The Necessity of Play for Children in Health Care

Maile Jones

Disclosures

Pediatr Nurs. 2018;44(6):303-305. 

In This Article

Abstract and Introduction

Introduction

Play is the work of a child; it is how they learn and grow. Beginning with the child's first social smiles, and through the development of babbling, fantasy, games, hopping, skipping, and jumping throughout the months and years, play is one of the most powerful vehicles children have for trying out and mastering new skills, concepts, and experiences (Bolig, 2018). Play allows children to use their creativity while developing their physical, cognitive, and social-emotional skills, from dexterity to executive functioning and even imagination (Yogman, Garner, Hutchinson, Hirsh-Pasek, & Golinkoff, 2018). Beyond play as a necessary developmental tool, it is also particularly important that children have opportunities to play when they are in stressful situations (Jessee & Gaynard, 2009). In the healthcare context, play provides comfort for children and an increased sense of normalcy. Play is an essential aspect of care that helps children express their feelings and regain feelings of control and competency often lost in the challenges of hospitalization and treatment (Jessee & Gaynard, 2009). Whether the child is verbal, non-verbal, developmentally delayed, physically disabled, or challenged with any kind of restriction, it is important that every child has the opportunity to play. Furthermore, play is a supportive technique that can take many forms and adapts to fit any situation, in any culture.

Although technologies such as iPads, video games, and computers are changing the landscape of play in the Western world, play is just as easily seen using simple outdoor products like sticks, rocks, and chalk. The term "play" may refer to a varied range of activities; however, certain broad criteria have been used to differentiate play activities from others. Specifically, there is some theoretical consensus that play is intrinsically motivating, involves attention to means rather than an end, and is non-literal or symbolic, free of external rules, and actively engaging (Rubin, Fein, & Vandenburg, 1983). Despite the variety in frequency and type of play, children's playtime remains essential for long-term development, especially in potentially stressful healthcare settings.

The role of play in child development has been investigated and described for decades. According to Piaget (1962) and Erikson (1972), play is a fundamental component of the normal growth and development of children. Vygotsky (1962) added that play gives children the chance to think abstractly within his or her socio-cultural environment. Table 1 summarizes these seminal theories across childhood and adolescence.

In addition to promoting normalcy and continued development, in healthcare contexts, play can also help children identify and implement strategies to cope with their stresses, overcome their fears, and develop a stable self-esteem (Gold, Grothues, Jossberger, Gruber, & Melter, 2014). As such, play relates to many areas of adaptive functioning and can be adapted to fit a patient's condition and available resources. Through play, children learn to focus or redirect their attention and solve problems, both of which build executive functioning and are essential to cognitive coping strategies (Yogman et al., 2018). In fact, high amounts of play are associated with low levels of cortisol and high levels of norepinephrine, which may indirectly affect brain functioning by buffering against adversity and reducing toxic stress that are more compatible with coping and resilience. Play, therefore, is an important aspect of care that can be supported by nurses, child life specialists, and other healthcare professionals, and can take the form of interventions, such as normalizing play, preparation play and distraction, and expressive arts play.

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