by Jamie Droke
Child Life Specialist

Kids are so gullible, aren’t they? Just think about all of the things that children will believe when they are young when parents tell them these things are true. An overweight man dressed in red and white rides in a carriage pulled by flying animals with antlers and delivers presents to every child in the whole world over the course of just one night. Blow out your birthday candles and make a wish, but don’t tell anyone your wish or else it won’t come true. Both of these things that children so readily believe involve something we child life specialists call magical thinking.

Magical thinking appears as early as the toddler years and is evident as late as the end of the school age years. Developmentally speaking it has to do with the child not being able to discern the real causes related to an effect. For example, since a child receives money under their pillow when they lose a tooth, this must have resulted from a tiny lady called the tooth fairy visiting them while they were sleeping. In most situations, magical thinking and imaginative play are appropriate and important for child development. However, I want to describe a few situations when magical thinking and active imagination can actually be detrimental to a child’s ability to cope.

The first situation is when a sibling visits a sick child in the hospital. Particularly for the pre-school and early school age child, I am always intentional about letting the sibling know that they did not do, say, or think anything that caused the ill or injured child to get sick or hurt. Why do children think that way? Because of magical thinking. For example, I have had siblings visit and say to the sick child almost immediately after they enter the room, “I’m sorry if I was mean to you.”

To family members and even other health care professionals this remark is nothing more than a kind and sincere apology. To someone who is familiar with magical thinking, this comment means much more. They are often feeling some guilt (unjustified to be sure, but just as real) over having done, said, or thought something mean about the sick child. These children may have been angry at the hospitalized child months ago and thought to themselves, “I hate her so much; I hope she dies.” While we know that this thought cannot cause a child to become sick, the child who is still prone to magical thinking has a difficult time differentiating between the possible causes of the patient’s illness or injury. One of my first steps is to make certain that the sibling is told repeatedly that the child’s illness or injury was not the sibling’s or anyone else’s fault.

The other common situation is when the patient thinks he or she did something wrong to cause her illness. Perhaps the patient did something that angered the parents a few weeks before the illness. Or in some situations, perhaps the child did something he or she had been told not to do which resulted in their injuries. My worry is not so much that the child thinks that he did something wrong to cause his injuries, but that his medical treatment is part of his punishment. For example, when a child reaches for a hot pan his mother told him not to touch and the hot contents of the pot spill and burn him, it is difficult for the child to understand that burn dressing change, IV starts, and other procedures are not meant as punishment but for helping and healing. I hope that this post helps you see the importance of clarifying things for children in situations where there are tendencies for them to practice magical thinking.