Play – The Key Ingredient to Pediatric Medical Care


Monday April 25, 2022


Play is the language, university, and business of childhood.  Medical play is a key part of child-focused health care, helping young patients learn, reduce fear, and take part in their care. Sophie Goldberg, child life intern and student of Child Life and Pediatric Psychosocial Care, explores what medical play is, and how you can use it to empower your child through their medical experiences.

 


A pile of fabric markers is surrounded by 4 blank cloth dolls of different sizes and colours

Cloth Doll Decoration Station in the child life program at a retinoblastoma event in Calgary, Canada, October 2019.

What is Medical Play, and Why Does it Matter So Much?

Envision a hungry, groggy toddler or preschooler arriving to an unfamiliar medical facility. Upon arrival, this child must interact with numerous strangers and allow these strangers to poke and prod their little body with objects.

One stranger is wrapping the child’s arm in a large thick band, accompanied by a loud beeping machine, while another stranger sends a stinging pain to the tip of the child’s finger, followed by a squeeze to release blood. This young child feels scared, traumatized, confused and anxious.

The child expresses that they are scared of needles and getting their vitals checked.  Their loud exclamation – “I am never coming back here” – is heard by all in the echoing waiting room.

Now, imagine that child arriving once again. This time the child is greeted by a child life specialist (CLS) who supports them through each step of the hospital experience. The child life specialist provides them with an opportunity to play, and prepares them for each medical experience they are about to face.

Most importantly, the child life specialist ensures the child has time to explore and feel the medical supplies in their hands, dress their beloved teddy bear in a hospital gown to match the one they are wearing, and to ask all their questions. Child life also gives the child a chance to test out the blood pressure cuff on their teddy bear; they even get to pretend to be the doctor.

The child now realizes that each piece of medical equipment and supply in the facility is not as scary as they anticipated. With the added ingredient of PLAY, the child’s worries are eased, and they approach their care and procedures with greater confidence. When the visit is complete, the child excitedly shares “I am a pro at this, I can’t wait to play doctor with teddy next time!”

Medical appointments, hospitalization, tests and procedures can be stressful for young children with cancer. Remember that your child is entitled to medical play. It is the key ingredient to improving their medical experience. The use of play in medical settings supports development, normalizes strange environments and reduces anxiety associated with the experience.

Are you still asking yourself “what the heck is medical play?”…

Medical play is broadly defined as the use of games, toys, books, art, and role playing, sometimes with real or pretend medical equipment, to help children understand and become more comfortable with medical tests, procedures, treatments, and their illness.

It gives children the chance to look at and become familiar with medical tools in their own time and in a relaxed fashion. Children benefit more from medical play when given time to play with the items, and then process any emotional responses related to the items.


Let’s dive in and unpack a few of the many benefits associated with medical play.

Identification of Stressors and Solutions

When your child uses their teddy bear or stuffed toy as the patient, they have an opportunity to identify what is making the teddy bear feel worried, and what we can do to help. This conversation is an indirect way for children to identify their own stressors,  and possible solutions.

The conversation might sound something like this…

Caregiver: It’s time for teddy to get an NG tube. I see that teddy looks ______ (insert an emotion that mirrors the child, e.g. worried, sad, scared, excited, mad). What does he feel (scared, excited, mad, sad…) ______ about? Do you feel the same way as teddy when you get an NG tube?

Child: Teddy feels nervous that the tubie will get stuck and hurt when the nurse puts it in his nose.

Caregiver: What will help make this easier for teddy?

Child: Teddy will feel better if he drinks water when they put the tubie in, and he would like to watch something on his iPad.

This type of natural dialogue surrounding medical play helps your child unpack what is making them feel worried. It is also a great opportunity to learn and practice effective coping skills such as taking deep breaths, squeezing a stress ball, playing with a fidget toy, and holding a caregiver’s hand.

When a child plays out big feelings and anxieties around their own or a sibling’s healthcare experience, they feel better prepared for upcoming procedures. This helps you and the health care team mitigate future stressors.

A fuzzy, brown teddy bear sits on a table with a blue table cloth. The bear has red and black plaid feet, a cream snout, black eyes, a brown nose, and a black smile. A nasograstric tube and a gastrostomy tube are inserted, and an IV pole and IV fluids are seen to the side. Behind the bear is a teddy bear sized hospital bed and a green curtain.

This teddy bear is used for medical play. The child can share what the stuffie feels nervous about, and what will help them cope.

Mastery and Control

Let your child lead the play and discussion. It is important that children feel in control as much as possible throughout hospitalization. The child feels empowered if they get to pick what medical supplies are used throughout the play session, and letting them be the leader of play is also key to instilling mastery.

It can be helpful to bring a blank medical doll so your child can decorate it and create its story.  They can choose what the doll looks like, their name, what medical care they require, and how they like to have their medication/procedure.

Children feel greater control over their experience when they are given the chance to move and manipulate medical equipment and supplies in their own hands. They also love to be in charge of time. If a child is leading the play and communicates that they want to stop, this is often a cue that they feel overwhelmed, and need a break from information.

Normalizing Medical Equipment

Children often believe that the equipment and supplies found in medical facilities can only be touched by medical staff and adults. This can make these items seem frightening. Medical play gives children an opportunity to discover how these tools are used, and how they work. When children are able to hold these items in their hands, they become more comfortable and familiar.

