Medical Play of
Children with
Illnesses and Siblings
Laura Nabors, Kenneth Woodson,
Jennifer Bartz, Rebecca Elkins, and
Rebecca Sievers , University of
Cincinnati, College of Education,
Criminal Justice, and Human Services,
School of Human Services, Children
Community and Health Research Team
Children and Play
O Play is children’s work
O They express their feelings through play and
repetitive play is a way to work through
issues in their lives (Virginia Axline & others)
O Play allows for emotional release and
control of upsetting emotions - as a child
work s through issues
Imaginal Coping
O Clark proposed that play and accompanying
stories about illness and recovery were a
form of “imaginal coping” for children with
chronic illnesses (2003, 2011).
O Clark viewed “imaginal” play as being
positive in nature, serving as a mechanism
to assist the child in coping with medical
trauma related to his or her illness (Clark,
1998).
Play and Our Study
O Play is a mechanism for children to gain
mastery and control over upsetting events in
their lives
O Our study:
O Children with medical illnesses and their
siblings have opportunities to participate in
activity groups at a local Ronald McDonald
House, and our team made medical play
with toys a key activity to select during the
group
Activity Groups
O Children had choices to participate in other
art and creative activities, but they
gravitated to…
O Hospital toys: doctors kits, stuffed animals &
favorite toys were Playmobil figures with
hospital beds, IV, casts, wheelchair, doctors,
ambulances
O Thus, idea for our study…
Participants
O Groups at RMH
O 15 children with chronic illnesses
O Children had cancer, GI problems, were
awaiting or recovering from transplant etc.
O 14 siblings
O We also recruited a comparison group
O Children were young, under age 10
(range 2-10 years), average age about 56 years
Methods
O Groups videotaped and pictures taken of toy
play (hands and toys only) using a flip cam
O Children were asked open ended questions
to tell a story about what was happening in
their play
O Grounded theory used as a method to
search for themes in review of videos and
notes from the groups
Themes Children w/Illnesses
O (1) mastery play, where the child arranged/re-
arranged medical toys or told stories indicating a
need to control of the situation
O (2) stories where a character benefited from
social support
O (3) stories where a character expressed fear
related to needles
O (4) stories related to the withdrawal of blood by
evil doctors who made their patient angry or
afraid.
Fear of Loss of Blood
O “She’s going to take the blood; she puts the
blood in the huge shot. So then she gets
the blood and puts it in that tiny (points to IV
bag), then she keeps the blood, she’s the
evil doctor, she gets the blood and puts it in
the puke bag.”
Themes: Siblings of Children w/
Illnesses – vicarious learning
O (1) stories reflecting their own observations
and experiences of a brother or sister’s illness
O (2) wanting the attention of a distracted parent
O (3) depicting medical illness as a “family affair”
(4) aggression toward medical staff
O (5) vicarious needle fear
Illness is a family affair
O Story from a sibling
O One girl discussed a girl who was sick who
had to go far away to see a doctor. In her
story, the girl picked up a figure and said
she was, “…the sister. She’s kinda sick too.”
The interviewer said, “She is? How is she
sick?” The girl replied, “She is like, kinda
sick, she has the flu. Next, all the other
sisters in the family “got sick too.”
Getting well
O Lots of wishes for getting well
O “getting better”
O From both children with illnesses and their
siblings
O Support from others was a resilience factor
for “getting better”
O Distraction from the medical scene and
experience was a coping strategy
Comparison Group
O No detailed stories
O Did not play long with medical toys
O Cartoon-like quality to stories
O Wishes for getting well and recovery not
evident in stories
Medical play was…
O Opportunity to release emotions
O Work through upsetting feelings and recall
of traumatic situations
O Child had mastery over start and stop of the
event and had ways to rescue the child,
supporting Clark’s idea of imaginal coping to
gain mastery
Medical play was…
O Children who came several times to groups
– had scripts that they kept telling to work
through their feelings
O Just like adults tell stories over to work
through emotional events – children may
work through play scripts to “retell” and
work through upsetting or traumatic events
Future
O See what play therapy techniques further
enhance child healing and make use of play
therapy more effective!
O Future research should focus on ways to use
play techniques to help medically ill children
and siblings cope with medical trauma
O Remember, siblings may need support to
work through vicarious observations!
O Thank you very much!
O References available from Laura
Nabors [email protected]
Disclosure
O The following personal financial
relationships with commercial interests
relevant to this presentation existed
during the past 12 months:
Laura Nabors and other authors
O No interests to disclose