Play Therapy in Pediatrics

Play Therapy: Play is the universal language of children. It is one of the most important forms of communication and can be an effective technique to relate with them.

Goals of Play Therapy

• To maintain normal living pattern
• To minimize psychological trauma
• To provide optimal growth and development of the child

Functions of Play in Hospital

• Provides diversion and relaxation
• Helps the child feel more secure in a strange environment
• Lessens the stress of separation and feeling of homesickness
• Provides a means for releasing of tension and expression of feelings
• Encourages interaction and development of positive attitudes toward others
• Provides an expressive outlet for creative ideas and interests
• Provides a means for accomplishing therapeutic goals
• Places the child in an active role, providing the opportunity to make choices and to be in control

Classification of Play Therapy

Therapeutic play

It is a nondirected play technique and focuses on helping the child to cope with his or her feelings and fears. Supervised play with medical equipment in the hospital environment can help children work through their feelings about what happened to them.

Dramatic Play

It is a well-recognized technique for emotion release, allowing children to reenact frightening or puzzling hospital experiences. It enables the children to learn about procedures and events that are of concern to them and to assume the roles of the adults in the hospital unit.

Types of Bedside Play

1. Storytelling — imaginative or anecdotal

• Children <5 years: Stories with themes about people who shut their eyes and ears, things that are missing, change in appearance, etc.
• Children between 5 years and 10 years:
  Stories with themes about making things that last, acquiring competitive skill, pleasing adults, role model, triumph over danger, being ashamed or losing face, and patterns of living with friends.

2.Water plays during bath

• Blowing soap bubbles, filling and squeezing a bath sponge, bathing a doll,

3. Television and playing with boats.

• Telling about programs, commercials, etc., and use of closed-circuit television to present health-teaching films and to provide lessons in finger crafts.

4. Needle play

• Handling empty syringes (without sharp needles), intravenous (IV) tubing, etc. and pretending to give shots to a doll, stuffed animal, parent, or nurse. The nurse can demonstrate the method of giving an injection by drawing up the solution or water and squirting a bit into the air.

5. Pre- and postoperative teaching

• Handling operating room mask, cap, gown, etc. and any material relevant to care.

6. Art

• Drawing with crayons or blank paper followed by discussion of what is drawn.

Nurse’s Responsibilities

• The nurse must consider the age, interest, diagnosis, and limitations imposed by the illness when planning activities for any child.
  For example, an acutely ill child can enjoy storytelling.
• Avoid the term playroom when caring for older aged children and adolescents, instead call it the “activity room” or social room. Ideally adolescents should have their room space.
• Use play as appropriate while providing routine nursing care to the child, for example, to encourage deep breathing, encourage the child to blow bubbles or blow a whistle.
• Award the child a sticker, special pencil, or any small gift if he or she reaches a certain level of performance.
• When using play as a part of nursing care, it is important to evaluate the outcome of play. For example, for the child blowing bubbles, determine whether this activity enhanced coughing and deep breathing.
• Special consideration must be given to the children who are isolated and have limited movements or restricted extremities.
  Note: Toys for children in isolation unit must be disposable or be disinfected after use. Stuffed animals should not be used in this unit.
• Have parents provide the child with a shoe box, a small suitcase, or backpack for easy storage to prevent small play items from becoming lost in the sheets or under the bed.
• Providing space for special needs of children in age group can be difficult. Hence, playroom schedules can be structured to allow one age-group at a time.
  For example, adolescents can use the facilities in the afternoon when younger children are asleep.
• When supervising play for children who are ill or convalescing, it is best to select activities that are simpler than would normally be chosen according to children’s developmental level.
• Incorporate opportunity for musical expression into routine nursing care, for. example, dance or movement suggestions may encourage a child to ambulate.
• Avoid doing any painful procedures in playroom whenever possible.
• Teach the child to take care of toys.

Play Activities for Special Procedures

• Fluid intake:
• Make ice pops using child’s favorite juice.
• Cut gelatin into funny shapes.
• Use small medicine cups, decorate the cups.
• Color the water with permitted food coloring or powered drink mix.
• Let the child fill a syringe (without needle) and squirt it into the mouth or use it to fill small, decorated cups.
• Cut straws into half and place in a small container (much easier for child to suck liquid)
• “Make a progress poster.” Give rewards for drinking a predetermined quantity.
• Deep breathing
• Blow the bubbles with a bubble blower or straw.
• Blow on a pinwheel, feather, whistle, and balloon.
• Practice band instruments such as flute.
• Have blowing contest using balloons, cotton balls, etc. among children.
• Suck and leave the paper or cloth from one container to other using a straw.
• Take a deep breath and blow out the candles on a birthday cake.
• Use a little paint brush to paint nails with water and blow nails to dry.
• Range of motion and use of extremities
• Play pretend and guessing games (e.g., imitate a bird, butterfly, horse).
• Have tricycle or wheelchair race in safe area.
• Play video games (fine motor development).
• Play “hide and seek hide toys somewhere in bed (or room if ambulatory) and have child find it the using specified hand or foot. ‘
• provide clay to hold with fingers.
• Paint or draw on large sheets or papers placed on floor or walls.
• Encourage the child to comb own hair.
• Pretend to teach aerobic exercises or dancing.
• Position bed so that child must turn to view television or doorway.
• Soaks
• Play with small toys or objects (cups, soap dishes) in water.
• Wash dolls.
• Pick up coins from bottom of bath container.
• Make designs with coins on bottom of container.
• Pretend a boat is a submarine by keeping it immersed.
• Sitz bath: Give the child something to listen to or look at (e.g., music).
• Punch holes in bottom of plastic cup, fill with water, and let it rain on child.
• Injection
• Let, child handle syringe, vial, and swab and give an injection to doll or stuffed animals.
• Draw a magic circle on area before injection, draw smiling face in circle after injection but avoid drawing on puncher site.
• Have child count numbers during injection,
• Give rewards for successful cooperation.
• Ambulation
• Give the child something to push, for example, toddler-push-pull toys; school age-wagon or decorated IV stand.

Guidelines for Infection Control in Play Therapy

Play materials are the source of potential infection. Hence, infection control in play area can be maintained by the following measures:

• Do not allow stuffed or non-washable play materials in the playroom.
• All the toys should be washed with soapy warm water after use. Special care should be taken when it is used by children who are having infectious diseases or drooling problems, the materials should not be used by others without washing.
• Clean the toys using cloth immersed in disinfectant if they cannot be washed.
• Encourage handwashing of personnel/caregivers accompanying the children before entering playroom.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
8. Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

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