Play and the Pediatrician's Role

Child’s Play
What is a pediatrician’s role?
Matt Swenson, MD
“Playful Parenting” -Daniel Siegal, MD
“Attending” - Rex Forehand, Ph.D.
“Play-listening” - Patty Wipfler (attachment)
“Special Time” - Russell Barkley, Ph.D.
Play is a common
denominator for most
parenting approaches
An important marker of development
A means of communicating
integral to building relationships and
competence
We could talk about play as:
We can look at play type, quality or pattern
• Adult-oriented Play
• On-looker Play
• Solitary or Independent Play
• Parallel Play
• Associative Play
• Typicality
• Rigidity/flexibility
• Intensity
• Persistance
• Regularity
• Sensitivity
An important marker of development
A means of communicating
integral to building relationships and competence
We could talk about play as:
Lets focus on this last one
Published in 2007 as a “clinical report”
AAP Committee on Communications
AAP Committee on Psychosocial Aspects of Child and Family Health
Consultants at AACAP and American Psychological Association
Play is so important to optimal child development that it is recognized
by the United Nations High Commission on Human Rights as a right of
every child.
"Play is essential to the cognitive, physical, social and emotional well-
being of children and youth."
"The interactions that occur through play tell children that parents are
fully paying attention to them and help to build enduring relationships.
Parents who have the opportunity to glimpse into their children's world
learn to communicate more e!ectively with their children and are given
another setting to o"er gentle, nurturing guidance. Less verbal children
may be able to express their views, experiences, and even frustrations
through play, allowing their parents an opportunity to gain a fuller
understanding of their perspective. Quite simply, play o"ers parents a
wonderful opportunity to engage fully with their children."
"Parents need to feel supported to not passively accept the media and
advertising messages that suggest there are more valuable means of
promoting success and happiness in children than the tried, trusted,
and traditional methods of play and family togetherness."
"Although no one can be sure what skills will be needed, certain
character traits will produce children capable of navigating an
increasingly complex world as they grow older. These traits include
confidence, competence or the ability to master the environment, and
a deep-seated connectedness to and caring about others that create
the love, safety, and security that children need to thrive."
confidence competence
a deep-seated connectedness to and caring about others
confidence competence
a deep-seated connectedness to and caring about others
Basic psychological needs:
1" Relatedness #love, a$ection"

2" Significance #work, a%rmation"
The Play Book
Connection - Power - Emotional Healing
Connection Power
#Significance" #Relatedness"
Connection
Attachment
“The Cup” analogy
Think of filling and re&filling your child's cup
The caregiver is the child's reservoir, a place to start from
and return to between explorations Their cup is emptied
by being tired, hungry, lonely or hurt. Their cup is filled
by being loved, fed, comforted and nurtured
Children whose cups are usually filled carry a strong sense
of security
Insecurely attached children may appear anxious and
clingy, or withdrawn and indi$erent
Some children learn to try to "refill their cup" by stealing
from others cups, or by acting out #a nasty refill &&
punishment && is better than no refill at all"
Some children seem to have leaky cups, always in need of
refills. They can be annoying to adults and subsequently
be ignored, only worsening their plight
Some children's cups are severely cracked by abuse or
neglect. This posses significant long&term challenges
Connection
#Relatedness"
• Mirroring: in the spirit of Simon Says or Follow the
Leader. Works with all ages. *Note: they cannot feel
teased
• Peekaboo: plays with delicate balance of connection
and loss of connection. Think of the entertainment
value of juggling. The "fun" of romance is balancing
connection, disconnection and reconnection
• Blissful gaze: The first connection between mother and
infant. Often lost after two but needs not be. Try a
staring contest. Sustain eye contact while comforting.
Best without words. "This is a serious and solemn
occasion"
• "Love gun" or "Love punch": try turning aggressive play
into an opportunity to playfully love and connect. If they
come with arms swinging, try dancing; when they lock
themselves in a room or closet, slip 'love notes' under
the door. Alternatively, play 'dramatic death' by
repeatedly falling on them and pleading for the doctor
• Connection games: chase, tag, pillow fights, wrestling,
etc.
