I. Introduction

Children who have to suffer pain from their physiological disease is a heart broken thing for their parents. Even though we can not prevent child patients from being sick, caregivers and medical professionals can make an effort to prevent child patients from sowing the seeds of fear of medical treatment, considering how to relieve their psychological pressure and help them assess their physical pain; these are significant issues that require the attention of adults. Psychological burden exacerbates pain (Crowell qtd. in Lin et al. 318), especially for children who suffer from serious illnesses, have to experience long-term medical treatments, and have to adapt to new hospitals and treatment givers again and again. There are several methods that can help to relieve pediatric patients’ psychological pressure; one of the methods which is worth discussing is to provide them with sufficient information including their illness condition, medical treatment, and hospital environment in appropriate ways. Child patients, especially school-aged children, can take part in a preparation program and acknowledge information, they can reduce anxiety prior to surgery, and their parents to some extent, could be relieved too (Smith et al. 230). Moreover, it is also important for parents getting access to adequate information about their children’s medical condition when their children are in hospitals (Yin & Twinn, Carey et al., and Miles qtd. in Hopia et al. 219). Therefore, we can see the importance of medical information between child patients, their parents and hospitals. This paper discusses the reasons why children have negative emotional reactions to lack of information, and explores how effective do medical APPs (applications) can help to transmit information such as medical treatment and patients’ disease condition and how digital APPs provide assistance to children.

In the hospitals, there are several disturbed factors which can cause child patients to be anxious. For example, the terror of medical equipment and procedure, untranquil environment filled with children crying sounds, and oppressive physical restraint from medical workers and caregivers. Potentially negative experience of child patients is based on ineffective interaction with different figures. “For children, the experience of hospitalization is bound to give rise to feelings of fear, anger and insecurity, which in turn will often affect their condition and behavior in hospital” (Hopia et al. 213). Children’s negative emotion, such as anxiety and fear will lead to uncooperative behaviors during treatment (Li et al. 224). Therefore, we can see unpleasant hospitalized experiences will lead children to have negative emotions and resistance. There are three main figures which have close connections with sick children in hospitals, that is, caregivers, physicians and nurses. Those are people who have opportunities to harm child patients in medical occasions but at the same time, if they use appropriate methods to interact and transmit information to children, they can give significant assistance to children to relieve pressure.

We all have more or less experience of seeing doctors with confusion about medical jargon that doctors said. If doctors are patient enough, they would try their best using pictures, drawings, models as auxiliary instructions; but if, unfortunately, doctors are too busy to explain to patients, they would skip the details and just ask patients to do what they prescribe. Patients might be suspicious and uneasy, which causes patients to start to find medical information themselves. The same situation can happen to child patients as well. How much information and its form should child patients receive before their treatment? Take children who are going to undergo a surgery for example; Most child patients had not received medical information about themselves from their doctors directly (Smith et al. 230). Also, the research shows “there is widespread agreement that children should be given information prior to surgery but continuing debate about the most appropriate form and content of preadmission preparation” (230). If pediatric patients and their parents get information of medical treatment in advance from medical units such as preadmission clinics, it has a significant positive impact on them. Compared to well-informed patients, it is harder for those who have lack of information to deal with demands before treatments (232). Therefore, if pediatric patients receive enough information before treatments or surgeries, their fear of unknown medical treatment, to some extent, can be reduced and they have higher possibilities to face the difficult process of medical treatments.

When it comes to discussing the appropriate form to deliver information to young patients, there are two worth-discussing things we can dive into first to better analyze this issue. The first one is what is the age range of children. Could they understand the medical information which comes from medical professionals? A major reason that parents and doctors choose not to transmit medical information to pediatric patients is because they think children do not have ability to understand medical terminologies and it is hard for them to explain to children, therefore they prefer not to say and hide the cruelty of the truth. In general, the receivers that doctors tell the diagnosis of child patients are children’s parents or caregivers. Sometimes children are on the side and sometimes not, and it depends on the serious level of illness. Medical professionals find difficulties to explain to child patients so they would rather tell their parents instead. Research discovers doctor participants with a high percentage of 87%, have difficulties when facing this situation. Uncertainty about children’s understanding ability and their emotion is a main reason. Doctors will adjust what to tell according to how serious a pediatric patient’s illness is as well (Last et al. 1). Therefore, there is a lack of efficient communication between doctors and child patients, which lead to exacerbate child patients’ feelings of ignorance, furthermore, frustration. The second aspect is how detailed information should parents and doctors convey to children. On the one hand, too detailed and unmodified information can cause pediatric patients to have unnecessary imaginations of frightening treatment; on the other hand, too vague information or misinformation can let children search for information via informal ways such as television, the Internet, or word of mouth. Thus, APPs can make significant impacts here, assisting in presenting medical information in a modified way. For instance, showing images of patients’ physical conditions with drawings rather than showing them real X-ray images, creating fictional characters and stories to explain the process of surgery and letting child patients convey their pain by pointing at substitute characters’ images. Research also indicates that children’s inferential comprehension starts to emerge at age three years and will constantly increase as they grow up. Therefore, we can use characters and stories in APPs to transmit medical information to child patients, and the target audience should be above four years old because children in this period of time have the sense to infer problems from stories. Furthermore, children five to six years old have better ability to infer goals of characters and try to solve problems from stories (Filiatrault-Veilleux et al. 1105). Thus, APPs can facilitate doctors and child patients’ communication and convey medical information in an appropriate way. However, how completely can child patients understand the content which APPs attempt to transmit is also related to the ways how medical APPs design.

