Where surgery is child's play


When Robin advises Batman to take his medicine, you can be sure little James will follow suit. Three-year-old James Boyle was re-admitted to Our Lady's Hospital for Sick Children, Crumlin, in September because he blankly refused to take the antibiotics prescribed to clear up an infection in his leg, after a limb-lengthening operation.

Sheila Merouan, one of the play specialists at the hospital, devised a comic sketch in which Batman had an infection in his leg after an operation. The problem was, he wasn't taking his medicine until his faithful assistant, Robin, suggested this really would be the best thing to do. James Boyle's infection, too, cleared up - although his parentsid and Daniel, still call on Robin's assistance from time to time.

Trained play-specialists are a relatively new addition to the staff of children's hospitals in Ireland. This Wednesday and Thursday, their role will be highlighted through Children in Hospital Play Days.

This initiative, the first of its kind, is organised by Children in Hospital Ireland and the Irish Association of Hospital Play Staff. Its aim is to highlight the need for play to be a major part of the experience of all children during their stay in hospital.

Play specialists - unlike play therapists - simply play with children. Their job is to make the experience of hospital less traumatic. Through play, they talk to the children about their fears and worries and give them some fun times to ease the pain of operations, examinations and tests.

In contrast, play therapists work with children one-to-one, dealing with complex problems such as child abuse over a period of time. Play therapy is a four-year degree course, while play specialists do a one-year postgraduate diploma course.

Some 250,000 children are treated in hospitals in the Republic each year. For 135,000, this means an overnight stay or longer. More than one-third of these children are under five years old.

Mary Connor, the development director of Children in Hospital Ireland, believes there is a huge need for more play specialists in children's hospitals. She says there are 42 play specialists in Great Ormond Street Hospital, London, catering for 300 children, as compared to two (and one just about to take up a new post) at Our Lady's Hospital for Sick Children, where there is the same number of children. While Children in Hospital Ireland has provided volunteers to play with children in hospital since the 1970s, Connor believes the role of full-time play specialists is a crucial one in helping children cope better in hospital.

Claire Oakden is a play specialist at Our Lady's Children's Hospital, Crumlin. "We call ourselves the play department but we can't reach everyone. Sheila Merouan works mainly on the orthopaedic ward and I work on the cardiac ward. We still have to provide play materials for all the hospital but it's a struggle.

"A new appointment has been made to the oncology ward. But, in all, we need at least 10 play specialists here. The opportunity for training as play specialists in Ireland is desperate, with only one full-time course, in Co Antrim. There really is need for a full-time course for play specialists in the South."

Colette Tarrant, the assistant director of nursing at Our Lady's Hospital for Sick Children, agrees. "Play is the only normal element in an abnormal environment. We need a play specialist on every ward and another in the outpatients' department. This means we need 11 in total. Two years ago, we only had one, now we have three. I would hope to have the rest on board within the next five years."

The situation is no better in other hospitals. There is one play specialist in the National Children's Hospital, Tallaght, four in the Children's Hospital, Temple Street, one in University College Hospital, Galway, one in Cavan General and one in Letterkenny General. Sligo General, Limerick Regional and Tralee General each hope to appoint a play specialist in the near future.

When Claire Oakden first meets a child in hospital, she brings along her little teddy bear jigsaw. This particular teddy bear has several faces (a smiling one, a crying one, an angry one, etc) and even if the child is a bit shy at first, he or she will make up the teddy bear with the face that best captures his or her own feelings. It's a simple, yet very effective opening move.

Claire will then begin to explore how the child is feeling about forthcoming surgery or tests with the help of Molly, her trusty puppet. Molly is well used to hospital life and to having needles put into her arm. The children can even give Molly a few injections themselves if they wish.

There are other dolls the children can play with - putting their legs in casts, bandaging their heads and dressing them up in theatre gowns.

Besides the illness that put them in hospital in the first place, children can suffer in other ways:

separation anxiety from parents, family and the routine of normal life;

fear of bodily harm, discomfort, pain and mutilation;

fear of the unknown;

uncertainty of what is acceptable behaviour

anxiety about loss of control and independence.

It is the job of the play specialist to identify each child's fears and go some way to alleviating them. "Sometimes, you have to undo things - because if children don't understand something, they will make it up," says Oakden. "They will fantasise and make up horror stories. By talking through things with them, you can even soften the language they use to describe the procedures."

There are at least five key times when a child will benefit most from hospital play.

Before treatment (pre-procedural play) a child can play with the materials (real canulas, stethescopes and theatre gowns are used when possible) of the hospital so they understand the proposed treatment. Afterwards (post-procedural play), children can relive their experiences in play, which provides a safe opportunity to ask questions and explore their feelings.

Distraction play, meanwhile, is when the hospital play specialist, or parent or nurse engages a child in play during the procedure. Other play sessions help to relieve boredom in older children and aid the development of young children or babies who risk regression because of hospitalisation.

Play specialists also organise pre-admission days when children can visit the hospital to see around and ask questions before being admitted. And anything goes - where possible. Children get to play with water, gloop (a messy mix of cornflour and water) and they can even make their own Rice Krispie buns if they are mobile.

Lisa Parker (10) was in Our Lady's Hospital for Sick Children earlier this year for a bone marrow transplant. While there, she spent an hour a day making things with the play specialist. "It was brilliant. It kept my mind off things. I really looked forward to seeing her. And I took home stained glass and spiders made out of pom-poms to show my friends."

Her father, Padraig Parker, adds: "The play was definitely a major contributing factor in her recovery. I believe her psychological well-being contributes 50 per cent to her recovery and the medical intervention covers for the rest."

Tara Galligan, staff nurse on the cardiac ward at Our Lady's Hospital for Sick Children, comments on the recent arrival of a play specialist on the cardiac ward. "Prior to Claire's arrival here last April, we only had volunteers who came in three morning a week to play with the children. The children had to fend for themselves the rest of the time. This is a really busy ward and we just don't have the time to stimulate the children.

"We also have social admissions regularly. These are children who have nothing wrong with them but who end up here because they have nowhere else to go. Claire's role is vital with these children."

Children in Hospital Play Days are on Wednesday and Thursday. Wednesday's focus is on providing information about play specialists to health professionals and parents of children in hospital. Thursday is an all out play extravaganza with jugglers, clowns, face-painters, balloon sculptors and other entertainers.

Participating hospitals are Our Lady's Hospital for Sick Children, Crumlin; The Children's Hospital, Temple Street; National Children's Hospital, Tallaght; Cherry Orchard Hospital; Beaumount Hospital; National Medical Rehabilitation Hospital, Dun Laoghaire; University College Hospital, Cork, South Infirmary and the Mercy Hospital, Cork; Sligo General; Limerick Regional; Our Lady of Lourdes, Drogheda; University College Hospital, Galway; Tralee General; Portiuncula Hospital, Ballinasloe; Cavan General; Wexford General, Waterford General and Letterkenny General.

Children in Hospital Ireland is at Carmichael Centre, North Brunswick Street, Dublin 7, 01 8780448

Irish Association of Hospital Play Staff, 24 Avonmore, Leopardstown Road, Dublin 22. 01-2893787