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The Purpose of Play
last updated:
Fri, 2/03/2012 9:30 AM by Jamie Droke
In a report published in 2007, the American Academy of Pediatrics gives several purposes of play. Of course, not every benefit on the list is attained through every type of play, and I will cover types of play and their benefits in the next post I write. So, let’s start by looking at some of the purposes or benefits of play as outlined by the American Academy of Pediatrics:
If you think closely about this list (which is by no means all-inclusive), you can see that there are few other activities in which children can engage to attain these benefits. And of course there is the benefit that play is enjoyable to children. In fact, to discipline children, we often suspend a child’s play. Discipline is important and should not be left to chance, but don’t make your child go without play for too long. When they are not playing, they are missing out on so many opportunities for growth and expression. Next time I will give you the scoop on the types of play and how to encourage all of the different types of play for your child.
The Importance of Control
last updated:
Thu, 9/22/2011 9:30 AM
by Jamie Droke As children are growing and learning, one thing that many parents notice is their intense need for control. My mom has always said that my first full sentence as a toddler was “I can do it myself” and this sentence is probably not much different from other kids’ first sentences. (If that’s not true, I’m not sure what that says about my independent nature.) This need for control is much better understood when looking at it through the lens of developmental stages. Control first comes into play in the toddler years (about 18 months to 3 years old). Erik Erikson was the man responsible for titling the stages of development that we will look at today, and he titled this stage autonomy vs. This need for control continues into the preschool years (about 3 to 5 years old). This stage is called initiative vs. guilt. You can see the connection between autonomy and initiative. If children are not given opportunities to practice some forms of independence in the toddler years, they will be less likely to take initiative in the preschool years. Initiative in the preschool years turns into industry in the school age years (about 6 to 12 years old, the stage called industry vs. inferiority). When children learn to take initiative in some aspects of their life in the preschool years, they begin to be industrious in those areas in their school age years. Although the need for control is different in adolescents than in young children, the need for control persists. The adolescent phase (about 12 to 18 years old) is known as identity vs. role confusion. The children who learned to be industrious in their school age years begin to form their identity in their adolescent years based on what they do. As you can see, control is a very important piece in development. And when children come to the hospital, most of that control is stripped away from them. That is why in the hospital (and in life in general) it is so important to offer as many valid choices as possible and to resist the temptation to offer choices when a choice does not exist. I often offer choices of activities for kids to do while in the hospital. Or during a procedure I offer them choices about how they want to cope (by sitting in mom’s lap, holding mom’s hand, or watching what the nurse is doing). Even with the best intentions, sometimes health care professionals offer choices where a choice does not exist. They ask if they can listen to a child’s heart or start another IV. These are not real choices because even if the child says no, the health care professional still has to listen to the heart and start a new IV. Instead, health care professionals can tell children what they are doing instead of asking if they can do it. (“I’m going to...” instead of ”Can I...”) When children feel like they have lost control, they will find a way to regain some; but it is much better for their development when they are given control throughout their admission. Abra Cadabra: Magical Thinking
last updated:
Tue, 9/20/2011 9:30 AM
by Jamie Droke 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 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. Noise and Newborns
last updated:
Mon, 5/23/2011 9:30 AM
by Amanda Meyer
With all the excitement and anxiety that comes with taking your newborn home, there is one thing often forgotten: NOISE. Like anything that is bad for your newborn, noise should be moderated. Many parents aren’t aware of how hearing matures in a child. Unless there is already a concern, noise awareness is not something parents are taught before leaving the hospital. A child’s hearing continues to develop until about age five. Hearing Development
Unfortunately, newborns cannot protect themselves from loud noises, so you must do it for them. You can limit the number of sound sources your baby is hearing. You can provide appropriate noise such as a mobile, lullaby music, or nature sounds. Even with other children in the home, you can implement a quiet hour which reminds everyone the importance of a calm environment. When going out in public, always be aware of the potential harm to your child. Try to avoid loud restaurants or events during the first year of life. Keep loud toys on a low volume and mute loud appliances if possible. Noise awareness is so important that there is an International Noise Awareness Day recognized. The day is a small reminder about the importance of noise control for newborns and young children. On this day and every day it is encouraged to observe a few minutes of silence. The goal is to be aware of the noises around you and to realize the potential negative outcomes. You can always try the “Quiet Diet” for a way to start applying noise control in your home…
Shhhhh, child sleeping, resting, growing, learning, and developing! Developmental Milestones
last updated:
Mon, 2/28/2011 9:30 AM by Cassie Gorman
Let's pause here and talk about my oldest nephew, also in this picture. He is two and a half and is certainly meeting the use of 2 to 5 word sentences milestone. The other day we were telling him to be nice, and his response was, "Ummmmm, I'll be nice tomorrow." : ) Oh, the funny things kids say!