More effective communication can be reached by combining medical information with interesting interaction on APPs; this can not only help facilitate communication but also implement the importance of “play” for ill children. Research indicates “Child-focused anthropologists have described how sick-children utilize 'Play' and 'imagination' as a tool to cope and make-meaning of their illness-experiences.” (“New Pediatrics Study Finding”). The behavior of play has positive impacts on child patients and their parents as well, such as psychosocial support and health education (Tonetto et al. 2). The essential fun experience for child patients during medical procedures has been valued. There is a profession called “Health Play Specialists (HPS)”, they specialize in using play to enhance communication and deal with pediatric emotional problems during the medical process. Therefore, if medical APPs can transform into gamification, which means making medical APPs become a kind of game for children to get involved in, medical APPs can maximize the advantages. There are advanced technologies which can provide pediatric patients with more realistic user experience through digital devices. For instance, a Virtual Reality technology (VR) company called “JSC GAMES” integrates VR technology into child patients’ preoperative process to imitate the process of surgery and anesthesia induction (Ryu et al. 3). From this, we can see the benefits of “play” and how people integrate advanced technologies into medical area.

When it comes to medical information, plenty of information could be found in medical facilities, for example, medication instructions, surgery procedure, disease side effects, treatment schedule and traffic flow. In addition to informing patients orally, we can see hospitals using leaflets, television screens and posters to transmit various information to the public often. However, the ways which are just mentioned, are one-way transmission, so they just have the function for carrying information. Fortunately, nowadays, there are advanced technology devices that aim to help communication between parents, treatment givers, and pediatric patients. Technology devices can show engaging animations and images to allay children's fears about treatment and are convenient for adults to explain children’s illness conditions. Moreover, APPs can provide fascinating interaction with pediatric patients, interactive games can convey information in an interesting way, and also bring some fun to their daily lives in treatment. From the research mentioned before, we can see the importance of information needs for pediatric children. Next, we will explore how advanced technology devices assist medical information delivery and some APP examples and their features.

Comparing APPs and traditional information mediums such as leaflets and posters, APPs provide users with more interactive experience for information through senses of sight, hearing and touch. It is a worthwhile method for child patients to engage in receiving medical information, because most of the children can put more attention on dynamic effect, especially for preschool children, and the digital platforms which combine with excellent UX design can promote children’s learning fluency as well (Lin et al. 322). According to the research which specifically explores the attention and engagement between children and interactive products such as digital game, robot and video, children can show high attention to the game through long-term treatment, and their attention didn’t decrease apparently over time (van Otterdijk et al. 11). Therefore, high interactive medical APPs are suitable for enhancing medical treatment experience not only because they can help to enhance efficient communication between doctors and patients but also can attract pediatric patients’ attention, which can contribute to help children absorb more medical information and reduce communication gaps between doctors and child patients during their treatment. In the current medical APP market, we can see there are few medical APPs which aim to assist child patients in receiving medical information and conveying their physiological and psychological condition independently. Everything which is related to the medicine field should be carefully dealt with. Even if it is an assistant medical APP which aims to enhance communication or pain self-assessment, it should be designed with rigorous and needed medical professionals to intervene APP development, especially for children who can be affected easily by external effects. Therefore, how creative should product designers be during creating medical APPs could be a difficult issue. In my opinion, the medical information should be completely authentic and can not be tolerated if APPs transmit wrong information to patients, or on the other hand, misunderstand patients’ expressions which lead to hold up facts that patients want to deliver to doctors, that would not be a handful tool for doctors and patients. Since the medical profession is always an area which needs high authentication and medical APPs need to meet regulatory requirements, there are few medical APPs which we can see to be used in hospitals. Addition to the accuracy of medical information, designers can still add some fictional elements in medical APPs to increase children’s interest and enhance their engagement, such as fictional characters and characters’ background stories.

