When discussing the child life profession, a common reaction I hear from people is “wow, you get to just play with kids all day- what a fun job!” While in my mind I am quickly constructing a list of other tasks that often must be prioritized before play can occur (diagnostic education, procedural preparation and support, emotional support, etc), I take this time to address one small piece of their statement-it is never “just play.”

Play is the most fundamental way for children to explore and learn about the world around them. Children from cultures all over the world play, indicating that play is a universal and essential piece of human development. Play is the work of all children and it is extremely important.

But what is play? And how do child life specialists use play as a therapeutic medium?

Play has several criteria that must be met. It must be voluntary, internally motivated, pleasurable, active for the mind and body, unique, and unpredictable. A child life specialist must look through this lens of play with children to help provide them a sense of control and, ultimately, mastery. “The ability to guide children through the multiple dimensions and processes of play according to their developmental and environmental needs is a competency that is core to the practice of child life” (Child Life Council, 2008).

Why do child life specialists use play? As we know, play is a universal language amongst children. It provides an opportunity for the child life specialist and child to build rapport and for the specialist to teach and evaluate a child’s learning. Play provides children a means to express themselves and their feelings both verbally and nonverbally. Additionally, play is a distraction from painful, scary or difficult events occurring in the hospital setting.

Play becomes therapeutic when it is specialized to provide developmentally supportive activities that facilitate the emotional well-being of a pediatric patients. This play promotes mastery of developmental milestones, while helping children to respond more effectively to potentially difficult medical experiences. Therapeutic play can take many forms. General components of therapeutic play and potential examples of each could include:

1. Encouragement of emotional expression: decorate a mask to depict how a child is currently feeling
2. Instructional play for medical education: use of medical equipment on a doll
3. Physiologically enhancing play: blowing bubbles to enhance lung function
4. Dramatic play- allowing a child to create characters and to express ideas about a situation

Therapeutic play in the hospital often has specific goals. For example, a child who is having difficulty separating from their caregiver may have fears of abandonment. A child life specialist may engage this child in separation play like hide and go seek (with clear limits) or peek a boo, depending on the child’s age. If a child is having difficulty identifying their feelings, a child life specialist may engage the child in some type of play that allows the child to create a story. Rather than asking the child “what did you draw?” or “what happens next to the dolly” allowing the child to create this narrative on their own assists the child in recognizing their own emotions. If there are challenges or barriers to play present: a child being unable or too weak to move due to burns, broken limbs, surgical restrictions or end of life concerns, the child is still able to participate in play. A child life specialist will allow the child to vicariously play through them. The child life specialist can manipulate the toys present, making the child the director, designer, producer, etc. The child can then participate in play despite any challenges that are present.

Therapeutic play in the hospital may be direct or indirect. Direct play is when a child life specialist guides and focuses play to achieve a specific goal. Whereas indirect play is child led and does not have a specific goal in mind. Often this type of play provides opportunities to learn about children’s misconceptions. Often I find myself utilizing both approaches. I will engage a child in playing with a teddy bear in direct play, as I help explain step by step what their procedure will be like. I will then take a back seat during indirect play and have the child play out the information they received. Often this helps me to identify if there are any lingering fears or concerns regarding the procedure or potential misconceptions present.

The following table reviews various types of therapeutic play utilized in the hospital setting, the rationale behind each type and examples of play activities child life specialists may offer to pediatric patients.

Play in practice is simple, fun and flexible. In theory, defining play is a complex concept. In addition to the types of therapeutic play reviewed thus far, medical play also has defined categories of its own. Child life specialists utilize medical play on a daily basis with the activities completed with pediatric patients being divided amongst four conceptual categories.

No matter what type of play a child may participate in during their time in the hospital, it will be a vital piece of their coping and adjustment to the hospital environment. With a brand new place full of unfamiliar people and objects, the warm comfort of a familiar toy or game provides the child an arena in which they are the master. Allowing a child to control this piece of their time allows them to cope more effectively with other pieces of their day that may be out of their control: needing to take medicine, go get an x-ray, stay in their hospital bed. Child life specialists provide play to children through bedside activities, individualized trips to the playroom, organized formal play groups or activity groups or special events in the hospital. Child life specialists can make an assessment of what they feel the child’s needs are and provide the appropriate medium of play and expression. While a child is receiving the medical care they need, child life specialists ensure that every day includes a large, healthy dose of play and fun.