Senior Child Life Therapist, Ms Tanuja Nair, conducts medical play for a patient.

Hospital stays and medical procedures can be challenging and stressful for children and their families. With help from Child Life therapists and volunteers at KK Women’s and Children’s Hospital (KKH), every year, more than 2,000 young patients and their caregivers are supported through their hospitalisation journey using the modality of play.

Child Life Therapy is part of the Child Life, Art and Music Therapy Programmes (CHAMPs) service at KKH, which utilises the modalities of play, art and music to address the various psychosocial needs of the child and their family.

“Play can be therapeutic, or a form of therapy. Depending on the varied needs and age of the child, we initiate different forms of play to address challenges that may arise from hospitalisation, to reduce stress, anxiety and fear that our patients may face,” shares Ms Tanuja Nair, Head and Senior Child Life Therapist, CHAMPs, KKH.

Child Life Therapy focuses on helping the child cope with their experiences within the hospital, as well as helping them transit back into their home environment. Intervention is broadly categorised into medical play – a therapy programme by referral that is conducted by trained Child Life therapists, and general play – which is facilitated by Child Life volunteers for its beneficial general therapeutic effects.

Medical play for children

Medical play is typically prescribed for children who need help to cope with challenges faced during a hospital stay, which include:

1. Understanding and coping with a diagnosis or procedure;
2. Managing concerns and expectations surrounding a hospital experience and
3. Providing stimulation and psychosocial support for patients who require prolonged or frequent hospitalisation.

“Our objective is to normalise the child into the hospital environment through play, to allay their fear and anxiety of being in a foreign environment. Normalisation has two facets – one involves preparing the child for a medical test or procedure that is upcoming or has had to take place suddenly, and the other involves teaching the child and their family coping and relaxation strategies to address pain that may occur during the hospital stay,” shares Ms Nair.

Specific play techniques are utilised at a developmentally-appropriate level for children who are aged from six months to 18 years old. The patient and family are also consulted to better understand the child’s diagnosis and procedures that they will need to undergo, and the family and caregivers’ existing strategies to cope with and manage the child’s condition.

“If a child has to undergo a procedure, we may prepare them by explaining the process in a step-wise manner, to help them anticipate what is to come. If they are diagnosed with a medical condition, we can engage in medical play with them, to help them understand what is taking place within their body, and how the diagnosis will impact their lives.”

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Techniques for younger children

Younger children (aged four years and below) are less able to comprehend and make sense of a procedure through simulation. Hence, Child Life therapists focus on teaching caregivers techniques of distraction and comfort, such as bringing along a favourite toy or playing a video, to manage anxiety. Parental involvement is especially important to build the bond and establish security that the young child would need to rely on when undergoing an unfamiliar procedure.

Techniques for older children

For older, school-going children (aged seven years and above), role-play and simulation are helpful to introduce them to common medical equipment and procedures in a non-threatening manner. This can include listening to their own heartbeat with a stethoscope, or the use of medical toys such as a doctor’s set and dolls; with the child playing the role of a doctor or nurse conducting a mock examination of the doll, and other routine procedures that the child themselves would eventually have to undergo. These familiarisation and desensitisation techniques can help them feel less anxiety during the actual procedure.

Techniques for adolescents

For adolescents and teenagers, therapeutic recreational projects, card or board games that are specially modified to include medical themes, are used to introduce them to common medical procedures or medical terms. Some sessions utilise therapeutic medical dialogues where open communication through informal chats are facilitated. Such sessions encourage patients and families to share their fears and anxieties on a safe platform, and provide opportunities to address worries or clarify misconceptions ahead of the actual procedure. Coping techniques are also discussed and diversional strategies are mapped out so as to help the patient and his/her family through their medical experiences.

Techniques for medical procedures

To educate children on specialised procedures such as a tracheostomy, or magnetic resonance imaging, videos, picture books and games involving customised medical toys and dolls are used to help them to better visualise the steps involved, in aid of mental preparation.

While child life therapy typically takes place before the child undergoes a procedure, a child may at times suddenly require a life-saving procedure urgently, with the child life therapy session occurring post-operatively. For such patients, the Child Life therapist would, review the procedure and explain the sequence of events, to help the child to understand and clarify their concerns. In this way, therapy can be helpful in mitigating trauma by helping the child to reframe a situation that they had identified as a negative incident.

A range of toys, games and videos are utilised in Child Life Therapy. These include (from left to right):

1: Books and videos to educate children and caregivers on hospital and healthcare procedures;

2: A mood bottle project offers adolescents an opportunity to practice mindful deep breathing as a coping technique;

3: A toy doctor’s bag is used during role-playing, to aid in familiarisation and desensitisation; and

4: Toy models and dolls help to introduce children to medical equipment and care practices that may become part of their new routine.

Playing to help patients develop

Some patients who require prolonged or frequent hospitalisation may not have the opportunity to interact with their peers beyond the hospital setting. Child Life volunteers engage these patients in generic play similar to early childhood play, exposing them to games and toys that provide cognitive and developmental stimulation, such as puzzles and shape sorters, to enable them an opportunity to put their skills to practice. Volunteers also recreate age-appropriate play using toys such as tea party sets, which provides these children with social interaction, nurturing their social skills and building camaraderie.

Playing to help patients live well

Following their time in the hospital, some children may need to incorporate new routines into their daily lives, such as taking medication, or receiving food and water through a nasogastric tube. Child Life Therapy utilises medical play to encourage children to be involved in these new daily routines, giving them a sense of autonomy about their health. This plays a vital role in helping them to better cooperate in adhering to the new routines after they are discharged from the hospital.

“When a child is in the hospital, they have to go through procedures in accordance with their diagnosis, and they usually do not have an opportunity to say ‘no’,” Ms Nair shares. “We reassure them that they can have a say in their health, and can look after themselves. When they feel that they are part of the situation, they are more cooperative and have a sense of ownership of what is taking place within their body.”

“For patients who have to comply to new routines – such as those with gastroenterological issues who may require a stoma bag – we educate them on the impact on their daily life; such as what they can continue doing or the rationale for what they can no longer do, as well as break down the steps of how to care for the stoma bag every day.”

Journeying to recovery together

“Regardless of age, everyone experiences some level of anxiety when they are hospitalised. As Child Life therapists, we actively try to anticipate our patients’ fears and anxieties, and try to allay these through education, support and procedural preparation – working towards creating a positive experience for the child during their stay in the hospital,” shares Ms Nair.

“While Child Life Therapy may not mitigate all of a child’s anxiety or completely undo the negativity that is associated with a hospital stay or medical procedure, it plays a vital role in helping the child to process what has happened, and reassuring them and their family that they do not have to face this challenge alone.”