Play School Lessons: Types of Play
last updated:
Tue, 2/22/2011 9:30 AM by Jamie Droke
Of course there are many other types of play in addition to the ones listed here. If you are a parent, what type of play do you see your child or children engage in the most? Next time, I will tell you more about how we use play in the hospital setting. Play School Lessons: Stages of Play
last updated:
Tue, 2/08/2011 9:30 AM by Jamie Droke
These six stages are not always moved through one step at a time by all children. Some children will demonstrate multiple stages at once and some, for example, may reach the third or fourth stage without ever demonstrating the first or second one. For all practical purposes, though, the first few stages of play tend to decrease as a child grows and develops while the last few stages tend to increase. So here are the six stages of play:
Unoccupied play, while a relatively infrequent stage of play, most often occurs in infancy. An infant might be engaging in unoccupied play when it appears to adults that they are moving their arms and legs without purpose. As children grow, they begin to engage in play with objects. These objects can be toys, but they can also be ordinary every-day objects that children use for play. In this stage of solitary play, children seem to not even notice if other children are around. The next stage is onlooker play. This stage involves children watching, but not participating, in the play of others. Children may ask questions of the child who is playing, but they will not engage in play until the next stage. In parallel play, children will imitate the play of another child with the same type of toy, right next to that child, but not engage in playing with the child. In associative play, children will engage in play together as the social interaction aspect of play begins to play a larger role than the toys. This stage of play may seem unorganized to adults because it often does not have a goal or set of rules. The goal and rules come into play in the final stage of play. In cooperative play, children play towards a certain goal or under the authority of pre-determined rules. This stage of play is what occurs when children play board games, but it is also apparent when children play house. While these are interesting stages of play to notice as your children grow and develop, they are not stages to hurry your children through. Just because an older child tends to engage in solitary play every once in a while does not mean he or she needs to be pushed to the next stage. As children play, they will learn and grow and most often, these stages will occur naturally. Next post I will give you an idea of different types of play and the benefits of each. Play School Lessons: The Purpose of Play
last updated:
Tue, 1/25/2011 9:30 AM by Jamie Droke
It has been said that play is the work of childhood. In the same way that adults work some kind of job, children work too in the form of play. Over the next several blog posts from me, I hope to cover the purposes of play, the types of play, and specifically the importance of play in the hospital setting. A vast majority of what we do as child life specialists involves play, in one form or another, and the reason for this is not just because children need to be entertained. Of course it is true that play helps keep children occupied and happier, but this is certainly not the most important reason that children need to play. In fact, this reason is a long way down on a long list. In a report published in 2007, the American Academy of Pediatrics gives several purposes of play. Of course, not every benefit on the list is attained through every type of play, and I will cover types of play and their benefits in the next post I write. So, let’s start by looking at some of the purposes or benefits of play as outlined by the American Academy of Pediatrics:
If you think closely about this list (which is by no means all-inclusive), you can see that there are few other activities in which children can engage to attain these benefits. And of course there is the benefit that play is enjoyable to children. In fact, to discipline children, we often suspend a child’s play. Discipline is important and should not be left to chance, but don’t make your child go without play for too long. When they are not playing, they are missing out on so many opportunities for growth and expression. Next time I will give you the scoop on the types of play and how to encourage all of the different types of play for your child. Reading to Your Baby
last updated:
Tue, 10/26/2010 10:57 AM By Tracey Deaux
Research shows an infant has over 100 billion brain cells, or neurons, that store information received through different senses. Each neuron is connected to thousands of other neurons that form synapses in the brain. These synapses must be used over and over again or else they will be eliminated. On a positive note, each time an infant uses his or her senses, the synapse connection grows stronger and shapes the way he or she thinks, feels, and behaves. Reading to your child will not only promote the senses, but will also teach your child about communication, build memory and vocabulary, and give your child important information about the world around. Research also shows that when reading, your baby hears you using many different expressive sounds and emotions, which in turn, promotes social and emotional development. And, when reading to your child, maybe the most important thing to you—your connection with your baby—is fostered! Interestingly enough, it takes between fifteen and twenty years for a child’s brain to grow to its full size, but most connections are made in the early years of life. Reading to your baby can only make these connections in the brain much stronger! Identifying Stress Behaviors
last updated:
Tue, 5/04/2010 2:11 PM by Thomas Hobson We’ve all been in situations when the stress involved almost (or in some cases, did) make us flip out. Who hasn’t had a moment where the pressure, anxiety, and/or fear built up to the point when you could pull your hair out and scream at the moon? As an adult, you probably have learned to control your reactions to stress. However, I would be willing to wager that you know someone that hasn’t, and there are numerous stories of them acting “crazy” in stressful situations. In the case of children, most have not mastered controlling the behaviors that arise out of stressful moments. In the hospital, we see it more than you might imagine. When you take the level of stress that children can experience from the unknown and general fears it’s not surprise.