Allowing children to explore these items with all their senses enables them to understand each one more. Questions can support in normalizing unfamiliar items.  For example: “How does that feel? Is it cold or warm, hard or soft? What does it smell like? What does it sound like?”

Two white cloth dolls and one dark brown cloth doll lie on an examination table covered in a white sheet. The first white doll is bald with eyes, eyebrows, nose and smile drawn in purple marker, and wears a t-shirt coloured in purple marker, and pants coloured in blue marker. This doll has a neon pink foot and leg cast on the left leg. The second white doll has hair drawn in black marker, and blue and purple marker eyes, nose and mouth. This doll has red and pink heart drawn on the left chest, and the outline of blue shorts and t shirt are drawn. An IV line is inserted in the right hand, covered in teddy bear patterned medical tape. The dark brown doll is decorated as superman, with top, shorts, and big letter S on the chest drawn in black marker. This doll has a bright pink bandage wrapped around their head, and a red cast on their right arm.
A brown cloth doll lies on an examination table covered in white paper. All features on this doll are drawn on with coloured marker pens: brown hair, black eyes, blue round glasses, and a red smile. Green and blue pants and a long sleeve top with three green buttons drawn on down the middle. The doll features black open-toe shoes and red painted finger and toenails. A laceration is drawn on the forehead, and a gastrostomy tube is inserted.

These medical play dolls were decorated by children, who manipulated them with medical play supplies to create casting, IV’s, laceration repairs, and feeding tubes.

Clearing of Misconceptions

Listening to a child’s self-talk can be helpful in assessing their current understanding and perceptions of the medical experience. Asking questions such as “what is that?” or “what is that for?” will help you identify what they do and don’t understand. This is also the perfect opportunity to correct and clarify any misunderstandings or possible misconceptions.

If your child does not understand something and you do not know how to explain, that is okay, and very normal. A great way to respond is to first validate their curiosity, then commit to finding out together. This might sound like:

“That’s a really good question, I am not sure either. Let’s find out together!”

When your child has a hard time understanding verbal explanations, this is a great opportunity to dive deep with them back into play, to show them visually.

Rainbow confetti on a grey background. White text box on top reading “Play is our brain’s favorite way of learning.” Diane Ackerman

Fun

Medical play does not always look like the child taking on the role of health care staff or acting out various procedures and coping strategies. Medical play can take the form of fun activities such as art and creative expression.

Mixing classic art mediums and medical materials is a fantastic way to normalize these items. Visual art activities can also be a great way to release big feelings in a therapeutic way. Find and enjoy some funky ways to manipulate medical items below.

Syringes

  • Painting: Fill syringes with paint and creating splatter art.
  • Water Play: Fill syringes with water or bubbles to play in the bath.
  • Baking: Fill syringes with icing to decorate cupcakes or cookies.

Eye Dropper

  • Milk Rainbow: Drop paint colours into a bowl of milk to create a rainbow.
  • Eye Dropper Art: Drop paint colours onto paper to create amazing art.
  • Tie dye: Use a dropper to drop dye onto clothing or artwork.
A school aged child sits cross legged on a grey concrete floor, their head and shoulders are out-of-frame. They are wearing a teal shirt, blue plaid shorts and navy blue crocs with a red and white striped sole. In front of the child, a muffin tin holds a different paint colour in each compartment (green, orange, brown, red, pink, and purple), and a syringe filled with that colour. The child is holding a syringe in their hand, splattering purple paint all over teal and orange construction paper.

Splatter Painting – credit: Hands On As We Grow

Anesthesia Mask

  • Bubble Blower: Dip the mask in bubble solution and practice breathing in deep and blowing out slowly to create a cascade of bubbles.
  • Little Critter: Use paint, colouring pens, or other craft materials to turn the mask into a fun character.

Band-Aids

Spring Art: create a butterfly (Band-Aid abdomen and medical gauze wings) or flower (Band-Aid petals).

Three butterflies created from bandaids and medical gauze decorate a light blue piece of construction paper. The first butterfly has a blue bandaid body, the second has a green bandaid body, and the third has an orange bandaid body. All three butterflies have black antennae drawn onto the construction paper, and their white medical gauze wings are decorated with purple marker dots.

Band aid Butterflies – credit: No Time for Flashcards

Urine Sample Jar

  • Calming jars: Fill a jar with baby oil, glitter, and water.
  • Search and find: Fill the jar with rice and miscellaneous items such as beads.

A Final Word

When the language of play is used to communicate with children, their overall medical experience will be positively impacted. The benefits to medical play are endless. Don’t forget to always advocate and make room for PLAY – The Key Ingredient to Pediatric Medical Care!

About the Author

Sophie Goldberg is a student in the Child Life and Pediatric Psychosocial Care Program at McMaster University. Through her child life internships, she has worked in the inpatient oncology/haematalogy unit at The Hospital for Sick Children, the inpatient eating disorder program, and emergency department at Michael Garron Hospital, and in community settings through Morgan Livingstone’s private practice.

As an aspiring child life specialist, Sophie is passionate about fostering a meaningful childhood for individuals of all abilities and levels of health. She is eager to practice in a strength based approach, encouraging multidisciplinary health care teams to see children’s abilities before their differences. She is keen to advocate for the child’s voice to be heard within care to ensure their unique wishes and needs are met.

Sophie Goldberg is smiling at the camera, with foliage behind her. She has wavy blond hair and is wearing glasses, a black top and caramel jacket, and a silver heart pendent.
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