Your four-year-old client needs a feeding tube. How do you explain it without scaring her? Adapt a doll with the same equipment, teach the child how to perform the procedure on the doll, and you’ve got a powerful tool for easing fears. It’s called medical play, and it’s used by child life specialists to prepare children for medical procedures that can be frightening and painful.
“In hospital, all patients – but especially children – lose control over what happens to them,” says Marusia Heney, child life specialist at Bloorview MacMillan Children’s Centre. “Medical play helps children understand what will happen and why, and allows them to practice ways of coping so that they feel they have some control.”
Marusia uses a cloth doll that she fits with the same equipment a child will use. It may mean sewing in a feeding tube, slipping on an oxygen mask or covering a doll in EEG leads. Dolls have also been equipped with splints, casts and external screws that hold mock bones in place.
Putting real equipment on a doll “helps to normalize it,” Marusia says. “A child can say to her friends: ‘Oh look, I have a doll who’s just like me because she has a feeding tube.'”
Marusia begins by giving a child a faceless doll. She asks the child to paint its face and name it, “so that it becomes their friend.” She then teaches the child how to perform the procedure on the doll. At every stage, Marusia asks the child how the doll is feeling, and what will help the doll feel more comfortable.
“Young children will talk through the doll,” Marusia says. “For example, they’ll tell me ‘she doesn’t like needles’ or ‘she wants to look away,’ when really they’re talking about themselves.”
Using the child’s insights, Marusia helps the child develop a coping plan. This is a written plan outlining strategies to reduce anxiety at every step of the process. For example, one girl who was terrified of having blood drawn had a document that specified the kind of gauze, needles and skin cleaner she preferred, when she wanted to look away and have a hug, and the treat she was to receive afterwards.
Most plans include relaxation and distraction techniques. Children may be trained to slow their breathing by watching a geometric ball expand and contract, or by blowing bubbles. The nurse or doctor involved in a procedure receives a copy of the plan in advance. “Giving children control in this way often means that it’s not necessary to sedate or hold a child down, which can be traumatizing,” Marusia says.