In a stressful situation a child might respond by refusing to take medicines, participate in treatments, follow rules, and even “purposely” break rules. At home, this may include refusing simple requests (i.e. brush your teeth, put that toy away). As you can imagine, this is frustrating to families, who can be left scratching their heads. Since it’s not the typical behavior, some families will respond by being more firm with the child. Typically, you can see the child respond by further strengthening their resolve for the behavior. You can see the cycle of behaviors beginning as each side escalates into a lose-lose situation. As child life specialist, the most important question we explore is what is causing these behaviors because chances are it may not be on the surface. Families can use the same question at home to understand the behaviors. When we understand what the cause is it becomes easier to deal with the root issue. Now, why would a typically sweet, compliant child do this? Simply put, it is something that they can control especially when they are in a situation that gives them no control. The child is trying to regain control over their life. Remember the classic child development mantra, even negative interaction is better than no interaction. Or to put it another way, even control with negative consequences is better than no control. In tomorrow’s post, I’ll talk about some strategies that Child Life Services uses to break the cycle of stress behaviors that you can use at home. Also, if you have some examples of this behavior with your own children leave a comment below. We’d love to hear from you. The Role of Positive Reinforcement in the Hospital
last updated:
Fri, 4/30/2010 1:20 PM
by Thomas Hobson Several posts back I mentioned the importance of positive reinforcement within the realm of disciplining children. After writing it, I was struck by just how much positive reinforcement is used at Le Bonheur Children’s. It seems only appropriate that we are using the same advice that we are giving families. So, I thought I would take the opportunity to tell you about the role that positive reinforcement plays in the hospital.
It’s a natural reaction for many children to become scared or defensive when placed in a stressful situation. Our goal, as the treatment team, is not to focus on all of the negative things that a child is doing, but instead to build trust and understanding by praising the positive behaviors. When we praise a child for an appropriate action they then know more about what is expected of them and are more likely to continue that behavior. A great example of this is when a child is getting an IV, and they begin to become uncooperative. Instead of getting frustrated and threatening punishment if the child does not comply, the associates will focus on praising the child for what they’re doing correctly. The child may be crying, which is a coping technique, and keeping their arm still. The Le Bonheur Children’s staff will focus on praising the child for keeping their arm still, and not focus on the fact that the child is crying. I would also remind you, that positive reinforcement goes hand and hand with teaching the child about the process and giving them a “job” during the experience. By teaching about it, you are preparing the child for what to expect, and by giving them a “job”, you are actively involving them. When these are coupled with positive reinforcement, it is amazing how different the experience is for everyone involved. Remember what Mary Poppins taught us, “a spoon full of sugar helps the medicine go down.” Well, at Le Bonheur Children’s, a kind word and praise helps the procedure go by. Children and Mascots
last updated:
Tue, 4/06/2010 10:37 AM
by Thomas Hobson
Picture this scene in your mind: It’s the season for a major holiday. Everyone is cheerfully making plans with family and friends, and taking all of the necessary steps for the wonderful family traditions. Parents of toddler age child think that it would be great to go to the mall and have their child’s picture taken with the holiday mascot.