• "You'll never get away": pretend to hold them tight
(either physically or with psychic powers) and dare
them to get away. Fosters physical closeness/contact
• The sock game
• Repetition until connection: Say 'hi' or 'how was your
day' several times in different ways until you connect
• Gum sharing: (for older children who may be ignoring
you) ask if you can have the gum they are chewing so
that you can get close to them in whatever way you
can.
• Insist on connecting, but allow them
to set the terms
• How can we expect children to
connect on our terms #talk" when we
refuse to connect on theirs #play"? This
includes learning to love games we
hate.
• Children really do want to connect
even when it looks like they want to be
left alone
• When people disconnect, they
typically have to struggle through
di%cult emotions like anger or loss in
order to restart a connection
Power
#Significance"
STAGE CRISIS RELATIONSHIP STRENGTHS
Infancy
Basic Trust vs. Basic
Mistrust
maternal person Hope
Early Childhood
Autonomy vs. shame
and doubt
paternal people Will
Play Age Initiative vs. guilt basic family Purpose
School Age Industry vs. inferiority neighborhood, school
Adolescence
Identity vs. identity
confusion
peer groups Fidelity
Young Adulthood Intimacy vs. isolation
partners in friendship, sex,
competition, cooperation
Love
Adulthood
Generativity vs.
stagnation
Divided labor and shared
household
Care
Old Age Integrity vs. Despair humankind, "my kind" Wisdom
Stages of Psychosocial
Development
Competence
Power
#Significance"
• Children need to avoid feeling
powerless, which leads to shame, guilt,
doubt, inferiority
• Let them win, make the rules, lead,
choose the activity, define the
characters, allow for some aggression,
etc.
• It's time for the adult to be the
incompetent, clumsy fool!
• Play is the best way to foster healthy
aspects of power and increase
competence and confidence
• Play the "poopyhead game": Captures the intersection
between children's two great loves -- bathroom humor
and name calling (both very much related to power).
Respond by saying, "How did you know poopyhead
was my secret name? . . . Please don't tell anyone. Just
kidding, my real secret name is Rice Crispy Treat!"
• Don't you dare: When a child provocatively uses an
inappropriate word, try saying, "well you can say
_______ all you want, but if you say bobbledydoo you
are going to be in big trouble!" Then pretend to get
them in trouble. *Note: this is not reverse psychology, it
is allowing your child to experiment with power -- the
power to break rules -- in a setting where it can be
playful and contained. This will decrease the likelihood
of such power struggles with peers.
• Stop and Go: to avoid power struggles, try allowing a
child to maintain power in frightening situations (getting
nails cut) but saying "stop" or "go" as the clippers slowly
get closer. You can occasionally insert a "go" if needed.
Make sure giggles are involved.
• Role reversal: they play the capable adult while you
play the clumsy, blubbering fool. Could use a puppet.
Child could be feared animal while you are the scared
child.
• Winning & Losing: set up games to address these
themes. Could be as simple as a coin toss. Perhaps
they always win and you make a silly fuss about
loosing, or you boast about how great you are then
miss every shot. Whatever helps them laugh away
some of the life or death feelings around competition.
• Freeze tag
Laughter: Let Goofy
be Your Guide!
• If a child giggles at something, do it again, and
again, and again...
• Don't talk in a regular voice when you can talk in
a silly voice; don't talk at all when you can sing,
don't stand up when you can fall over. #if you feel
too silly, pick up a stu$ed animal and make them
do this"
• Think of the blundering, stumbling villain
• With older kids, try rapping or doing a Katie
Perry impersonation. They will feel embarrassed
but also empowered #less silly themselves" and
connected
• Ask kids to try to make you laughing order to
get a better feel for what they think funny
• Lighten up the scene: rather than say "...or you
will no to your room," try, "... Or I will have to
pour this water on my head." #You don't need to
actually do it but you have successfully lightened
up things and perhaps changed the focus"
• caution tickling
(Lose your dignity to find your child)
Rough Play is great for helping
kids deal with feelings of
powerlessness and disconnection
Rules for roughhousing
1. Maintain safety
2. Find any opportunity for connection
3. Find any opportunity to foster power
4. Provide just the right level of
resistance and usually let them win
5. Stop when someone is hurt
6. Stay attuned
7. Keep your own feelings from getting in
the way
A brief note about
media violence
“In our anxiety to understand and control
real-life violence, we’ve tried to reduce our
children’s relationships with their fantasies
of combat and destruction to vast
generalizations that we would never dream
of applying to their fantasies about love
and family and discovery and adventure.

