particularly toward childhood cancers for the moment, I would emphasize that these children have very vulnerable immune systems.  The fact that their consultant has allowed them to attend this event at all means that they can do, for that day, all the 'normal' things that everybody else gets to do whenever they want, so the best thing you can do is help make it really normal for them.  You don't need to make any special fuss because that child has cancer and the ones you normally paint in the supermarket or down at the mall don't.   In fact, the ones on long term chemo may not even look all that sick as their bodies adjust to accommodate the medicines and their hair may well re-grow after three or four attempts at baldness... so if you were going to make the assumption that only the bald kids have cancer, I just saved you from possible embarrassment!  (Having said which, my son was much more adventurous when he was bald, loved to get his whole head painted, and saw it as an opportunity to do something he couldn't normally.  Everyone feels differently about their baldness, so just go with the flow - some kids find it fun, lots hate it and want to wear a wig or hat.  You may have to learn to paint someone who is wearing a baseball cap....) You do need to take some precautions tho....
Precautions for Painting Sick Kids
Don't paint if you have a cold or other contagion, if one of your kids has had chicken pox in the last 3 weeks, if you had chicken pox in the last 3 weeks, or if you have had shingles, diarrhea, or bugs in the last 3 weeks, or could be carrying any nasty bugs (eg, there's something unpleasant doing the rounds at your kids school, but you haven't' caught it yet). 
In fact, if you are painting at an outdoor event fro immunocompromised patients DON'T GO TO THE EVENT.  If you are painting on a ward full of immunocompromised patients, STAY HOME.  To ignore this advice could be to put a young life at risk, and I do not say this lightly!   This is possibly the only time someone will thank you for cancelling!
If you are asked to paint at the birthday party of an immunocompromised child, do have some care about where your prior engagements are that day...
Painting Round Medical Obstacles
Baseball caps - can easily be turned back to front if the child doesn't want to take the hat off. 
Sit to paint children in wheelchairs even if you normally stand.
Painting children in the ward means that some will have to be painted in bed. Raise or lower the bed so that it is a comfy height for you and learn to work from both sides of the bed.  Learn to adjust the backrest (and I do mean learn - ask to be shown if you have never had to do this before) - or get a nurse to help you do this so that the child is positioned comfortably for you to work - with the emphasis on the child's comfort obviously!
If the child is in traction or a body cast, they may have to remain lying down to be painted.  Get your own kids to lie still so you can practice doing it without accidentally knocking them about the head!!  Learn to be extremely deft, accurate and gentle.  Place towels over and around the pillow to catch any stray glitter .. if you have drips, your paint is too wet!
If the child is plugged into a machine or is on a drip, as Adam is when he is in hospital, do not automatically assume that they can't be painted.  Be fantastically careful not to jog the line tho - there is a big big needle on the end of it, inserted into either a vein or a permanent drip-site called a 'port', and a small jiggle will cause a lot of pain.
If the child is on a drugs pump or drip which passes through a rate monitor, the alarm will almost certainly go off while you are in the room with them.  This is because a) the thing is driven by a computer and you know that technology is sent to try the patience of us all, and b) because any slight cough, laugh or sneeze will cause a fluctuation in the child's blood pressure, causing back-pressure on the pump, which will sound its alarm, and summon a nurse.  Don't feel bad and don't panic just 'cos you made a child laugh in these circumstances!  You should have heard the alarms going off in every room on Edinburgh Sick Kids cancer ward when the clown doctors visited....  Being a mum who lived with one of these machines for months, I know how to turn off the alarm and re-set it - but I'm not telling you that!  You have to sit tight and wait for the nurse to come and do it for you, like the rest of us had to when we were still green!  And then, when it does it again in 2 minutes, look sheepish...
If a child has a nasal feeding tube, you can paint right up to and all around it. It looks  bit alarming but is nothing - absolutely nothing - to be scared of.  They sleep, play and do everything else with these tubes in place.. it allows them to lead a more normal life, so act like it's normal and soon it will feel normal anyway...
Children being treated with chemotherapy will have delicate skin - don't use stipple sponges or anything of less than baby softness!  Take care not to drag or pull the skin.
I once 'painted' a child who had an allergy to water.  It literally burned her skin, like acid - but the snaz powders were more than up to the task.  Do remember tho', that children who are in pain will need to trust you an awful big lot before they'll let you near them with a brush.
Never forget the versatility of hand and arm painting.  Kids can derive just as much pleasure and may find it a much more comfortable experience, particularly when they are in a strange place with lots of new and strange things being done to them by new and strange people.
Painting in a Hospice
Really, this isn't any different to working in a specialist unit in hospital.  These kids are very very sick, and many, ultimately, will die.  But so do we all, and a hospice is not a miserable place, but a very positive and happy one, where everyone wants to have the best time they possibly can.  You are not there to speculate, you are there to entertain.  Not everyone can 'shut off' in the way they need to and still interact with the kids, so if it's really not for you, please don't go there because you won't be helping anyone in the slightest.

You need to be a bit discreet when you work in hospitals, remembering that why someone is there is not necessarily your concern.  If a parent or child turns you away, move on with good grace: they may be simply overwhelmed by their situation.  In the case of very sick children, what they and their family are experiencing is intensely personal and it is easy to intrude without intending to.  Those that do want to chat, generally don't want to chat about their child's condition.  Let them take the lead, or else just work quietly, concentrate on the child as you would at any other gig, and move along to the next...
Sick children are not always the well-mannered little angels we would like them to be!  Don't let this put you off, obviously some may simply not want to be painted, but if they do, then paint them.  Try to  make it a gentle and pleasing experience if they don't seem to be in the mood for a whole lot of fun.  I remember a number of people who came and went, talking much too loudly and clearly straining themselves with the effort of making everything Fun (injections and inspections included) when Adam was clearly not in the mood to be jollied along.  They just looked stupid and insensitive, actually, and often woke the baby (!) so try not to fall into that trap!
Photographing children on the ward needs their parents/careers consent.  I always take photos at clinic as a matter of course and the following week take the photos in for the kids to pick up.  If you have permission to photograph children on the ward, or in the clinic, make sure the ward gets copies to pass on to the children - and never use these children's photo's in competitions or publications without the family's consent for each and every time you wish to use it.  This is one area where copyright should ideally belong to the model and the models family.
Still Want to do It?
Ok - I was living in the ward with 2 of my kids when I got involved with kids in hospitals, so it was kind of easy ..!  If you are fortunate enough not to have a child on long-term treatment you'll need to make contact with the hospital some other more difficult way..
To get started, you will need to introduce yourself to the ward manager to offer your services.  Most modern hospitals have play assistants attached to each ward, and they will be people you need to talk to as well.  You could call the hospital switchboard and ask to be put through to the children's ward, but without knowing the ward number, some security conscious operators will not be able to put you through. Ward staff are busy!  T'was ever thus - so try writing, and include all the information they'd be interested in, such as sensible health and safety precautions, code of practice, how many years experience you have, and enclose some photos so they can see examples of your work - but keep it short and sweet!  Your contact details will get passed on down the line but someone somewhere will get in touch.  Another way is to find out if you have local 'clown doctors' and ask them how to get in touch.  Most hospitals have a charity or support groups associated with it, be it the League of Friends or some more specific charity geared toward providing help for specific areas of the hospital, such as the children's ward.  They are usually much easier to track down than ward staff, and may also be able to help. 

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