The Power of Play
When Play Matters Most
Children suffering from traumatic illnesses and injuries gain powerful benefits from medical play.
Poked, prodded and pricked by more medical devices than any young child should have to endure, Christopher was understandably wary of what his doctors, nurses and specialists might do next. Undergoing hospice care at home, the terminally ill 6-year-old was tired of all the medical personnel parading in and out of his house. So were his parents. Christopher’s mom and dad wanted him to laugh and enjoy the fun before his brief life ended. They wanted to see their once-exuberant boy experience a bit of joy. They wanted to see him play again.
“When we arrived at his home, Christopher answered the door,” says Lorie Walton, owner of the Family First Play Therapy Centre in West Bradford, Ontario. “His little body looked pale and weak, but his character was strong and stubborn. He yelled, ‘Mom!’ and ran and climbed into his hospital bed in the living room. Christopher watched me from afar as his mother sat down with us and began talking to my colleague.” Walton visited Christopher’s home at the request of his parents. They wanted to use play therapy to emotionally connect with their son in other ways besides medically caring for him. As Walton slowly opened a toy medical bag, Christopher pretended to ignore her. When she took out paper and markers, he looked at her quickly—and just as quickly looked away. Seeing Walton pull out a small hedgehog puppet, the boy swung his feet over the edge of his bed. A big Saint Bernard puppet called Marty finally won his heart. “Christopher leaped off the bed and grabbed Marty from my hands,” says Walton, a certified child psychotherapist play therapist and past president of the Canadian Association for Child and Play Therapy. It was best friends at first sight. As I made the hedgehog talk, Christopher responded through Marty. He laughed and teased the hedgehog. He expressed his hatred of needles, doctors and hospitals. The puppet helped Christopher cope with the stresses of his illness and the scary parts of the hospital
“His parents were soothed knowing their son had something he could use to express his overwhelming emotions. They used the puppet to express themselves, laugh with one another and add some lighter moments to their lives. The play helped this small child with his final days.” That was clear in the works of Plato, Rousseau and Freud. The way children play has long been seen as a window to their inner beings. In the early 1900s, the play gained prominence as a viable way to therapeutically help children in overly stressful situations. The wide acceptance of the field led to the formation of numerous organizations in the 1980s, including the Association for Play Therapy, which has some 5,000 members in more than 25 countries today. Canada, in particular, embraced play as an important medical component. The Canadian Child Psychotherapy and Play Therapy Association helped develop certification standards for the field. The Canadian Play Therapy Institute took its cause worldwide with Play Therapy International, which has sister organizations across Europe, the United Kingdom, Asia-Pacific and Africa.
Why does play work for children facing medical challenges? Studies are nearly universal in their conclusions, citing diverse case studies on play's emotional and physical merits. “Play normalizes what would otherwise be an abnormal life experience,” says Melissa Smith, Executive Director of the Kiwanis Orthopedic Clinic of Washington, D.C., and chief executive officer of Play-Based Physical Therapy, an outpatient clinic. “Play can help reduce children’s anxiety, occupy them and even help them advance their progress.
Children learn by playing. Play is their work. We are just helping them get better at their work in a very natural way.” Smith uses a variety of toys to draw children toward successful outcomes. For example, a child working on balance might launch foam rockets into the air by stepping on an air-filled launch pad. A child relearning to crawl after an injury might reach for Mardi Gras beads placed at the end of a tunnel. Depending on their age, the children may cherish the memories of their play therapy activities well into adulthood. “One of our young adult patients with cerebral palsy told me he has fond memories of learning how to ride the adapted tricycle in the Kiwanis Orthopedic Clinic,” Smith says. “He has an adapted adult tricycle now. It’s a perfect example of a person with a disability finding an activity that’s fun and good for his whole body. An activity that is play turns into an activity that becomes an essential part of staying healthy.” Besides its emotional and physical benefits, play can familiarize children with the different environments related to their care. Jane Le Vieux, a psychiatry consult liaison nurse and a registered play therapist at Children’s Medical Center of Dallas, Texas, uses play to address that anxiety. “Medical play allows children to become familiar with the procedures and equipment they may see and experience while hospitalized”
Le Vieux explains. “It minimizes the traumatic effects of illness and hospitalization. Child life specialists can facilitate coping and adjustment in circumstances that might be overwhelming.” She once used a sandbox to help a four-year-old boy overcome the anxiety caused when a dog mauled him. He would spend most of his session with her in the sandbox, recreating the incident that had scarred him physically and emotionally, often providing vivid details. “The play therapy relationship provided this child a safe and caring environment where he was allowed to regain a sense of control and empowerment that enhanced his self-esteem,” Le Vieux says. “Play offers children an arena to work out feelings of fear, anger, frustration and even resentment related to their illness. As the weeks went by, his grandmother reported that he was sleeping better at night and wanting to play outside again.”
Sometimes it’s just a matter of helping children get over small misconceptions that seem gigantic in their minds. At the University of California, Davis, Children’s Hospital, Diana Sundberg recalls a young boy who had been in and out of the hospital since his premature birth. He was always told to look away when given a sedative via a needle. “He would struggle and scream, so it was very difficult for him,” says Sundberg, the hospital’s Child Life Program manager. “Through therapeutic play with puppets and medical equipment, he expressed a huge misconception regarding the needle size. He thought it was as big as his outstretched arms. Deciding the misconception needed to be broken, I showed him the actual size of the needle. “The next time he had to go to the operating room, I suggested he look at the needle instead of looking away during the injection. Once he saw it, he pulled up the sleeve on his gown, stuck his shoulder out, looked at the doctor and said, ‘I’m ready.’” Lorie Walton of Ontario’s Family First Play Therapy Centre believes parents benefit from play therapy, which helps their children.
“Once parents understand how their child’s emotional and physiological system has been impacted, they are open to learning new ways to soothe, regulate and therapeutically parent their child,” Walton says. “It’s often parents who make the most significant changes in this process, which helps their child’s behaviour with positive shifts toward healing.” Even when a child’s diagnosis is dire, Walton believes play can help the grieving family face the outcome with some sense of closure. In his final days, 6-year-old Christopher used his Saint Bernard puppet to tell his dad that he was no longer afraid of dying now that he had Marty with him.
“Christopher’s mom told me that Marty helped Christopher cope with his last few days on Earth,” Walton says. “He hugged him at night and helped him sleep. Marty was buried with Christopher a few days later. Though this story has a sad ending, I can’t help but think that Marty the puppet helped this little boy in a way no human might’ve been able to.”
