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- Postprocedural support
- Encourage expression of feelings
- Playing with medical objects provides children with the opportunity to play out fears and concerns with supervision by a nurse or child life specialist
- Positive reinforcement
- Children need to hear from adults that they did the best they could in the situation—no matter how they behaved.
- It is important for children to know that their worth is not being judged based on their behavior in a stressful situation.
- Reward systems, such as earning stars, stickers, or a badge of courage, are appealing to children.
- Play activities for specific procedures
- Fluid Intake
- Make ice pops using child’s favorite juice.
- Cut gelatin into fun shapes.
- Make a game out of taking a sip when turning page of a book or in games, such as Simon Says.
- Use small medicine cups; decorate the cups.
- Color water with food coloring or powdered drink mix.
- Have a tea party; pour at a small table.
- Let child fill a syringe and squirt it into mouth, or use it to fill small, decorated cups.
- Cut straws in half, and place in a small container (much easier for child to suck liquid).
- Use a “crazy” straw.
- Make a “progress poster;” give rewards for drinking a predetermined quantity.
- Deep Breathing
- Blow bubbles with a bubble blower.
- Blow bubbles with a straw (no soap).
- Blow on a pinwheel, feather, whistle, harmonica, balloon, or party blower.
- Practice band instruments.
- Have a blowing contest using balloons, boats, cotton balls, feathers, marbles, ping-pong balls, or pieces of paper; blow such objects on a tabletop over a goal line, over water, through an obstacle course, up in the air, against an opponent, or up and down a string.
- Suck paper or cloth from one container to another using a straw.
- Dramatize stories, such as “I’ll huff and puff and blow your house down” from the “Three Little Pigs.”
- Do straw-blowing painting.
- Take a deep breath and “blow out the candles” on a birthday cake.
- Use a little paint brush to “paint” nails with water and blow nails dry.
- Range of Motion and Use of Extremities
- Throw beanbags at a fixed or movable target or throw wadded-up paper into a wastebasket.
- Touch or kick Mylar balloons held or hung in different positions (if child is in traction, hang balloon from a trapeze).
- Play “tickle toes;” have the child wiggle them on request.
- Play Twister game or Simon Says.
- Play pretend and guessing games (e.g., imitate a bird, butterfly, or horse).
- Have tricycle or wheelchair races in a safe area.
- Play kickball or throw ball with a soft foam ball in a safe area.
- Position bed so that child must turn to view television or doorway.
- Climb wall with fingers like a “spider.”
- Pretend to teach aerobic dancing or exercises; encourage parents to participate.
- Encourage swimming if feasible.
- Play video games or pinball (fine motor movement).
- Play hide and seek: hide toy somewhere in bed (or room if ambulatory), and have child find it using specified hand or foot.
- Provide clay to mold with fingers.
- Paint or draw on large sheets of paper placed on floor or wall.
- Encourage combing own hair; play “beauty shop” with “customer” in different positions.
- Soaks
- Play with small toys or objects (cups, syringes, soap dishes) in water.
- Wash dolls or toys.
- Pick up marbles or pennies* from bottom of bath container.
- Make designs with coins on bottom of container.
- Pretend a boat is a submarine by keeping it immersed.
- Read to child during soaks; sing with child; or play game, such as cards, checkers, or other board game (if both hands are immersed, move board pieces for child).
- Sitz bath: Give child something to listen to (music, stories) or look at (View-Master, book).
- Punch holes in bottom of plastic cup, fill with water, and let it “rain” on child.
- Injections
- Let child handle syringe, vial, and alcohol swab and give an injection to doll or stuffed animal.
- Draw a “magic circle” on area before injection; draw smiling face in circle after injection but avoid drawing on puncture site.
- If multiple injections or venipunctures are planned, make a “progress poster;” give rewards for predetermined number of injections.
- Have child count to 10 or 15 during injection.
- Ambulation
- Give child something to push:
- Toddler: Push-pull toy
- School-age child: Wagon or a doll in a stroller or wheelchair
- Adolescent: Decorated intravenous (IV) stand
- Have a parade; make hats, drums, and so on.
- Give child something to push:
- Extending Environment (e.g., for Patients in Traction)
- Make bed into a pirate ship or airplane with decorations.
- Put up mirrors so that patient can see around room.
- Move bed frequently to playroom, hallway, or outside.
- Fluid Intake
- Encourage expression of feelings
- Postprocedural support
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