Play is vital to the growth and development of any child. Hospitalization and illness can hinder a child’s ability to play, and thus, reach age-specific milestones. St. Joseph’s Child Life Department offers many different types of play to facilitate normal growth and development as well as educate pediatric patients and help them to cope with feelings they experience as a patient. Certified Child Life Specialists, and other members of the department, are trained in specific areas of play.

In addition to age-appropriate play for normal growth and development, other types of play offered by Child Life staff includes:

• Medical Play: Used to educate and desensitize patients about medical equipment and/or procedures they experience with illness and hospitalization. Toy and real medical supplies may be used based on the age and assessment of the patient.
• Expressive Play: Allows pediatric patients to express emotions they may be experiencing, but are unable to vocalize in a daily conversation. Various dolls, action figures, toys, or crafts are used during this type of play.
• Non-Directed Play: Led by the pediatric patient while a Child Life staff member observes what is expressed during the play session. The best way to conduct a non-directed play session is to have a pediatric patient in an activity room or offer a broad range of play supplies, so the patient can choose the toys or activities he/she wishes to play with during the session. A pediatric patient will often choose the toys that can help him/her play out feelings, such as anger or fear.
• Directed Play: Led by a Child Life staff member to accomplish a specific goal, such as assessment of the patient’s home situation. Toys, crafts, or other supplies are offered to the patient by a staff member. A dollhouse, various family member figures, and house accessories would be utilized in a session to assess a patient’s home situation.

A multitude of toys and supplies are needed to provide therapeutic play sessions to our patients. Material for infants/toddlers may include musical toys, light up toys, and large blocks; preschool and school-age patients need dolls, action figures, games, and crafts while teen/young adult patients require items such as advanced art projects, critical thinking games, and technology-based items. Some companies even produce supplies and toys specifically for therapeutic play interventions which are usually much costlier than more well-known toys that can be purchased from local stores or websites.

Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program (American Music Therapy Association, 2020).

St. Joseph’s Child Life Department has a full-time, board-certified Music Therapist that offers music therapy sessions to inpatient pediatric patients and families 40 hours per week. Patients are included in music therapy sessions for reasons such as:

• Coping with illness
• Expression of feelings
• Pain
• Stress/anxiety
• Depression
• Noncompliance with treatment
• Wellness

A wide variety of instruments and technology are used to aid in accomplishing music therapy goals with patients and families. Instruments include the guitar, ukulele, various types of drums, xylophone, kalimbas, bells, shakers, and technological devices and/or programs such as Garage Band.

The Music Therapist may provide individual bedside sessions to patients as well as parents. Services, at times, may also be extended to siblings based on assessment. Small group sessions occur throughout the year to help introduce patients who may be roommates or have the same illness. When appropriate, recordings and videos may be produced for patients and families for legacy building.

This program is defined by the saying, “When words fail, art speaks.” The art therapist at St. Joseph’s Children’s Hospital focuses on children’s emotional state and helps them use art to express inner thoughts or feelings that they may be unable to verbalize.

The art therapist visits St. Joseph’s at least twice each week and at the start of each shift, works with Child Life staff to identify the patients who are most in need of services and would benefit the most from art therapy. On average, the art therapist treats four to five patients each day, or eight to ten patients each week.

St. Joseph’s art therapy program is trauma-informed and evidence-based, and complements medical care.

Art therapy benefits our pediatric patients in several key ways:

• Addresses adverse childhood experiences (ACEs) as they are happening, to prevent long-term negative effects on physical health, well-being, emotional health, and mental health. (ACEs have been recognized as a public health issue, as they are linked to impaired development, greater risk factors and risky behaviors later in life, disease, and even premature death). Art therapy has proven effective in helping children cope with ACEs.
• Provides patients the opportunity to talk and work through issues, while simultaneously enabling the therapists to assess and identify what the child is experiencing by checking for emotional indications manifesting in the artwork, motor/cognitive challenges with completing tasks during sessions, etc. For example, children asked to draw a bird’s nest may reveal several important factors simply through creating this piece of artwork – perhaps they have drawn an isolated bird, separate from the rest of the family unit; or a nest that is falling to the ground, indicating that the child feels unsafe. Art provides an outlet for children to express these complex feelings that may be difficult to put into words.
• Attends to behaviors that could stand in the way of medical care.

Horticultural therapy uses planting, gardening, and nature-based play activities to support the rehabilitation of physical, cognitive, social, and emotional functioning.

The horticultural therapy program is currently offered one to two times each month, serving approximately 30-40 children per visit as well as patients’ family members.

After introducing the day’s scheduled activity to patients and their families, the horticultural therapist provides educational information and facts on the plants she is using, and incorporates more generalizable lessons (for example, flowers are all different, just as people are all unique). She then models the project and assists patients and families as they create their own projects.

Developmental needs addressed during horticultural therapy include:

• Improvements in attention span
• Increased self-esteem
• Reduced stress
• Decreased anxiety
• Improved mood
• Increased sense of control
• Increased feelings of calm and relaxation
• Increased social interaction

Horticultural therapy enables pediatric patients and their families to learn about the environment as they interact with natural elements and express their creativity through craft and planting projects. This is particularly critical for St. Joseph’s population, as many children and families living in Paterson, a densely populated urban area, do not have access to outdoor space for various reasons—thus, exposure to the natural world is not an everyday occurrence. St. Joseph’s patients have reacted extremely favorably to learning about nature.

St. Joseph’s AAT Program is specially designed to improve functional outcomes, stimulate healing and recovery, and provide comfort to pediatric patients.

All sessions are goal-oriented, documented, and conducted with highly trained dogs and their certified professional handler.

The Children’s Hospital staff and nurses routinely report increased patient compliance, improved communication between staff and patients, and an overall more normalized patient experience after one or more AAT sessions.

AAT helps healthcare providers accomplish the following objectives:

1. Compliance: Patients that refuse to take medication, eat, or engage in other treatments can observe the handler lead a therapy dog through a simulation of the activity the patient is refusing, which ultimately encourages the patient to comply.
2. Preparation Through Medical Play: Patients can use medical kits designed specifically for use on trained dogs to perform a “play” procedure such as an IV preparation. This activity prepares a patient to undergo his or her own treatment.
3. Normalization and Communication: Dogs can comfort a patient with anxiety or depression and help them communicate their emotions to staff. For example, the dogs are trained to play games with yes/no question cards to encourage a patient to articulate feelings.
4. Socialization and Ambulation: Dogs can serve as an intermediary between staff and patients, and help patients re-engage with staff after a procedure.

The AAT is available to patients two days per week, reaching approximately eight patients per week.

For a recent shared patient story, animal-assisted therapy was introduced to an eight-year old patient who refused to eat and faced a possible gastrostomy tube placement (G-tube). After feeding Sheldon – a therapy dog – during his session, the patient ate an entire meal in the hospital cafeteria and continued to eat properly, avoiding the placement of a G-tube.