Play

Definition

Play is the work of children. It consists of those activities performed for self-amusement that have behavioral, social, and psychomotor rewards. It is child-directed, and the rewards come from within the individual child; it is enjoyable and spontaneous.

Description

Play is an important part of the childhood development. Through play children learn about shapes, colors, cause and effect, and themselves. Besides cognitive thinking, play helps the child learn social and psychomotor skills. It is a way of communicating joy, fear , sorrow, and anxiety .

In the early 2000s, children of all ages and from every socioeconomic background often prefer television, computers, and battery-operated toys to self-directed, imaginative, and creative play. This tendency leaves children developmentally deprived, because imaginative and fantasy play allows children to explore their world and express their innermost thoughts and feelings, hopes and fears, likes and dislikes. Through play, decisions are made without penalty or fear of failure. Play allows children to gain control of their thoughts, feelings, actions, and helps them achieve self-confidence.

Play takes different forms for different children, and its definition entails many aspects. Play is the direct opposite of work; it is frivolous. It provides freedom and invites the impulse to engage in foolishness. Yet it provides a means for ego development and a process by which social skills and physical skills develop as well.

Play with imagination and fantasy is the child's natural medium of self-expression and one that gives cues about the child's conscious and unconscious states. In play therapy, clinicians employ various techniques designed to reveal the child's psychological and social development. Clinician-directed play therapy is, therefore, not naturally self-directed play, but play designed by a professional to facilitate understanding of the child and the child's healing process.

Categories of play

Categories of play are not mutually exclusive; different forms or categories of play may overlap. Having choices is important since an action that appeals to one child may be of no interest to another, and the child's interest is likely to change throughout the play period. An understanding of play in many forms can help parents understand its importance for children of all ages. Some specific categories of play are as follows.

• Physical play. When children run, jump, and play games such as chase, hide-and-seek, and tag, they engage in physical play. This play has a social nature because it involves other children. It also provides exercise , which is essential for normal development.
• Expressive play. Certain forms of play give children opportunities to express feelings by engaging with materials. Materials used in expressive play include tempera paints, fingerpaints, watercolors, crayons, colored pencils and markers, and drawing paper; clay, water, and sponges; beanbags, pounding benches, punching bags, and rhythm instruments; and shaving cream, pudding, and gelatin. Parents can take an active role in expressive play by using the materials alongside the child.
• Manipulative play. Children control or master their environment through manipulative play. They manipulate the environment and other people as much as possible. Manipulative play starts in infancy. Infants play with their parents; for example, they drop a toy, wait for the parent to pick it up, clean it, and return it, and then they drop it again. This interaction brings the infant and parent together in a game. Children move objects such as puzzle pieces and gadgets to better understand how they work.
• Symbolic play. Certain games can symbolically express a child's problems. Because there are no rules in symbolic play, the child can use this play to reinforce, learn about, and imaginatively alter painful experiences. The child who is in an abusive family may pretend to be a mother who loves and cuddles her child rather than one who verbally or physically abuses her child. Or in play this same child might act out abusive experience by hitting or screaming at a doll that symbolizes the child. Parents can be surprised by their child's perception of family issues. Children mimic their parents in certain play; in other games they may pretend they are the heroes they read about in books or see on television. At certain developmental stages children believe they can fly or disappear. Symbolic play may be used by children to cope with fear of separation when they go to school or to the hospital.
• Dramatic play. Children act out situations they suspect may happen to them, that they are fearful will happen, or that they have witnessed. Dramatic play can be either spontaneous or guided and may be therapeutic for children in the hospital.
• Familiarization play. Children handle materials and explore experiences in reassuring, enjoyable ways. Familiarization prepares children for potentially fearful and painful experiences, such as surgery or parental separation.
• Games. Some video and card games are played by one child alone. Games with rules are rarely played by children younger than four years of age. Board games, card games, and sports are enjoyed typically by school-age children. In these games children learn to play by the rules and to take turns. Older children enjoy games with specific rules; however, younger children tend to like games that allow them to change the rules.
• Surrogate play. For children who are too ill or incapacitated to play, another child or a parent may serve as surrogate. Watching the surrogate who plays on behalf of the sick child is stimulating to the sick child. When parents engage in expressive art by painting or redecorating a room while the physically challenged child watches, they stimulate the child.

Functions of play

Play reinforces the child's growth and development. Some of the more common functions of play are to facilitate physical, emotional, cognitive, social, and moral development .

