Play in Children With Life-Threatening and Life-Limiting Conditions: A Scoping Review

Abstract

Unfortunately, little attention has been paid to the need for play in children living with life-threatening and life-limiting conditions (LTC/LLC; Amery, 2016; Boucher et al., 2014). The number of children diagnosed with LTC/LLC worldwide is estimated to be more than 21 million (Connor et al., 2017). These children often experience loss or impairment that affects their participation in play, but the role and value of play may be even greater for vulnerable children with LTC/ LLC than for healthy children (Amery, 2016; Boucher et al., 2014). In addition, prognoses are variable, and some children with LTC/LLC live into adulthood and thus will require the skills that play can enable them to attain (McNamara-Goodger & Feudtner, 2012; Shaw et al., 2015). Play is integral to the experience of childhood; children benefit from engagement in play (i.e., full experience of their childhood through interaction with peers) and from the outcome of this participation (i.e., development of later-life skills). Regardless of children's prognoses or medical conditions, they remain children and have the right to act and live as children, including to engage in play (Boucher et al., 2014; United Nations, 2006). Children with LTC/LLC need encouragement to continue playing as a way of preserving their childhood and facing their illnesses with the least trauma and best quality of life possible. However, little is known about play in this population. The aim of this scoping review was to examine empirical studies investigating play in children with LTC/LLC to explore their play characteristics and factors influencing their participation in play. Additionally, we sought to identify related issues that influence these children's participation in play. By so doing, we add to the body of literature related to understanding play in children living with LTC/LLC. Method Little is known about play as part of the daily life of children with LTC/LLC. Therefore, we conducted a scoping review to map the available literature broadly and comprehensively (Arksey & O'Malley, 2005; Armstrong et al., 2011). The review was conducted and reported in accordance with Aveyard (2014) and Peters et al. (2015). We followed a strict protocol to promote the reliability of the findings (Aveyard, 2014; Cronin et al., 2008). We identified, critically appraised, and synthesized relevant studies from a range of professional contexts-including health, palliative care, social services, sociology, and design and architecture-to gain a comprehensive understanding of existing research on play in children living with LTC/LLC (

The social and physical environmental factors associated with the play of children living with life threatening/limiting conditions: A Q methodology study

“…Play is an essential determinant of children's health; a strong positive relationship exists between participation in play and children's health and well‐being (Gerlach et al, 2014; Law & King, 2014; Moore & Lynch, 2018). However, play is under‐researched for children living with life threatening/limiting conditions, despite the fact that these children are experiencing sustained disruption in their play (Jasem et al, 2020). Life threatening/limiting conditions are mainly characterized with shortened lifespan, where the likelihood of death is before reaching adulthood (i.e., before their 18th birthday) (McNamara‐Goodger & Feudtner, 2012).…”

“…They can benefit from the process of engagement (i.e., interaction with peers allows children to fully experience their childhood) and from participation (i.e., developing later‐life skills) (Lynch & Moore, 2016; Mandich & Rodger, 2006; Sturgess, 2003). The few available studies have indicated that a hospital stay (or hospitalization) restricts play for children who are living with life threatening/limiting conditions (Angstrom‐Brannstrom et al, 2013; Jasem et al, 2020; Lima & Santos, 2015). It has been shown that children are often unable to engage in many of their desired play activities, such as building Lego or colouring and reading, because of hospitalization (Angstrom‐Brannstrom et al, 2013; Gibson et al, 2010; Lambert et al, 2014b; Lima & Santos, 2015; Nabors et al, 2019).…”

“…Specific limitations to children's play can indicate more broadly that the environment that surrounds play may be a major factor in limiting the play participation for these children (Jasem et al, 2020). However, there is lack of evidence to promote our understanding to what factors within the environment these are.…”

“…Specific limitations to children's play can indicate more broadly that the environment that surrounds play may be a major factor in limiting the play participation for these children (Jasem et al, 2020).…”

“…Furthermore, most of the established evidence is limited in its generalisability worldwide, as the majority has been based on Northern Hemisphere hospital practices, and they have not considered culture as a factor, which may influence children's play (Jasem et al, 2020). This is despite the fact that evidence proposed variations across cultures regarding play (Hughes, 2010;Rubin et al, 1983).…”