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Therapeutic (medical) play

What is it?

This is a useful (and fun!) way to help your child cope with the anxiety, fear and stress around health care procedures, either at home or at the hospital.

Medical play allows your child to identify with a toy, such as a stuffed animal or a toy doll, and then to safely express his/her feelings and perceptions through pretend play that recreates the type of care that the child needs.

You can use the medical play at home to:

Through play, children have the opportunity to regain control over a stressful situation. In this way, children can show us, through words or actions, how they feel, what they believe about the care that they are receiving. Then it is up to the parent or caregiver to use this valuable information to help the child:

 

Play is important for all children

Children learn through play about themselves, their capabilities and the world around them. Through their play, children also express their perceptions and emotions. Even young children can tell us a lot about how they are feeling through their play.

 

Children with Medical Complexity can have a lot of stress

If your child has a chronic or complex condition, daily life can be challenging and may include repeated stresses such as special treatments at home, hospital visits, blood tests, painful procedures, medical tests (eg, like x-rays, scans, etc) and lots more…

Children may have strong feelings such as fear, confusion, sadness, anger and frustration. Sometimes, they are so upset that it is challenging to provide them with the care that they need safely. This can also become physically and emotionally exhausting, both for the parent and the child.

If your child is having a lot of difficulty tolerating treatments at home (eg, so stressed that there is a lot of crying, screaming, or movement during procedures), then please talk to your health care team immediately. Your team may wish to seek the advice of a child life specialist, a psychologist, a social worker, a nurse or another team member skilled in the management of stress in children with medical complexity.

While we may not be able to stop treatments or tests, medical play can help your child (and you!) prepare, learn and adapt to these events. Ultimately, the goal is to help empower your child and use his/her strengths in dealing with healthcare challenges.

 

How to use medical play at home: some basics to get you started!

  1. First, reflect on what you wish to accomplish. Is there a part of the care that seems to distress your child? Are you having a specific problem providing the care? If not, then consider modeling the type of care that your child needs (eg, suctioning a tracheostomy).
  2. Next, gather and put aside the items for play; choose a few stuffed animals, a doll or some other object which could “receive” the play care. Later on, let your child choose which of these objects is going to have the pretend care; this is a good example of providing your child with a reasonable choice. You can even purchase special dolls/puppets that have tracheostomies, gastrostomies, central lines, etc. Ask your health care team to find out more about this.
  3. Gather any of the usual care materials (the more realistic the better!), for example: syringes, gauze, bandages, catheters, tracheostomy tubes, etc. A toy medical kit, available at most toy stores, is another good idea.
  4. Consider your child’s age and developmental stage and review the table of play suggestions below.
  5. Identify a time and setting when and where your child feels comfortable and free to play.
  6. Introduce the “game” of medical play to your child, using simple words, for example: “Oh look! It’s 2 o’clock, time for one of your stuffed animals to have her medicines through her G-tube. Is it Teddy bear’s turn today? Let’s get the medicines ready to put in the G-tube. Teddy is afraid to have his medicines, even though he knows that medicines will make him feel better. How can we help Teddy take his medicines?”
  7. The goal is to initiate the play with just enough information to engage your child. Some children will need more support, others will dive right into the pretend play.
  8. Once your child is engaged in the play, let him lead the way. Your job is to follow your child in the play: listening, observing and responding to your child’s verbal and nonverbal reactions.
    The medical play is helping the child learn in detail about the real care that he/she is receiving. It is also allowing your child to express his/her own feelings about the care.
    Here are some examples of questions you can ask your child during the game:
    “Why does Teddy need his medicines?”
    “What time does Teddy need his medications?”
    “What will happen if Teddy does not take his medications?”
    “Is Teddy afraid that it will hurt when he gets his medications?”
    “What can Teddy do to feel better?”
    “Can Teddy help give himself the medication?” (hold the syringe)
    “Teddy looks worried that he might throw up… Let’s show Teddy how he can do some deep breaths to calm down.”
    “Teddy took his medications! Bravo! He was such a brave bear.”
    “Next time, he wants to help push the syringe.”
    “Let’s give Teddy a star sticker!”
    etc.
  9. Let your child set the pace; some children may want to play for only a few minutes the first time, that’s ok. As your child become more comfortable with the “game”, he will likely explore further, learning and expressing more each time. Pay close attention to your child’s reactions.
    Remember, children learn through play. Repeated play helps children develop a sense of predictable routine, which is very comforting.
  10. Have fun! This is the best part about medical play: the positive interaction between you and your child. Together, you are practicing to work as a team. Bravo!

Suggestions for therapeutic (medical) play by developmental stage of the child


Toddlers

Developmental stages and characteristic types of play

  • Mimic (copying) and pretend play.
  • Children develop symbolic play where they are able to transform sensory information into abstract mental images.
  • Much of play is focused on cause and effect.

Suggestions for medical play

  • Similar to infants, with more focused pretend play around the treatment routines.
  • An excellent time to role model the four phases pediatric approach (Anticipation, Preparation, Procedure, Recovery) with the selected toy or doll, including positioning and distraction techniques; eg, showing Teddy that the dressing has to be changed because it is dirty, teaching the teddy bear to sit still so that the dressing can be changed, acknowledging that Teddy is a little afraid, letting Teddy help pull the old tapes off, showing Teddy he can watch a movie or play a game while the dressing is being changed, etc.
  • Don’t forget to reward Teddy and acknowledge his strengths and those of his play caregiver (your child!) when the play is complete.

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A collaboration of clinical experts across Quebec has taken every care to ensure that the information contained in this document is accurate, complete, and reflective of evidence-based practices. However, “Complex care at home for children” collaboration cannot and does not assume any responsibility for application of the content of this document or for any information that may be present in the websites cited as a reference. These web sites are provided for informational purposes only and do not represent the collaboration endorsement of any companies or products. Always consult your child’s physician and/or a qualified healthcare professional to learn more about recommendations specific to your child’s health needs.

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