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 effectively with their children and are given another setting to offer 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 offers 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, affection)!

!2) Significance (work, affirmation)

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 indifferent !

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 difficult 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 stuffed 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 effects. 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 effectively!

• Play out difficult 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