The family gets the child excited about it, and loads up to have the memorable photo taken. The child chatters and plays in line, only to cry, scream, and yell when the time actually comes. That’s right, this previously happy, playful child is now a screaming ball of terror simply because someone is in a mascot suit.
My guess is that lots of you have seen this, and have thrown your hands up in exasperation. The truth is that this is a completely normal response. In the minds of these young children, they know that what they’re seeing isn’t right, and can’t figure out why everyone else isn’t scared. It doesn’t matter if it is their favorite cartoon character or a beloved figure, when confronted, it can be scary.
The advice I would give to parents is not to force your child to take the picture or interact with the character. In just a couple of years (or even months), your child will be running up to the character. However, when they’re screaming and crying is the time to “rescue” you child. Remember that in the end, they are children and sometimes need rescuing. Let them be children, and take them somewhere else to distract them from the experience.
I realize that as I write this that it may seem like it is about two or three weeks too late. However, in my experience you can never be too sure. Just ask my daughter, who 2 ½ years old at the time, was surprised by a mascot character at a restaurant. While the rest of us enjoyed our meals, she coward under the table and wouldn’t let go of my leg. Up to that point, I think it was the most stressful meal of her life.
So, as you plan trips to theme parks, go to sporting events, or event an occasional birthday remember they can all have mascots. Remember the advice, and a little planning can help to make the experience more enjoyable for the entire family. The Importace of Reading to Young Children
last updated:
Tue, 3/23/2010 9:30 AM
by Lauren Wilson
As you walk down the noisy toy isle at your neighborhood store you encounter all the latest and greatest toys and movies that are proven to make your child smarter and increase their language development. These gadgets and DVDs are said to stimulate the brain and enhance their mental growth. Yes, these toys are fun for your child, but why continue to spend your hard earned dollars on endless toys (that usually require batteries!) when one the most educational resources is probably already sitting on your shelf…a book.
Research shows that the time you spend reading to your child is the most beneficial way to help your babies’ brain grow and develop. Reading shouldn’t be reserved for school aged children who are learning to sound out words; reading should start at birth, or even before. By reading aloud to your child, they will be exposed to more words and sounds that will increase their language development. Books filled with rhymes and repetition help to strengthen the language connections in our pattern-seeking brain.
Reading doesn’t just stimulate the language side of the brain; it also encourages the social and emotional side. It is an intimate way to connect with your child. It is an opportunity to get away from the busy day-to-day life as you curl up and spend one-on-one time learning about each other.
As you read to your child, your touch and your voice comfort them. This is something a movie or TV show cannot provide because of the fast pace talking and flashing screens. A book allows children to hear different emotions through voice inflections and provides an opportunity to share smiles and laughter.
Our society has slowly strayed from spending quiet time digging into a good book and steered more towards time in front of the television or playing video games. Start a new hobby with your children that will benefit them at school and in life. Help them grow to love reading by spending uninterrupted time in front of a book each day. It’s never too late or too early to start. Children and Mirrors: A Love Affair for the Ages
last updated:
Tue, 2/23/2010 10:06 AM
The other day, I was getting my children ready for bed, and we were going through our typical routines. Going to the bathroom, brushing our teeth, asking for one more hug, you know the usual stuff. As I was talking with my children, I noticed something; they were not looking at me. Instead, they were looking at themselves in the bathroom mirror.
To take it one step further, they were “acting” to it. They were entranced by their reflects, make facings and watching themselves as they spoke. Then they broke that ever-important parent rule: they quit listening to me. Instead, they were wrapped up in a world of themselves, just two five-year olds playing to the mirror.
Here’s the good news: a child entranced by their reflection is completely normal. As a matter of fact, children can learn a great deal from mirrors, and you can use them to see developmental growth. The truth is children learn a concept of self through mirrors. The child realizes what people see when they talk, make faces, and other activities. You especially see this between 12 to 24 months, as children develop their sense of self.
For instance, place a small dot of lipstick on the nose of an infant and put them in front a mirror. You can see the developmental growth as they realize that the mirror is not another baby, but instead them, which you can tell as they touch the spot on their own nose. As a parent, this is an exciting developmental step to see first hand.
