Play is Magical: Child Life Specialist Shares the Importance of Play in the Health Care Environment

Child Life Series: This series will discuss the pillars of Child Life  – emotional safety, family-centered care, and play - within the hospital environment and how Child Life specialists at Cook Children's serve patients and families.

By Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's

It’s amazing to see what one bright-colored toy or fidget can do to change the feeling in an exam room. Recently, I have started grabbing something to take to patients when I get a call to help prepare them for a procedure or support them.

Typically, I grab something small – a pop-it, a Hot Wheels car or something else that I can offer them upon entering the room. You can see kids’ eyes when you walk into the room. They are scanning your hands to see why you came and what you are there for. They are really looking for a SHOT!

When they scan my hands, they often see an iPad and some small toy or fidget of some kind, and their face melts a bit. They soften. Why does this happen? Because play is magical…

Play is the act of engaging in something for fun or enjoyment. We know that play is universal and crosses many cultural and language barriers. In fact, child life specialists would say that play can be a language of its own. Play is a pillar of child life practice, and we could not engage patients and families without it.

We see the expression of a child’s emotions and experiences being worked out in play often more than words. We also know that play is an integral part of cognitive, speech/language, social/emotional, and gross and fine motor development.

This makes play essential in a pediatric health care setting. It is our goal to continue the normal growth and development of children even during stressful experiences like hospitalizations, traumatic experiences and chronic illnesses.

There are several ways that we utilize play in the health care environment. We use play for normalizing the environment, preparing and teaching the patient and family about medical procedures, and for processing their experiences.

Normalizing the Hospital Experience

Developmentally appropriate play is the most natural aspect of childhood that kids know and understand. We use developmentally-appropriate play to help normalize what is otherwise a very stressful place. Just as I referenced in the story above, walking in with a toy or a stuffed animal immediately changes the atmosphere.

Basic things like coloring, Play-Doh and bubbles are the framework of breaking barriers with kids in this seemingly very scary place. You will notice in many exam rooms around the hospital and medical center that there are eye-spy art pictures for children to engage in while they wait.

Each age group plays differently and has different needs. When I would meet kids as an inpatient child life specialist, I would often ask kids what they loved to do if they were stuck in bed at their house. We want to start with their favorite things and what brings the most comfort. Thankfully, we are able to provide play opportunities to every kid that enters our doors in some way.

Through hospital allocations and community donations, play is always possible. I’ve played countless hours of Barbies and Battleship with kids. UNO tournaments were a norm in our inpatient playroom. Nerf guns and over the door basketball hoops can bring incredible laughter and smiles even on the worst of days.

Even in the NICU, our babies experience play. We make sure that babies have stimulation at the bedside with mobiles and textured lovies, and jumpers are provided as they are able.

Developmentally appropriate play is just a standard part of childhood. We want to meet the basic needs of children in the health care environment, too. Play is essential.

Processing - Therapeutic Play

While a large part of the play within the health care environment is just for fun, we also spend a lot of time playing with purpose. This is therapeutic play. Therapeutic play can be led by a patient (non-directive) or led by the child life specialist (directive) with the goal of emotional expression, medical teaching or to be physiologically enhancing (blowing bubbles to encourage deep breaths) (Koller).

Some could argue that all play is therapeutic allowing a child to express themselves and process their experiences. However, therapeutic play within the hospital environment is vital. These type of play experiences allow children to build their resilience while developing and practicing new coping skills. We utilize specific medical play often which is discussed in detail a little later.

We also provide art and music opportunities through our CARPE program and other play modalities for patients to express their feelings and work out their thoughts. Remembering that play is a language, we can learn a lot about our patients and families by watching them play or engaging in play with them. These things allow us to better serve our patients and families and develop care and coping plans during their stay.

Preparing for Procedures or Teaching a New Diagnosis

We also utilize play when preparing children for procedures or teaching them about a new diagnosis. This is a type of therapeutic play with a very specific purpose. We often utilize a stuffed animal or doll to first demonstrate a procedure. We may tie a tourniquet around a stuffed animal’s arm so that a child can see what that looks like. We frequently place IVs in dolls and stuffed animals so that the child feels less alone in their experiences while also seeing the steps and understanding the process.

As child life specialists, we facilitate what is called medical play. This may be as simple as a toy doctor’s kit to more complex play using real medical supplies while teaching with a patient and/or sibling.

One of my favorite activities is using an insulin syringe to inject dye into a medical play doll. This ultimately makes a tie-dyed doll, but it also allows a patient to get comfortable with the needle and syringe (under the supervision of a child life specialist).

At Cook Children’s, we host a Kid’s Clinic for patients to come down for a specific time just to do patient-led medical play. Patients are given a medical play doll and then are invited to use medical equipment on their doll. Patients place IVs, casts, and more.

This play often mimics their own experiences while giving them an opportunity to get more comfortable with medical equipment and process their feelings around their own story. Children not only learn from this type of play, but they leave feeling more empowered in their own medical care.

As child life specialists, play is not only essential but also at the forefront of every interaction with a patient and family. Cook Children’s recently lost a precious child life specialist. Amy Johnson was a child life specialist extraordinaire. As we were attending her funeral, many past patients’ families shared stories of Amy.

I was profoundly impacted that what the patients and parents remembered most fondly about Amy was her ability to PLAY – nerf gun wars, water gun fights and more! She had SO much fun during some of the worst moments, and this is the memory that the patients and families had ingrained in their hearts forever. Play is not only essential, but it also changes the environment and allows children to be the very best versions of themselves!