We were curious about… children’s perspectives on what it is like to play in hospital
In hospitals, play is seen as a means of bringing some normality into an otherwise atypical setting for childhood. It is also often used to help children understand and cope with hospitalisation, illness, and treatment. Research from the UK and USA has highlighted that children emphasise the role of play in their healthcare and find it to be the ‘best thing’ about being in hospital. However, the importance of play in children’s healthcare is not consistently valued, understood, or utilised. Play in hospital can be stigmatised as a nice, yet non-essential, aspect of children’s healthcare experience. Additionally, because children in hospital are particularly vulnerable, play tends to be managed by adults rather than children themselves, reflecting a broader tendency to prioritise adult perceptions of children’s needs and health priorities. Though hospitals are more child-oriented than ever before, and children’s views are more frequently sought about their hospital outcomes and experiences, studies rarely focus on children’s play in hospital. We wanted to understand what playing in hospital is like from the perspectives and experiences of young children themselves.
And so we did… observations and interviews on a paediatric unit
Over the course of five months, we conducted over 120 hours of observations on a paediatric oncology ward in a large teaching hospital. Additionally, 16 children between the ages of 3-13 years participated in interviews about their play. During their interviews, children could also choose to draw a picture or write a story about playing in hospital or to do some storytelling about a small animal character who was ‘wondering how to play in the hospital’. Children’s interviews were recorded and then transcribed, including both verbal responses and behavioural expressions (such as nodding, pointing, shrugging). Notes taken during observations and interview transcriptions were analysed individually and then as a whole set, in order to create overarching themes.
We learned that… listening to children’s perspectives about play in hospital can encourage children’s active participation in their healthcare
Our study revealed three key insights:
1) Children naturally play, but hospitals are not naturally playful. Children need to feel safe and welcome for play to be possible. Play both facilitates and requires children’s trust and comfort, and can fundamentally influence their perspectives on hospitalisation.
ABBY (13)
I kind of wish I got like, into like, doing more stuff with [the play team] ‘cause I feel like I was a bit… like they’d always give me the opportunity to but I was just like, at the beginning I was just like ehh… (scrunches up face, mimes feeling uneasy).
PARENT
Yeah, but you were very poorly, so you know.
ABBY
Yeah, but I kind of wish that I wasn’t like so (leans back, pushes hand forward as if stepping away) ‘no thank you’ in the beginning… Just takes a little getting used to.
2) Playing in hospital is complex and personal; children decide for themselves when play is enjoyable or beneficial. There can be many barriers to play in hospital; children might find play tiring or a reminder of their current limitations. Children demonstrate agency in deciding whether or not to play, and how play makes them feel.
KG
How does it make you feel when you play?
CONNOR (3)
Tired.
PARENT
Connor, you know your colour monsters? (He nods, sits up and reaches out his arms to be picked up) When you’re playing, which colour monster do you feel? When you are doing lots of playing in the playroom?
CONNOR
Tired. (Hugs her and rests his head on her shoulder)
3) Play is meaningful to children, regardless of where they experience their childhood. Play is a way for patients to be (and be seen as) children first and foremost. To children, play is a normal, expected aspect of their lives; therefore, it is inherently linked to how they feel cared for as individuals.
KG
What is important for other kids to know about playing in the hospital?
CLAIRE (7)
To be happy. That’s it.
KG
Why do you think play is important for kids?
CLAIRE
Because, um… you have to care about your daughters… your kids, your sons, your granddaughters… you have to care about everyone.
Children, even as young as 3, are capable, knowledgeable experts about their play experiences. The results of this study highlight play as a unique area of childhood in a hospital where children have expertise about their own experiences. We can learn a lot by paying close attention to these experiences. Integrating play more cohesively in paediatric care can be a way of encouraging children to be active participants, not just recipients, of their healthcare. Importantly, play in hospitals can only be child-friendly if children find it friendly. We can only know if play is meaningful and effective in influencing children’s healthcare experiences if we listen to children themselves.
*Pseudonyms used for all named participants.
This research was conducted by Kelsey Graber as part of her PhD studies.
The paper was published in Child: Care Health and Development on 3 July 2024. The full article can be found here.
