Play Health Article

Therapeutic play

When a child is ill or traumatized the care plan may include therapeutic play. Unlike normal play in design and intent, therapeutic play is guided by the health professional to meet the physical and psychological needs of the child. Because play is the language of children, children who have difficulty putting their thoughts in words can often speak clearly through play therapy. There are three divisions of therapeutic play, including:

• Energy release. Children release anxiety by pounding, hitting, running, punching, or shouting. Toddlers pound pegs with a plastic hammer or pretend to cut wood with a toy saw. An anxious preschooler pounds a ball of modeling clay flat; a relaxed child may build the clay into shapes. Balloons tied over the bed of a school-age child or adolescent can be punched.
• Dramatic play. Children act out or dramatize real-life situations. They act out anxiety and emotional stress from abuse, neglect, abandonment, and various painful physical experiences. Imaginative preschool children enjoy dramatic play. An abused or wounded child might not communicate the experience verbally but may be able to use an anatomically correct doll to show what happened. Therapeutic play can teach children about medical procedures or help them work through their feelings about what has happened to them in the medical setting.
• Creative play. Some children are too angry or fearful to act out their feelings through dramatic play. However, they may be able to draw a picture that expresses their emotions or communicates what they know. To encourage this expression children can be given blank paper and crayons or markers and asked to draw a picture about how they feel. Some children are so concerned about a particular body part that instead of drawing a self portrait, they will draw only the body part that worries them.

Many children draw pictures that reflect punitive images to explain unhappy experiences. They need reassurance that they are not being punished. Health-care providers need to make sure that these children are not being abused. Other children may draw pictures that are symbolic of death (an airplane crashing, boats sinking, burning buildings, or children in graves). These children need assurances that they are not going to die. Some drawings express the child's fear of abandonment and loss of independence. Pictures may suggest the parent cannot find the little child who is in the hospital. The child needs to be reassured that their parents know where they are. They need to know when the parents will visit and the parents should appear when they say they will be there.

Older school-age children and adolescents may not be interested in drawing, but they can make a list of experiences they like and dislike.

Parental concerns

Parents express interest in age-related play that prepares children for group exercises in preschool. They want to know the right kind of play for an only child or sick child who may not be able to play with other children in their age group. The following age-related play and toys serve as a guide to parents with these concerns.

• Infant. The infant enjoys watching other members of the family; the infant enjoys rocking, strolling, time spent in a swing, supervised time on a blanket on the floor, crawling, walking with help, and being sung and read to. Play is self-absorbed; it is difficult, if not impossible to direct play. Infants are engaged in the vigorous process of self-discovery, learning their world by looking, listening, chewing, smelling, and grasping. Most of their learning comes through play. They need safe toys that appeal to all of their senses and stimulate their interest and curiosity. Infants need toys and play that include oral movements. They like peek-a-boo; playing with the parent's fingers, hair, face, and the infant's own body parts; playing in water. Soft stuffed animals, crib mobiles, squeeze toys rattles, busy boxes, mirrors, and musical toys. Parents can give them water toys for the bath, safe kitchen utensils, and push toys (after they begin to walk), and large print books.
• Toddler. Toddlers fill and empty containers and begin dramatic play. As they increase their motor skills, they enjoy feeling different textures, exploring the home environment, and mimicking others. They like to be read to and to look at books and television. Toddlers enjoy manipulating small objects such as toy people, cars, and animals. Favorite toys are mechanical; objects of different textures such as clay, sand, finger paints, and bubbles; push-pull toys; large balls; sand and water play; blocks; painting or coloring with large crayons; nesting toys; large puzzles; and trucks and dolls. Toddlers explore their bodies and those of others. Therapeutic play can begin at this age.
• Preschooler. Dramatic play is prominent. This age group likes to run, jump, hop, and in general increase motor skills. The children like to build and create whether it is sand castles or mud pies. Play is simple and imaginative. Simple collections begin. Preschoolers enjoy riding toys, building materials such as sand and blocks, dolls, drawing materials, cars, puzzles, books, appropriate television and videos, nonsense rhymes, and singing games. Preschoolers love pretending to be something or somebody and playing dress up They enjoy finger paints, clay, cutting, pasting, and simple board and card games.
• School-age child. Play becomes organized and has a direction. The early school-age child continues dramatic play with increased creativity but loses some spontaneity. The child gains awareness of rules when playing games and begins to compete in sports. Children in this age group enjoy collections (comic books, baseball cards, and stamps), dolls, pets, guessing games, board games, riddles, physical games, competitive play, reading, bike riding, hobbies, sewing, listening to the radio, television, and videos, and cooking.
• Adolescent. Athletic sports are the most common form of play. Strict rules are in place, and competition is important. Adolescents also enjoy movies; telephone conversations and parties; listening to music; and experimenting with makeup, hairstyles, and fashion. They also begin developing an interest in peers of the opposite sex.