This article was written by Sian Spencer-Little, Specialised Play Practitioner
at The Princess Royal University Hospital (Kings College NHS Foundation Trust), author of ‘Playcreateinspire‘ Blog and visiting lecturer at London South Bank University – Children and Young People’s Nursing.
Working with children and young people and their families is a great opportunity to be more playful, and use the imagination skills we had when we were younger. If you are a Health Play Specialist you get to do this every day, knowing you are making a difference to children and young people whilst they are accessing healthcare.
If you’re not a Play Specialist, it can be a little trickier – so I am thrilled to be asked to share a few tips with you! They will not work for all – and some of them you may already know – but for those just starting out in paediatrics they might just make the transition that bit easier. This is also not an exhaustive list, but some key pointers clinicians have asked for.
What we do know is that visiting a hospital and having any clinical procedure can be a traumatic time for a child and their family. Whether it be their first visit or 100th, it can bring lots of fears and anxieties about what will happen, so creating an environment which is non-threatening, supportive while introducing a little fun is key to supporting them and helping find coping strategies that work for them.
Working with your Play Teams, Health Play Specialists and or Child Life Practitioners means having a ‘whole team’ approach – and it is also important in providing a stable consistent person who will act as an advocate for the child.
Specialists vs Therapists…
Health Play Specialists are qualified and experienced in carrying out support, distraction play and preparation programmes to children and young people within hospital and healthcare settings. They are trained specifically to work with children and young people, those with immediate acute admissions as well as with long term health conditions.
You can find out more about us via www.nahps.org.uk which is our National Association of Health Play Specialists.
Play Therapists are qualified and registered with the BAPT British Association of Play Therapists – they work with children and young people suffering from a range of psychological difficulties and complex life experiences- within mental health, education and health settings as well as private practise.
You can find out more via www.bapt.info
Specialised play and Therapeutic play use different techniques and approaches – often picking up on the subtle changes in voice, physicality and mood of the child or young person. Having a Health Play Specialist alongside a child during the preparation for a procedure is key – they need to be part of the procedure before it starts, not just for the distraction element.
Top Tips for Thinking like a Play Specialist
Observation is a key skill in our assessments. We look for ‘age and stage’ appropriate behaviour, as well as development. We also need to understanding the procedure, the events, the plan – without this we are unable to access our “store” of language and explanations. Having a good sound knowledge of child development and when milestones are reached is really helpful when making an assessment of what resources will work – then we can use the most appropriate approach for that age group.
I have often found that when a child or young person is faced with high levels of fear and anxiety their behaviour can sometimes regress, and they will seek activities that are normally enjoyable for younger children. These activities can make them feel safe and secure and can easily be engaged in. For example, playdough and sand, creative activities with paint and glue used with teenagers – these might allow an anxious young person to relax while engaging in messy play.
Finding your ‘inner child’ is sometimes tricky. So is getting the balance right between seriousness/silliness and professionalism! However you find your balance, it is absolutely possible to be playful and professional – Health Play Specialists do this every day (and don’t worry, a child will tell you if you’re being silly!) Each child or young person is unique and what works for one child or family may not work for another. Be creative and open to new ways of engaging. Children and young people can be creative when describing pain or fear in hospital. Some of my patients have described it as ‘a dinosaur pounding on my head’, others ‘like there is a thunder storm in my ear’.
Asking children and young people to describe what they pain feels like in the physical sense is key to understanding what it feels like for them. It can also be useful to use visual props – I have had a child show me how big he thinks the cannulation needle is, and how much blood he will have taken using empty baby bottles!
Parents and Carers know their child the best. They will know what makes them excited and anxious; what their likes and dislikes are; listen to them and work with them.
Language – make sure you use uncomplicated language to describe a procedure. Also explain what will happen next, and any plans for further investigations so there are no surprises. Leave time and space to process the information, and make sure the young person knows that questions can be asked without judgement or fear.
Real Time! If you can, use real equipment to explore what happens in a procedure – syringes, plasters, wipes, gauze, O2 masks, BP machine – all of these can be safe to play with in a guided way. If appropriate, ask them if they would like to help you get ready- this way you can both explore what will happen and why. Perhaps you can run through the procedure first, using a favourite doll or teddy.
Listen, Engage, Be Honest. Open a dialogue of communication. Whether this involves explanations, honesty, tough questions or listening to their personal story – narratives from children and young people are some of the most powerful ways we learn about what matters to them. “S” took a long time to engage and found it very difficult to communicate as she was so frightened. I spent several sessions with paint and creative activities on a table that went untouched until I picked up a paint brush and started painting my own picture – “You’re using the wrong brush Sian!”
If they are non-verbal- do you have access to visual cues, or sign language?
Distraction What do you have in your pocket right now? Because the key to engagement for our younger patients is whatever we can use to help with distraction. It doesn’t have to be anything fancy if you use your imagination – it could be a pen that turns into “Silly Sid the Pen” or even “Penelope the bubble eating Pencil”…
Mobile Phone Apps for distraction and explanation – if you are able to take some time, have a look at the following suggestions. They are just a few of the apps out there I have used regularly. These apps should always be shared together with an adult- which is why it is important for you to have a look at them first.
Hetty’s Hospital – interactive app following children in a variety of procedures and what happens next.
Four in a row – This is Connect 4 – great for distraction!
Get well soon – This app goes along with the television series ‘Get Well Soon’ with Dr Ranj Singh- you can follow Dr Ranj throughout the hospital and be interactive with various children and situations.
Cbeebies Story Time – This is a collection of story books which you can share alongside a child. There are regular downloads.
Little Journey – journey around the hospital (designed by Dr Chris Evans at UCL as apart of his higher degree qualification sections for children aged 3-7yrs and then 8-12 yr old) Can also be used in 3D virtual glasses.
My MRI Journey – both on mobile phones and 3D virtual glasses
Little George – interactive story for children with a sickle cell diagnosis
Play is an essential part of learning and coping. It is powerful, purposeful, preventative and most of the time unplanned within the acute paediatric setting, but time spent playing with children and young people is never wasted.
- The Provision of Play in Healthcare service delivery – A literature review 2014 Dr Alison Tonkin
- Play and education in preparation for imaging procedures in children- British Association for child and adolescent public health and British association of General Practitioners 2014. L ODea, A Stephen, G Subramanian.
- Play in Healthcare- Alison Tonkin
- Exploring the impact environments have on children and young people’s experience of healthcare- A review of the literature – Dr Alison Tonkin and Kath Evans
- Paediatricians and the development of health play specialists- RG Wilson, I O’Donnell