So, don’t worry if your child loves watching themselves in the mirror, it’s completely normal. That's why so many children's toys have mirrors on them, they’re exploring the world and themselves. Besides, you can always do what I do, make faces right along with you child. The Importance of Play
last updated:
Mon, 1/11/2010 10:00 AM
Play is important to how children learn social skills (i.e. turn taking), master environments and roles (i.e. playing school and being the teacher), and negotiating skills (i.e. 'let's play with the ball together instead of taking it from each other'). You can literally watch your children develop physically, cognitively, and emotionally through their play. I tend to view play as the serious work of childhood. Here is an interesting article on development of play from Parent Magazine.
Free play is a great time to be active with your child. You build your relationship, are helping your child learn, and both of you are being active. Playing is a natural event, and is tremendously bonding, all you have to do is engage in it. Play along with their made up games, and you'll be surprised what will come from it. One of my children's favorite game is Sweetie, where I am Sweetie and they are little mommy and little daddy. (I think you capitalize the S. I'll have to ask them.) Let them direct the play, and you'll be amazed with what your child can do. Encourage them when they pretend to be you, or anyone else.
My one warning: don't over schedule your child. Let them be a child, which means playing outside, getting dirt, and probably breaking something. Children need the free time to grow, develop, and express themselves.
Sneak preview for tomorrow: Why play is important in the hospital. |
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While some of us might remember learning how to play a certain game as a child, I can bet that no one remembers learning how to play. Play is something that children just know how to do, even as infants. Of course the play of an infant is very different from the play of a teenager, but the purposes of play remain the same. It has been said that play is the work of childhood. In the same way that adults work some kind of job, children work too in the form of play. A vast majority of what we do as child life specialists somehow involves play and the reason for this is not just because children need to be entertained. Of course it is true that play helps keep children occupied and happier, but this is certainly not the most important reason that children need to play. In fact, this reason is a long way down on a long list.
shame. In this phase of development, it is essential to children that they learn how to be independent and in control of some aspects of their lives. Don’t get me wrong; I am not saying that children should control everything. But it is important that they have some opportunities to practice their new found autonomy.
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.
Diapers…check, Bottles…check, Baby…check
A child’s first exposure to noise is often in a hospital setting. If the hospital has proper noise awareness, staff talk quietly, monitors are set on low volume, phones are set to vibrate, and the environment is calm. On the journey home, your newborn may be exposed to new and often over-stimulating noises like a car radio, telephone ringing, wind, cars honking, doors shutting, people talking loudly, etc. Exposure to loud noise can cause increased stress on your newborn, thus affecting normal development. Noise stressors can include increased heart rate, blood pressure, and intracranial pressure, hearing impairment, or sleep disruption. Parents sometimes forget that infants need quiet even when they are awake.
Developmental milestones are a set of age specific skills or tasks that most children can do at a certain age. Child development refers to how a child becomes able to do more complex things as they get older. I'll start at three months, because that is how old my youngest nephew is. The picture in this post is a great shot of him meeting my most favorite milestone. : )
Over the last couple of posts from me, I have discussed the 
The last blog post from me addressed the 
While some of us might remember learning how to play a certain game as a child, I can bet that no one remembers learning how to play. Play is something that children just know how to do, even as infants. Of course the play of an infant is very different from the play of a teenager, but the purposes of play remain the same. 
As a parent, you may be wondering about the importance of reading to your infant. Sure, you’ve heard it’s important to read to your baby. But, why is it important? An infant won’t understand everything you read anyway, right? However, you wouldn’t stop talking to your infant just because he or she doesn’t understand everything you are saying. 
Young children may not have the “right” words to describe feeling stress. They might call it scared, angry, or any other number of feelings. However, in my experience, they may not try to explain their feelings, but instead make a change in their behavior. One of the easiest ways to tell is from “acting out” behavior in the child.
As is no big surprise to most people, the hospital can be a scary place. To a child that doesn’t understand what is happening around them, the experience can be even more terrifying. It is this fear that can lead the child into behaviors that are out of character and, at times, defiant. (By the way, that last sentence felt a little like 
This is not an isolated incident to my house, but instead is played out repeatedly. I’ve even had some people ask me if their child is being narcissistic. If we remember our mythology, Narcissus feel in love with his own reflection (after shunning the love of Echo), and spent the rest of his life looking at his own reflection. Needless to say, people have been worried about this for a long time.
I was re-reading the American Academy of Pediatrics clinical report on the 
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