How Play Can Help a Child Cope With Stress at the Hospital

As a child life specialist, I’ve seen countless examples of play transforming a child’s mood in the hospital environment.

I remember the day when one particular little boy lay curled in a ball beneath the covers in his hospital bed, his bald head hiding beneath the sheets. He had not showed up in the playroom that afternoon, which was unusual. This was a kids who waited eagerly each day for the playroom door to open and was often the last one to skate his IV pole back to his room when we closed. I had yet to see him without a smile. He seemed to me like a content child with a quiet maturity that went well beyond his seven years. He took his medical treatment in stride and enjoyed the company of his brother and sisters, as well as just about every activity the playroom had to offer.

But not this day. It was mid-afternoon and we had yet to see him. His mother stopped by and informed me he had a complication which would require surgery.

The little boy was very upset and refused to leave his bed or talk to anyone. The removal of the catheter that allows patients to receive chemotherapy without an IV is difficult for any child, but it was important to find out what was upsetting him in particular. Understanding the details of what was causing this typically cheerful boy to retreat under the covers would give me a clue about what would help him cope.

With a soft knock, I entered his room and took a seat by his bed. His father sat vigil in a chair close by. I gently coaxed the boy to tell me what was wrong. He was having none of it.

“We were wondering why you weren’t in the playroom today. Your mom told me you have an infection.”

Silence.

“It can be pretty disappointing to have to go in for more surgery.”

Not even a nod.

“I am thinking you might be too upset to even talk about it. So I was wondering if you could draw a picture about the most awful part of what is happening. That way, I can understand a bit better what you are going through.”

I placed a piece of plain, white paper on the bed, along with some markers.

It took a few moments, but he uncurled from the fetal position and scooted up to a half-sitting position. He reached for a marker. I breathed an inward sigh of relief and sat back to see what he would draw. Placing his hand palm down in the center of the paper, he outlined it with a green marker. He still wasn’t talking, but he was communicating something important. He held out the drawing, and I took it from him.

“I see a hand outlined in green,” I said.

I had no clue what it meant. His father was the one who piped in with an explanation.

“He’s mad because without the Broviak, he will have to have an IV in his hand. It hurts and it’s harder to play with an IV there.”

“Oh, I get it,” I said. “Yeah, having to get an IV is no fun. And having more surgery stinks, too.”

I paused to see if I was on the right track. He wasn’t speaking, but he was making eye contact.

“I do have an idea though. How would you like to make a big mess that you don’t have to clean up?”

A tiny smile appeared on his face.

“Okay, then. I’m going to set something up and let’s see what a big mess you can make.”

Stepping out into the hall, I headed for the utility room on the unit. On the way, I snagged his nurse.

“We’re going to make a bit of a mess, but I promise I will clean it up,” I assured her.

She had no complaints. I gathered supplies for what I had in mind: one bedpan, a roll of toilet paper, a large piece of chart paper, tape, and an armload of towels and sheets. Reentering the little boy’s room room, I stopped at the sink to fill the bedpan with warm water, placing the filled bedpan on his rolling bedside table. The sheets and towels went on the floor against the wall opposite the foot of his bed. His eyes followed my every movement, showing curiosity and anticipation

So, here’s the deal.” I said. “Lots of kids have stuff happen in the hospital that they find upsetting or scary. Sometimes it helps to get these feelings out in a physical way. I am setting up a target game, where you will get to throw wet toilet paper at what is upsetting you until it is completely destroyed. The question for you now is, do you want to destroy the drawing of your hand, or is there some other thing you could draw that you’d like to obliterate?”

He picked up a marker, so I brought over the big piece of chart paper. He got right down to work, drawing a huge needle that took up the entire sheet of paper.

“Oh,” I said. “That looks like the needle that might have to go in your hand.”

He nodded. When he finished, I took it from him and taped it on the wall opposite his bed.

“Now for the demonstration,” I said, reaching for the roll of toilet paper. “See, you take as much as you can to make a nice, big wad.”

I unrolled it from the tube, wrapping it around my hand.

“Now, here’s the most important part. You dip it in the water, but you don’t squeeze any of the water out, so it’s sopping wet.”

He was riveted.

“Throw it as hard as you can at the target, yelling what makes you mad or scared.”

Winding up my arm like a star pitcher, I let go of the wad.

“I hate needles!” I yelled.

As my voice filled the small room, the toilet paper thwacked solidly against the drawing of the needle, sticking there a moment before falling to the floor. I turned to him.

He sat straight up and reached for the toilet paper roll. He followed my actions, and as he whipped his TP bullet at the target, his voice rose to a throaty yell.

“I hate IV’s!”

I applauded him and he took it from there, yelling out the things that had been bottled up inside, until the chart paper sank to the floor in defeat. For the last few tosses, he rose to his knees in the bed and used his whole body to fling the wet mound at the target. It took a while to clean up the stray clumps of sticky toilet paper and mop the floor with towels, but I didn’t care one bit. He was now talking animatedly with his dad, and he ended up in the playroom not long after.

I learned about this technique at a play therapy training seminar from Heidi Kaduson. She writes about the activity in her book, “101 Favorite Play Therapy Techniques Volume III.” Many techniques from other disciplines are readily adaptable to the hospital environment, and this one in particular has brought relief and laughter to many children and teens facing extended hospitalization, isolation and painful procedures. I’ve also used it in a parent respite group with great success. If the child is unable to draw or write, they can always dictate to you and have you act as the scribe. I’ve learned that Kleenex and paper towels don’t work as well as toilet paper. They don’t make that wonderful, “thwack!” or provide enough proprioceptive feedback to the child. I’ve seen specialists experiment with food coloring with great success, but of course it is a bit messier. Taking before and after photos for the child, preferably on the family cell phone if there is one, can be especially validating. Either way, the process of getting a child’s fears or anger onto a piece of paper and role modeling how to obliterate it, is a win-win for all.

Bull’s-eye!

A version of this post originally appeared on PediaPlay: Connecting, Coping & Healing Through Play.

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 Thinkstock image by Keith Brofsky