AT CHILDREN'S HOSPITAL in Washington, a clutch of third-graders, clad in miniature scrub gowns, mills noisily about the atrium lobby, trying out stethoscopes and pumping up blood pressure cuffs.
Small heads bob among X-ray machines and exhibits of emergency room equipment. The orthopedics department, demonstrating casting techniques, has gathered a little crowd, where doctors are fitting the children's fingers with slip-on casts, then letting the kids paint these "hard bandages" to make whimsical finger puppets.
Although the atmosphere is playful, there's a serious purpose behind all this energy. It's a tour for local school children, aim at making them feel more comfortable with hospitals, in case they ever wind up in one.
Susan Salisbury-Richards, who coordinates these activities, says, "Getting well children in allows them to learn when they are not stressed by illness."
Another staff member, Betsy McGuire, adds, "When you have knowledge and information, you have a sense of control. Then children feel more like participants than victims."
A few decades ago, a boisterous group of third-graders would not have been allowed to finger the medical equipment in a big-city hospital. But within a generation, vaccines and advance treatments have wiped out such contagious diseases as polio and whooping cough, and with them has gone the absolute need for a rigid and isolating environment.
Kids still speed plenty of time in the hospital -- ironically, improved treatments for chronic illnesses may keep some hospitalized longer than in the old days -- but their stays are considerably more comfortable.
With the support of an organization called the Association for the Care of Children's Health, young patients these days have the advantage of art and music therapy, picnics, games even visits by clowns and live animals.
Parents, once restricted to fixed visiting hours, often can be with their children anytime. This new atmosphere is due in large part to professionals such as Salisbury-Richards who work in an area called Child Life services.
About 80 percent of the hospitals in the United States offer Child Life programs. Those at large long-established hospitals such as Massachusetts General in Boston, Bellevue in New York City and Johns Hopkins in Baltimore are particularly ambitious.
Hopkins, with 15 Child Life specialists, has one of the oldest programs in the country.
Most metropolitan hospitals, however, have programs about the size of the one at Lutheran General in Park Ridge, a suburb of Chicago.
There, Linda Bieschke, a 12-year Child Life veteran, is a staff of one, but she has 35 volunteers to help run activities for a 35-bed pediatrics ward.
In the music therapy program, children are encouraged to express their emotions, say fear or confusion, with instruments, and to carry on musical "conversations" with each other. If the idea fills the playroom with clattering cacophony, it also adds some happy disorder to what can otherwise be a formidable world.
Bieschke helps the children make cuttings from the playroom ivy plants and pot the plants in their rooms, using tongue depressors to support the stalks and needleless syringes to water them.
Allowing children to play with safe-to-handle medical supplies is a technique to make the equipment seem less threatening, says Bieschke: "There's always a purpose behind what we do."
Wednesday is "picnic day," when young patients who are will enough meet in the playroom and make their own sandwiches.
"We want kids to have choices in an environment with so few choices," Bieschke says. Even a small decision -- beef or ham, pickle relish or mayonnaise -- can make a difference, she says. Twice a month, veterinarian-screened puppies come to visit.
At Fairfax Hospital in northern Virginia, Child Life specialist Calli Sergentanis uses dolls that are nearly 3 feet high to help children entering the 60-bed pediatrics ward learn about hospital procedures.
Each doll's chest opens to reveal a layer of appliqued pink muscles, which lifts up to show, among other things, a yellow corduroy gallbladder and a detachable appendix -- allowing hospital staff to "remove" an organ and prepare youngsters for upcoming surgery.
Children need all kinds of reassurance about hospital stays. Doris Klein, a Child Life specialist at the University of Colorado Health Sciences Center in Denver, points out that even simple misunderstandings can have a tremendous negative impact.
"You have to make sure that information hasn't gotten twisted," she said. Small children, when told about the dye they will receive for an X-ray, for example, sometimes hear the word as "die." So it's a good idea to ask the child to repeat what's been said.
At Fairfax Hospital and other institutions that treat young cancer patients, peer support groups help youngsters better understand what to expect and also give them a place to talk out their fears.
Hospitalized children are not the only ones treated with far greater sensitivity these days, so are the other members of their families. Between 1981 and 1988, the percentage of U.S. hospitals allowing parents to visit around the clock increased from 76 percent to 98 percent. By now, in fact, many children's hospitals offer lounge areas and other amenities for parents who want to stay near their kids. Some, like Washington's Children's Hospital, go all the way and provide beds for parents in the children's rooms.
A few hospitals even let parents participate in the child's care, taking temperatures and blood pressure, for example; others allow parents into the operating room briefly, to hold the child's hand as the anesthesia takes effect.
Brothers and sisters are also permitted to visit hospitalized siblings nowadays -- something almost unheard of a generation ago -- and they are even prepared beforehand for the experience.
At Children's Hospital, for instance, a Child Life staff member will first take a small visitor aside and show the youngster a doll that is bandaged, hooked up to an IV or otherwise made to resemble the hospitalized child.
By the time youngsters enter the ward, says Salisbury-Richards, "they can focus on their brother or sister, rather than on the equipment."
Not only do these innovations lessen the terror for a hospitalized child, they can actually speed recovery. A 1988 study, comparing hospitalized kids who did and didn't have the benefit unlimited parental visits and special programs, found that the children who received such comforts recovered significantly faster. Frightened children not only get well more slowly, they can regress to bed-wetting, thumb-sucking and other unhealthy coping techniques.
Child Life programs even follow children home from the hospital. To help young cancer patients and burn victims fit into a normal routine, hospitals may send a doctor, nurse or Child Life specialist to the child's school to tell both teacher and class what to expect.
Similar teams coach families on how to care for their recovering children at home. Parents may learn to help the child with physical therapy or to give injections.
This saves families money, but perhaps most important for youngsters, adequate home care can prevent anther trip to the children's ward. Hospitals may be more fun than they used to be, but most kids, like most adults, would still rather stay at home.