Judy Walker On the evidence base for hospital play

Published: 22/04/2002, Volume II4, No. 5902 Page 27

'I do not want to go home' is not what you would expect from a fouryear-old boy in accident and emergency who needed stitches to a cut on his head. But the play specialist, who had been with him throughout the procedure, was using distraction toys to help him remain calm, and he wanted the fun to continue.

Local satisfaction surveys show that good-quality play in hospital makes children happier with the healthcare experience. But there is also a small, meaningful body of research to underpin this work.

Theoretical models describe play as vital to emotional health, allowing anxious children to reconstruct, re-enact and reinvent their stressful experiences to understand and take control of them.

These theories are supported by a study comparing the play of threeand four-year-old children with leukaemia with a control group of well children with comparatively few stressors in their lives (Gariepy N and Howe N, Health and Development 29, 6 523-537 [2003]). The children with leukaemia had a smaller repertoire of play activities and revisited the same themes and activities each week. They also engaged in significantly fewer play behaviours, showing that children who are anxious and preoccupied may be unable to play at times and are therefore deprived of an active and safe means of coping and problem solving. The idea of facilitating good-quality play to promote coping would seem to be supported.

A child's right to information about their healthcare was only acknowledged in 1991 in the UK with the ratification of the UN convention on the rights of the child.While our education system recognises that children learn best through play, in healthcare the question of how play increases knowledge has not been asked;

instead studies have focused on how it reduces anxiety.

Schwartz et al in 1983 studied 45 three and four-year-old children hospitalised for dental surgery (Schwartz BH et al, J Pediatr 102:6342 [1983]). Children receiving a hospital play session were significantly more co-operative and less upset than a control group with no play and a group with an unrelated play session.

Visintainer and Wolfer in the 1970s showed that using play to give age-appropriate information and encourage children to explore their feelings led to significantly lower upset scores and higher co-operation at designated stress points (Visintainer MA, Wolfer JA. Pediatrics 64;646-655 [1979). Physiological measures such as heart rate, and first urination following surgery were also significantly better for the experimental group, as was 'emotional' recovery after discharge.

Such studies support the wealth of anecdotal evidence that hospital play can improve the emotional and physical well-being of children in hospital. Research shows that certain groups of patients are more at risk from long-term psychological distress and harm, especially those who experience frequent hospital admissions from the age of five, economic and social hardship and a large number of physical stressors.

Surely today's debate should not be whether there is enough evidence to show that play has value; rather how it can most benefit the most vulnerable children.

Judy Walker is chair of the National Association of Hospital Play Staff.