“We usually don’t ask whether game shows
predispose our children to greed, or
whether love songs increase the likelihood
of getting stuck in bad relationship. But
when aggression is the topic, we try to
puree a million games and dreams and life
stories into statistical studies. We ask
absurdly sweeping questions like, ‘What is
the effect of media violence on children?’
as if violence were a single, simple
phenomenon of which sandbox play-fights
and mass murder were mere variations, as
if the evening news and Reservoir Dogs
and Daffy Duck were indistinguishable. As
if children were like trees in an orchard who
could all be raised to identical form by the
same externalities.
“Many forces have been shown to
contribute to aggression: religious fervor,
patriotic fervor, sports rivalry, romantic
rivalry, hot summer nights. Entertainment
has inspired some people to violence, but
so have the Bible, the Constitution, the
Beetles, books about Hitler, and
obsessions with TV actresses. We don’t
usually condemn those influences as
harmful, because we understand them
better, we understand why people like
them and the benefits most of us draw from
them. What’s lacking is an understanding
of aggressive fantasies and the
entertainment that speaks to them.”
A rule to live by:
Get
curious

NOT
furious
•
Emotional Healing
• Just as adults feel helped by talking
things out, children experience healing
through play
• Connection, empowerment and
laughter have significant healing
e$ects. As do the tears that often
follow fun and play because the child
feels safe to release overwhelming
sadness that is too intense for giggles
• Releasing a backed up flood of tears is
good and healthy. We should 'stand by'
and allow this, without trying to stop it
too quickly and risk sending the
message that intense emotions are
unacceptable
• It easy to be frustrated when children
'melt down' after we have spend hours
entertaining. If we anticipate it, we can
deal with it more e$ectively
• Play out di%cult situations: "let's play
school," "lets play getting dressed,"
"lets play you want this toy real bad
and I won't share it," "lets play
crossing the street && oh no, the bunny
is going to get hit by a car!"
"There are some things that are so
predictable and inevitable, faced by
almost all children, that it is hard to
call them traumas. Nevertheless, they
are painful and they sap a child's
confidence. Losing a friend, having a
secret betrayed, and being teased are
just a few examples. As parents, we
want desperately to help children
escape these hard lessons of life, or
at least master them when they do
happen. We know that lectures don't
work but we keep giving them
anyway, just in case, because we
aren't sure what to do. A playful
approach is much more helpful."
He drew a circle that shut me out —
Heretic, rebel, a thing to flout.
But Love and I had the wit to win:
We drew a circle that took him in!
"Outwitted "
By Edwin Markham
(1852-1940)
Siblings
• Competing for filled cups: power and
connection.
• Children learn about morality by
arguing over rules
• Schedule free play time with each child
• Human tug of war: kids tugging you or you and
your spouse tugging over a child hamming up how
much you want them and need them
• Sharing: try taking the toy they are fighting over
and run away saying "now it's mine and you guys
can't get it," then they can unite to chase you
• Side with the younger sibling in a playful way
against a bigger one, but be us the bigger be still
feels powerful enough
• Don't underestimate younger siblings: "gee whiz,
that looked like it hurt, what do you do to get back
at him when he does that?" Or "that was mean,
what's going to happen next?" This gets them
thinking on their own about conflict resolution,
whereas a lecture is quickly forgotten.
• Teach older children how to "help" younger siblings
play.
• Collaborative Problem Solving or "half-answers"
• Try to unite them
in play #against
you"
• Stand back, but
with your eyes
open
Discussion?
The End