PHYSICAL DEVELOPMENT Play aids in developing both fine and gross motor skills . Children repeat certain body movements purely for pleasure, and these movements develop body control. For example, an infant will first hit at a toy, then will try to grasp it, and eventually will be able to pick it up. Next, the infant will shake the rattle or perhaps bring it to the mouth. In these ways, the infant moves from simple to more complex gestures.

EMOTIONAL DEVELOPMENT Children who are anxious may be helped by role playing. Role playing is a way of coping with emotional conflict. Children may escape through play into a fantasy world in order to make sense out of the real one. Also, a child's self-awareness deepens as he explores an event through role-playing or symbolic play.

When a parent or sibling plays a board game with a child, shares a bike ride, plays baseball, or reads a story, the child learns self-importance. The child's self-esteem gets a boost. Parents send positive messages to their child when they communicate pleasure in providing him or her with daily care. From these early interactions, children develop a vision of the world and gain a sense of their place in it.

COGNITIVE DEVELOPMENT Children gain knowledge through their play. They exercise their abilities to think, remember, and solve problems. They develop cognitively as they have a chance to test their beliefs about the world.

Children increase their problem-solving abilities through games and puzzles. Children involved in make-believe play can stimulate several types of learning. Language is strengthened as the children model others and organize their thoughts to communicate. Children playing house create elaborate narratives concerning their roles and the nature of daily living.

Children also increase their understanding of size, shape, and texture through play. They begin to understand relationships as they try to put a square object in a round opening or a large object in a small space. Books, videos, and educational toys that show pictures and matching words also increase a child's vocabulary while increasing the child's concept of the world.

SOCIAL DEVELOPMENT A newborn cannot distinguish itself from others and is completely self-absorbed. As the infant begins to play with others and with objects, a realization of self as separate from others begins to develop. The infant begins to experience joy from contact with others and engages in behavior that involves others. The infant discovers that when he coos or laughs, mother coos back. The child soon expects this response and repeats it for fun, playing with his mother.

As children grow, they enjoy playful interaction with other children. Children learn about boundaries, taking turns, teamwork, and competition. Children also learn to negotiate with different personalities and the feelings associated with winning and losing. They learn to share, wait, and be patient.

MORAL DEVELOPMENT When children engage in play with their peers and families, they begin to learn some behaviors are acceptable while others are unacceptable. Parents start these lessons early in the child's life by teaching the child to control aggressive behavior . Parents can develop morals while reading to children by stressing the moral implications in stories. Children can identify with the moral fictional characters without assuming their roles. With peers they quickly learn that taking turns is rewarding and cheating is not. Group play helps the child appreciate teamwork and share and respect others' feelings. The child learns how to be kind and charitable to others.

Age-related play

As children develop, their play evolves, too. Certain types of play are associated with, but not restricted to, specific age groups.

• Solitary play is independent. The child plays alone with toys that are different from those chosen by other children in the area. Solitary play begins in infancy and is common in toddlers because of their limited social, cognitive, and physical skills. However, it is important for all age groups to have some time to play by themselves.
• Parallel play is usually associated with toddlers, although it happens in any age group. Children play side by side with similar toys, but there is a lack of group involvement.
• Associative play involves a group of children who have similar goals. Children in associate play do not set rules, and although they all want to be playing with the same types of toys and may even trade toys, there is no formal organization. Associative play begins during toddlerhood and extends though preschool age.
• Cooperative play begins in the late preschool period. The play is organized by group goals. There is at least one leader, and children are definitely in or out of the group.
• Onlooker play is present when the child watches others playing. Although the child may ask questions of the players, there is no effort to join the play. This type of play usually starts during toddler years but can take place at any age.

Common problems

Promoting play for a sick child is a challenge when the child cannot voluntarily engage in play. Parents need to realize the importance of play to the well being of a sick child. Children can bring favorite books, games, and stuffed animals to the hospital. In hospitals young children need toys that they can manipulate independently, so that parents are free sometimes to focus on medical issues and the healthcare team.

Play activities vary depending on cultural and socioeconomic circumstances. When children do not speak the group's language, games such as stacking blocks or building with tinker toys are appealing. Playing tapes of well-loved children's songs can be effective too. The child does not need to be able to understand the words to enjoy the music or clap with the rhythm.

Assessing child health through play

Acutely ill children do not have the strength, the attention span, or the interest in play. They may enjoy being read to and the comfort of holding a favorite stuffed animal. Once the acute phase of an illness is over, the child's interest in playing returns. Spontaneous interest in play is a good index of health. The toys selected for play are good indicators of the child's recovery progress.

