The importance of play in children’s lives cannot be overstated (1). Through play, children explore the world around them, learn how to communicate and how to relate to one another and build meaningful connections with friends and family. It boosts their mood, nurtures their mental wellbeing, and helps their bodies grow fit and healthy (2).
This is true for all children, including those who have Special Education Needs (SEN), Profound or Multiple Learning Difficulties (PMLD), or other developmental conditions which impact their neurological or physical development and growth. The ways in which these can play or like to play may differ from what we conventionally think of as playful behaviour, and because they play differently, these children need access to different opportunities for play in order to enjoy play and engage in it fully. A lack of appropriate opportunities creates a barrier for children with developmental conditions to access all the essential benefits of play (3).
Children receiving treatment and care in hospital also encounter barriers to play due to both the hospital environment and their medical conditions. For children with developmental conditions, the barriers to play which they experience in hospital intersect with the barriers to play which they already face outside of hospital (4). Whilst it might be tempting to consider these as discrete barriers to be overcome one at a time, in reality they have to be considered and solved together because conventional opportunities for play in hospital may not be appropriate for a child with a developmental condition, and conventional approaches to play for children with developmental conditions may not be appropriate for those in hospital.
Giggle Doctors’ child-led approach to play provides one solution to overcome these intersecting barriers to play. They focus on connecting with the child and empowering them to direct the playful encounter. Giggle Doctors undertake extensive training to help them understand what they might expect from a child in hospital or a child with a developmental condition, giving them a toolkit for play which they can draw on. However, their approach is entirely improvised based on the individual child in front of them, responding to the individual needs, interests, preferences, and mood of the child or young person they are meeting at that moment.
The following short case studies explore the impact of Giggle Doctors taking a child-centred approach to play in different scenarios with a child and young people with developmental conditions.
Dylan
Dylan, aged 15, is non-verbal uses a passive wheelchair to support his whole body. When Dr Mish Mash and Dr Geehee arrive, Dylan is passive, looking ahead, and his mum is calm and smiling by his side. Although he isn’t able to reply, the Giggle Doctors speak to Dylan, coming close and moving slowly so he has time to focus on them. They sing a song with his mum, and he follows with his eyes when Dr Mish Mash holds coloured lights near his mum’s face. Then he starts to smile. When the Giggle Doctors leave, the room has a positive atmosphere and Dylan shows his active engagement with his surroundings focusing his gaze, and his positive mood through smiling at his mum and verbalising.
Eliana:
Eliana has spent 8 of her 19 months in hospital. She has ongoing medical and developmental conditions which mean she can’t often enjoy playing with children her own age, making play provision in hospital absolutely critical. Dr Ding Dong works closely with the play leader at Eliana’s hospital so they provide play for Eliana which is fun and offers her new experiences which will support her development. Today they play in a playroom with sensory toys and Dr Ding Dong and Eliana create music and games by turn taking. Before Eliana returns to lie in her bed again, her mum comments that access to play in hospital has helped Eliana’s development and communication enormously – something she feels deserves the same kind of credit her daughter’s medical team receive.
Emilie:
Emilie, who has a developmental condition, is a gregarious 8-year-old. She is outgoing and playful and immediately engages with the Giggle Doctors when she meets them. She takes a great interest in Dr Bungee’s red guitar, which he pretends he cannot find. She helps him find the guitar and then shows him how to play it. She shows pleasure and pride by announcing, “See!” with arms crossed and a pleased smile. She sings several songs with Dr Bungee and afterwards spends a long time investigating and playing the guitar over the course of the day. Afterwards, carers said they didn’t know she liked music and they looked forward to helping her to explore this interest further, drawing on the inspiration of Dr Bungee’s visit.
Stefan:
At 15, Stefan prefers to lie on his bed for much of the day and does not often choose to interact with others or engage in physical activities. He is non-verbal. When Dr Bungee and Dr Geehee enter his room, he shows little interest initially. Dr Bungee improvises a simple song which repeats Stefan’s name and lists some of the things he keeps in his room, while Dr Geehee blows up a heart shaped balloon for Stefan. She starts to wobble the balloon in time to the song, then passes it to Stefan. He takes the balloon and starts to wobble it too. He breaks into a shy smile and shifts to a slightly more upright position, leaning on his elbow to watch the Giggle Doctors play.
Immediate outcomes like positive mood or physical activity and engagement are easiest to see these case studies which focus on the moment of the encounter – and there’s enormous value in the chance to just have fun! However, anecdotal feedback we receive from families hints at a range of longer-term benefits, such as those alluded to by Eliana’s mum. There is also a wealth of literature which explores measurable benefits for medical teams and the tangible contributions playful interventions such as Giggle Doctors can make to supporting children’s medical journeys and experiences of hospital (5). A unifying theme which links Giggle Doctoring to these academic studies is the need to see beyond a child’s medical condition and when appropriate, set it aside entirely and focus instead on each child as an individual.
(1) The fundamental importance of children’s right to play is recognised the world over and enshrined in Article 31 of the UN Convention on the Rights of the Child.
(2)Countless references could be provided to support these assertions. One which provides a useful overview of the development of scholarly theory about play is: Geneser VL. Scholarly snapshots: the importance of child play as a human right. Lanham, Maryland: Rowman & Littlefield; 2022. You might equally find plenty of evidence by watching the children in your own life.
(3)There is ample academic research on this topic, and it is also widely covered in practical articles to support caregivers and educators working with children with all kinds of additional needs. See for example: How Outdoor Play Can be Beneficial for Children with Special Educational Needs [Internet]. Early Years Alliance. 2018. Available from: https://shorturl.at/cfw04; Durant G. The importance of play for children with special educational needs. SEN Magazine [Internet]. SEN Magazine. 2021. Available from: https://shorturl.at/kCDJ3; Wani. Benefits of Play for Children with Special needs [Internet]. Allied Care Website. 2022. Available from: https://shorturl.at/nrxPW; Tirraoro T. Have your say to lift the barriers to play for children with complex disabilities [Internet]. Special Needs Jungle. 2015. Available from: https://shorturl.at/vM178.
(4)This argument draws on principles taken from intersectionality, which is a sociological analytical framework used to consider how multiple social categories such as race, class, and gender may apply to an individual or group creating interconnected, overlapping systems of discrimination or disadvantage. For more on this framework, see: Crenshaw K. The urgency of intersectionality [Internet. Ted.com. TED Talks; 2016. Available from: https://shorturl.at/dzL14.
(5)A fascinating place to start is: Gray J, Donnelly H, Gibson BE. Seriously Foolish and Foolishly Serious: The Art and Practice of Clowning in Children’s Rehabilitation. Journal of Medical Humanities. 2019 Jul 23;42(3):453-69.
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