The Power of Play: Child Life Specialists Bring Empathy and Agency to a Hospital’s Youngest Patients

By Clare Nimura 

When children are faced with serious health problems at a young age, they can undergo medical treatments that are stressful or even traumatic. The support and guidance of a child life specialist can help a child navigate the challenges of illness and have even been shown to improve physical recovery. The Child Life profession has been expanding since the mid-1950s but is still not widely known nor a universal standard for pediatric care. In a perfect world, it would be. Child life specialists provide children with educational and psychological support during their illness  by helping them take ownership of their treatment and stay engaged in normal activities, which can reduce children’s anxiety during their time in the hospital. ​

What does a Child Life Specialist Do? 
A typical day for a child life specialist could include anything from accompanying a patient during a procedure, to a bedside birthday celebration, to conversations with social workers and nurses, to building a hospital out of Lego pieces. Their role is not only to educate and prepare patients and families for different steps in their medical journey, but also to build a strong relationship of trust and to maintain a sense of normalcy in the child’s life, which sickness has turned upside down. For anyone outside the medical profession, especially children, hospitals can be stressful places filled with ominous foreign jargon and scary-looking needles and machines. Part of a child life specialist’s job is to help alleviate some of this anxiety by teaching a child age-appropriate information about their medical condition and the procedures they will have and encouraging them to ask questions and express their feelings. For a child, understanding what is happening to their body can help them regain a sense of agency in the situation. 

What Tools and Methods do Child Life Specialists Use? 
How does one explain leukemia to a 5-year-old? Jessica Anenberg, a child life specialist at Memorial Sloan Kettering Cancer Center in New York City explains blood cancers to young children with an activity called “blood soup.” The first ingredient is a handful of Red Hot candies, representing the red blood cells that suck in oxygen and pick up nutrients to give the body energy, Jessica explains. Next, they add small chunks of sticky marshmallows: those are platelets, which stick together when you get a cut and form a scab to protect you. A few mint Mentos represent the big white blood cells that eat up germs and keep you healthy, and Smarties are the baby white blood cells, which are not strong enough to fight germs and instead make it harder for the other blood cells to do their jobs. A lot of little Smarties are added in—they are the leukemia making the child sick. Once all of the ingredients have been added to a Ziploc bag, Jessica pours in corn syrup as the plasma that keeps all the cells in suspension. The red food coloring from the Red Hots dyes the corn syrup, creating a very convincing “blood soup.” 

Another classic Child Life activity called “Captain Chemo” helps teach children about the side effects of chemotherapy. An array of colored cups are placed near each other on the floor, with each color representing a different type of cell in the body. The child is told that they are the chemotherapy drug and it is their job to kick down all the red cups, which are the cancer cells. Inevitably, some of the other colored cups are toppled by accident, illustrating how chemotherapy can unintentionally kill the healthy cells alongside the cancer cells. Those healthy cells might have been cells that help hair grow, for example, which explains the side effect of hair loss. 

Other activities can combine medical play with conversations about a child’s worries or fears. Kate Busch, another child life specialist at Sloan Kettering, sometimes helps patients write down all the things they hate about cancer or that scare or upset them on a bed sheet using colorful markers. She then hangs up the sheet on the wall and fills syringes with different colors of paint, which the child can shoot at all the things they have written. This activity can spark conversations about a child’s anxieties about their treatment so that the child life specialist and medical team can work together to ease those fears. It also familiarizes the child with syringes, which they might see during their treatments. 

As Jessica says, the goal of Child Life is to “create opportunities for expression, engagement, and learning about treatment.” These activities each create a safe space for a child to voice their thoughts and concerns, which can then be passed on to their medical team. 

The Importance of Play 
The blood soup and syringe paint activities fall under the category of medical play. Similar to how you might have pretended to be a doctor when you were younger and used a plastic stethoscope to listen to someone else’s heart, medical play familiarizes children with real and pretend medical items to help demystify parts of their experience in the hospital. 

Though it may seem trivial, play is so critical to optimal childhood development that the United States High Commission for Human Rights has deemed it a right for every child. Play expands self-expression, stimulates creative thinking, helps relieve stress, and is a form of learning; it can even act as a form of therapy for young children. For all of these reasons, play is vital for children facing medical challenges because  it can help them process what is happening during their treatment and work through confusing emotions regarding their experience. Not only does it ease psychological stress, it also has been shown to ameliorate physiological signs of stress such as hypertension and tachycardia. Though the correlation is not immediately obvious, dolls, arts and crafts, Legos, or even CandyLand can contribute to a child’s recovery. 
 
The Role of a Child Life Specialist in a Child’s Medical Team 
Though the Child Life profession does not involve prescribing medications or coming up with treatment plans, child life specialists play a vital role in a child’s medical care: they serve as the child’s advocate throughout their journey and try to maximize their odds for success. For instance, they can make sure the child has a movie playing when they get a scan done, which takes their mind off the procedure and helps them stay still, which improves the quality of the image. As another example, a child may have confided in a child life specialist that they really dislike the way a certain medication makes them feel. The child life specialist can then convey this information to the child’s medical team and find out whether there is an alternative solution that would make the patient more comfortable. For young patients, knowing that they have a trusted adult advocating for them and being psychologically prepared and educated before a procedure can greatly improve their experience and outcome. Preliminary evidence has even shown that the support of a child life specialist can help lower the cost of treatment by shortening hospital stays and decreasing the need for sedation and analgesics.

The Child Life Profession Today 
Child life specialists have a bachelor’s degree in child life, child development, or a related field, and complete a 500-hour Child Life internship and a certification examination. Once they begin practicing, many Child Life professionals specialize to work with the population of children that their hospital serves. Today, there are over 400 Child Life programs at pediatric care centers across North America and child life specialists are practicing in 25 countries. Having child life specialists on staff is an indicator of excellence in pediatric care, though it is still a luxury that many children do not have access to. 

As the profession grows each year, it continues to strive for integration into children’s medical teams and for greater diversity in the field in order to better support children and families from a variety of backgrounds. The services that child life specialists provide can make a world of difference in a child’s medical experience, improving their outlook and even their outcome. Hopefully, Child Life support continues its trajectory towards being a universal standard for pediatric care. ​