Play in a medical setting

When a child goes to see the doctor, the waiting room is likely to have other children in it. The arriving child may hear other children cry as they leave the examining room. The child may dread the examination. Parents should pack a favorite toy or book with which to distract the child. Having a parent sit with them is comforting, and they may venture a few feet away to examine toys in the toy box. Older children who go with the parent and the sick sibling to see the doctor should have toys and games for their entertainment, too, so the parent can focus on the sick child.

Hospitalized children can release fear, anger, or tension through effective play. Children in the hospital for a week or longer may enjoy playing school or socializing in the playroom with other children of their age. However, physical play for sick children must be supervised by a parent or healthcare provider.

Therapeutic play

When a child is ill or traumatized the care plan may include therapeutic play. Unlike normal play in design and intent, therapeutic play is guided by the health professional to meet the physical and psychological needs of the child. Because play is the language of children, children who have difficulty putting their thoughts in words can often speak clearly through play therapy. There are three divisions of therapeutic play, including:

• Energy release. Children release anxiety by pounding, hitting, running, punching, or shouting. Toddlers pound pegs with a plastic hammer or pretend to cut wood with a toy saw. An anxious preschooler pounds a ball of modeling clay flat; a relaxed child may build the clay into shapes. Balloons tied over the bed of a school-age child or adolescent can be punched.
• Dramatic play. Children act out or dramatize real-life situations. They act out anxiety and emotional stress from abuse, neglect, abandonment , and various painful physical experiences. Imaginative preschool children enjoy dramatic play. An abused or wounded child might not communicate the experience verbally but may be able to use an anatomically correct doll to show what happened. Therapeutic play can teach children about medical procedures or help them work through their feelings about what has happened to them in the medical setting.
• Creative play. Some children are too angry or fearful to act out their feelings through dramatic play. However, they may be able to draw a picture that expresses their emotions or communicates what they know. To encourage this expression children can be given blank paper and crayons or markers and asked to draw a picture about how they feel. Some children are so concerned about a particular body part that instead of drawing a self portrait, they will draw only the body part that worries them.

Many children draw pictures that reflect punitive images to explain unhappy experiences. They need reassurance that they are not being punished. Health-care providers need to make sure that these children are not being abused. Other children may draw pictures that are symbolic of death (an airplane crashing, boats sinking, burning buildings, or children in graves). These children need assurances that they are not going to die. Some drawings express the child's fear of abandonment and loss of independence. Pictures may suggest the parent cannot find the little child who is in the hospital. The child needs to be reassured that their parents know where they are. They need to know when the parents will visit and the parents should appear when they say they will be there.

Older school-age children and adolescents may not be interested in drawing, but they can make a list of experiences they like and dislike.

Parental concerns

Parents express interest in age-related play that prepares children for group exercises in preschool. They want to know the right kind of play for an only child or sick child who may not be able to play with other children in their age group. The following age-related play and toys serve as a guide to parents with these concerns.

• Infant. The infant enjoys watching other members of the family; the infant enjoys rocking, strolling, time spent in a swing, supervised time on a blanket on the floor, crawling , walking with help, and being sung and read to. Play is self-absorbed; it is difficult, if not impossible to direct play. Infants are engaged in the vigorous process of self-discovery, learning their world by looking, listening, chewing, smelling, and grasping. Most of their learning comes through play. They need safe toys that appeal to all of their senses and stimulate their interest and curiosity. Infants need toys and play that include oral movements. They like peek-a-boo; playing with the parent's fingers, hair, face, and the infant's own body parts; playing in water. Soft stuffed animals, crib mobiles, squeeze toys rattles, busy boxes, mirrors, and musical toys. Parents can give them water toys for the bath, safe kitchen utensils, and push toys (after they begin to walk), and large print books.
• Toddler. Toddlers fill and empty containers and begin dramatic play. As they increase their motor skills, they enjoy feeling different textures, exploring the home environment, and mimicking others. They like to be read to and to look at books and television. Toddlers enjoy manipulating small objects such as toy people, cars, and animals. Favorite toys are mechanical; objects of different textures such as clay, sand, finger paints, and bubbles; push-pull toys; large balls; sand and water play; blocks; painting or coloring with large crayons; nesting toys; large puzzles; and trucks and dolls. Toddlers explore their bodies and those of others. Therapeutic play can begin at this age.
• Preschooler. Dramatic play is prominent. This age group likes to run, jump, hop, and in general increase motor skills. The children like to build and create whether it is sand castles or mud pies. Play is simple and imaginative. Simple collections begin. Preschoolers enjoy riding toys, building materials such as sand and blocks, dolls, drawing materials, cars, puzzles, books, appropriate television and videos, nonsense rhymes, and singing games. Preschoolers love pretending to be something or somebody and playing dress up They enjoy finger paints, clay, cutting, pasting, and simple board and card games.
• School-age child. Play becomes organized and has a direction. The early school-age child continues dramatic play with increased creativity but loses some spontaneity. The child gains awareness of rules when playing games and begins to compete in sports. Children in this age group enjoy collections (comic books, baseball cards, and stamps), dolls, pets, guessing games, board games, riddles, physical games, competitive play, reading, bike riding, hobbies, sewing, listening to the radio, television, and videos, and cooking.
• Adolescent. Athletic sports are the most common form of play. Strict rules are in place, and competition is important. Adolescents also enjoy movies; telephone conversations and parties; listening to music; and experimenting with makeup, hairstyles, and fashion. They also begin developing an interest in peers of the opposite sex.

