Medical Play of Children with

Illnesses and SiblingsLaura 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 PlayO Play is children’s workO 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 StudyO 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 GroupsO 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…

ParticipantsO Groups at RMH

O 15 children with chronic illnessesO Children had cancer, GI problems, were

awaiting or recovering from transplant etc.

O 14 siblingsO We also recruited a comparison

groupO Children were young, under age 10

(range 2-10 years), average age about 5-6 years

MethodsO 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/IllnessesO (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 BloodO “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

learningO (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 siblingO 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 wellO Lots of wishes for getting wellO “getting better”O From both children with illnesses

and their siblingsO Support from others was a

resilience factor for “getting better”

O Distraction from the medical scene and experience was a coping strategy

Comparison GroupO No detailed storiesO Did not play long with medical

toysO Cartoon-like quality to storiesO Wishes for getting well and

recovery not evident in stories

Medical play was…O Opportunity to release emotionsO 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

FutureO 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 traumaO Remember, siblings may need support to

work through vicarious observations!O Thank you very much! O References available from LauraNabors naborsla@ucmail.uc.edu

DisclosureO 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