Another thing is worth mentioning that Medical Communication Systems mainly solve the difficulties of people with limited speech. Children, is a group which can be regarded as limited speech objects as well. Augmentative and Alternative Communication (ACC), which means the ways for increasing communication for people with limited speech, are divided into No-tech/Low-tech and High-tech options. The former includes several untechnical methods, such as, gestures, facial expressions, writing, drawing, expressing thoughts through pictures, photos and letter cards. The latter includes high technology devices like APPs, tablets, and speech-generating devices (“Augmentative and Alternative Communication”). Therefore, medical APPs can combine these methods to facilitate communication between children and medical professionals. And most of the medical APPs for children, use pictures, facial expressions and the methods which are mentioned above to attract children’s attention. To classify medical APPs into three main categories, the first one is feeling assessment APP, particularly aims to assist patients to assess pain and emotion level. The second one is doctor-patient communication APP, which facilitates information transmission between doctors and patients, using visual elements, virtual characters, animation and sounds for helping doctors inform child patients with medical knowledge which is hard for doctors to convey orally. And the third one particularly is responsible for delivering environmental information to patients. Take Achy Penguin, a pain assessment APP, for example, it incorporates techniques such as breathing, relaxation, visualization, and distraction. Using animal expression in different levels to represent different levels of pain, it leads pediatric patients to assess their own pain condition and let doctors have a more clear understanding if they get exacerbation or not (Birnie et al. 284). Which helps patients to express their pain and locate positions where pain is, especially for children who are not mature enough to express themselves clearly. Another APP which was produced by a digital innovation agency called Corporation Pop, specified designing 3D augmented-reality models and an artificially intelligent avatar guide to gamify medical processes to help users reduce stress (Raban 2). Also, information such as hospital environment, staff and processes are also involved in it with an interesting user experience.

i. Need for educating caregivers and medical staff members to value sick children’s emotions and treat them in appropriate ways.
After examining these issues, here are two aspects which need the public to focus on. The first one is, even though there are various appropriate tools for relieving pediatric patients, we need parents and medical professionals who attach importance to the mental health of pediatric patients. As previously mentioned, some fights and indifferent relationships between child patients and caregivers could happen during therapy. Since children can not express their thoughts clearly, sometimes caregivers can not comprehend their children’s uncommon behaviors and frustration during this difficult time, which can also cause broken relationships in a family. Taking care of chronic illness children is a fatiguing task. In particular, caregivers play important roles to pediatric patients during the process of hospitalization because they decide the ways of telling children about their illness. Also, parents are often feeling confused about their role when taking care of children and making decision (Balling et al., and Yin & Twinn qtd. in Hopia et al. 213), so they are not sure how much care-taken work is distribute to nurses and how much is parents’ job. Therefore, parents are under significant pressure in their children’s hospitalization, and will often blame children’s illness on themselves with guilt (Cimete qtd. in Hopia et al. 219). However, parents are emotional anchors for children, they should be supportive to avoid children being lost in these nightmares. Research shows that absence of parents or their anxious emotion will cause pediatric patients to have an horrible experience when they are in hospitalization (Shields qtd. in Hopia et al. 213). With parents’ company, children can earn much comfort and reliability to ease their anxiety during this uneasy time.

ii. Choosing appropriate APP to assist.
The second concern is, in the medical market, there are more than 40,000 health APPs. Among them, 86% of pain assessment APPs have not been intervened by medical professionals (Napoleone 14). Research also shows that the accuracy range of a particular dermatology app is wide and the lack of source of credibility for the information which is included in APPs (Hanrahan et al. 7). Therefore, the uncertainty of these medical apps can pose risks to patients, such as treatment delay and misinformation. This kind of risk is due to the lack of serious review by the APP store, because technology companies mostly focus on assessing technical issues, but for the contents of medicine, they don’t have enough time and professional staff to evaluate every medical APPs (Hanrahan et al. 8). Therefore, how can doctors choose qualified medical APPs to use and recommend to caregivers? There are some credible administrations which regulate the standard of designing medical APPs, for instance, Food and Drug Administration (FDA) and Federal Trade Commission (FTC). FDA divided medical APPs into three levels, and formulated their guidelines; while FTC ensured developers to obey the declaration of honesty, protecting users data privacy and ensuring to reserve important details of APPs when developing medical APPs (Hanrahan et al. 9). In conclusion, when choosing these medical apps which would be used on child patients, doctors and caregivers should be careful choosing medical APPs which have high verifications.

Pediatric patients’ emotions and psychological conditions are easily undetected by their parents, physician, or nurses in the process of their terrifying treatment. This paper indicates several benefits for pediatric patients to use medical APPs to decrease their pressure when they are facing medical treatment. However, even if advanced technology is convenient for users to access, doctors and parents should be careful to select appropriate APPs to use according to pediatric patients’ conditions and need to choose qualified APPs. Even technology devices can be a part of accompanying pediatric patients’ treatments; good company from caregivers is also important to ease sick children's anxiety. After summarizing the research among mental conditions of pediatric patients, it is undeniable certain technology benefits the medical area and efficacy of medical APPs for medical professionals. I believe that digital apps can play an important role in enhancing child patients from receiving and conveying medical information; furthermore, relieving their psychological pressure when under treatment. In the future, child patients require more designers to pay attention to their needs, researching and developing medical APPs specially for them, to help child patients from being trapped in fear when they are already trapped in hospitals.

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