Play for the sick child

Children who are confined to a bed need to have play periods built into their day. The length of play and the toys will depend the individual child's age and physical and emotional states. Short-term school projects appeal to school-age children because these activities help the children feel industrious and think about their future wellness. Parents can help children with their baths; encourage them to drink enough fluids; and prompt them to do deep breathing and muscle strengthening exercises.

Safety issues

Toys and games should be screened for safety , especially those used by a sick child. The toys should be washable with no sharp edges and no small parts that

could be swallowed or aspirated. Cylinder-shaped toys of 1-inch (2.5-cm) diameter (the size of a regular hot dog) are the most dangerous size because they can occlude the trachea (windpipe) if they are aspirated. As a rule, if a toy can fit through the center of a toilet tissue tube, it is too small.

Parents should be certain that toys do not lead children into danger. Tossing a ball to a toddler on bed rest may be safe, but if a child in a cast leans to catch the ball, he may fall. Chasing a ball may lead to falls and collisions. If children are bored with a toy because it is not stimulating enough or they have played with it too long, they may begin to use the toy in an unsafe way. For example, the child may throw blocks across the room for fun instead of stacking them.

Indoor toys

For home care of the sick child, parents may need to buy new toys suitable for indoor use. The ill child may need soft toys for bed play and sit-down toys such as magic markers, puzzles, books, or board games, for quiet out-of-bed play.

When to call the doctor

Parents and teachers who spend time observing and understanding childhood behaviors may want to report to the child's therapist what they see the child do.

Skin care is essential for children who are bedridden or in a cast or restraints. Children lose interest in playing if they are uncomfortable or in pain . Parents should look for pressure over the buttocks, elbows, heels, and other parts of the child's body. The skin should be inspected often and massaged with a moisturizing lotion to increase circulation. Redness, irritation, and sores should be reported immediately to the healthcare provider.

When children are ill, the rate of bladder and bowel elimination may slow down because of reduced physical action. School-age children and adolescents may hesitate to drink or eat a normal diet because toileting is uncomfortable or performed without privacy. Parents may need to seek medical advice about digestive and elimination aids and about adjusting the child's diet and fluid intake to promote normal elimination.

Resources

BOOKS

Barbour, Ann, et al. Prop Box Play: 50 Themes to Inspire Dramatic Play. Beltsville, MD: Gryphon House Inc., 2002.

Cassou, Michelle. Kids' Play—Igniting Children's Creative Passion. East Rutherford, NJ: Penguin Group, 2004.

Drake, Jane. Organizing Play in the Early Years: Practical Ideas for Teachers and Assistants. Philadelphia: Taylor & Francis Inc., 2003.

Humphrey, James Harry. Learning the 3 Rs through Active Play. Hauppauge, NY: Nova Science Publishers Inc., 2001.

Scarlett, W. George. Children's Play. Thousand Oaks, CA: Sage Publications, 2004.

PERIODICALS

Schulman, Lisa. "Good guys, bad guys: Pretend play." Parents Magazine. (June 2003): 169–70.

WEB SITES

Games Kids Play. Available online at http://www.gameskidsplay.net (accessed October 13, 2004).

Aliene S. Linwood, RN, DPA, FACHE