Child’s Play

Jul 13, 2022

by Richard E. Kreipe, MD, FAAP, FSAHM, FAED

As a medical student, I enjoyed pediatrics because it involved paying attention to the ever-advancing developmental capacity of patients.  For example, young infants would play peek-a-boo with me—a total stranger.  Their immature brains were already programmed to recognize my face as human, but unable to realize that I was still present when I covered my face with my hands.  When I parted my hands a few seconds later to expose my smiling face and exclaim “peek-a-boo”, it regularly elicited a gleeful response from the infant before me. 

Of course, the same response might be elicited by my cranking the handle of a 6 inch “jack-in-the-box” toy that would play the tune “Pop Goes the Weasel” for a few seconds, then the lid on top would pop open and a tiny toy doll would spring out of the box, surprising an infant listening and watching.  But it was much more fun to have the infant interact with me, rather than a toy.   Wanting to learn more about the transformational changes in human brains (and in human beings) between childhood and adulthood—adolescence—led me to specialize in adolescent medicine.

One of the joys of pediatrics1 and being an adolescent medicine specialist (aka, ephebiatrician2) was my learning about the need to be grounded in the present moment during an interaction, as well as informed by the patient’s relevant history to understand better the current situation, while also attempting to optimize the patient’s future development into healthy adulthood through preventive health care with things like immunization and counseling.  I also benefitted from having mentors who taught—and actively role-modeled—the importance of being child-like (innocence and kindness), rather than child-ish (irritatingly annoying) whether I was a clinician or a teacher working with adolescent patients.  

Two previous Mindful Practice in Medicine blogs included the word “play” in their title, an activity generally considered the opposite of “work”.    When Sigmund Freud wrote about the “cornerstones of humanness”, he proposed just two elements, focused on adults: love and work.  In relation to children, they were love and play.   Modern neuroscience shows that youth are often their most creative, most curious selves when they are engaged in play of various forms. 

In pediatrics, “play therapy” is a treatment method based on the “therapeutic power of play”.   Sometimes, it was only through play therapy that I could understand what a young patient was experiencing.  I recall a 5 year old boy who had been admitted to the hospital for a simple hernia repair, but who was so terrified and upset about what might happen during the operation that the surgeon considered canceling it.  The play therapist was able to quickly determine what the boy was worried about, reassured him, and all was well.  Even the internet address of the Association for Play Therapy, a professional organization devoted to this topic, is playful.  It is a simple 4-character URL: www.a4pt.org

The title of Jon Kabat-Zinn’s Mindfulness Based Stress Reduction3 program, focuses mainly on adults and includes the word “stress”.  However, its primary elements are child-like: purposeful interaction, presence in-the-moment, curiosity of a beginner’s mind, and noticing rather than judging.   My adolescent medicine colleague, Dr. Dzung Vo, has developed a number of materials on mindfulness for teens that are readily available on-line4.   Connecting with the image of child Buddhist monks in-the-making “monk-eying around” at the beginning of this piece, I want to acknowledge that one of the most influential contemporary contributors to the practice of mindfulness was a Buddhist monk named Thích Nhất Hạnh.  He remained child-like, and somewhat playful, throughout his human life of 95 years that ended in January 2022.

I recently purchased one of his calligraphy prints with the reminder that all you need to do is breathe… and you are on-line

References

  1. Ziai M.  The Joys of Pediatrics (www.publications.aap.org/aapbooks/book/588/The-Joys-of-Pediatrics) American Academy of Pediatrics. DOI: https://doi.org/10.1542/9781581105483  ISBN electronic: 978-1-58110-548-3  ISBN print: 978-1-58110-141-6  Publication date: May 2004
  2. Ogilvie H. Ephebiatrics. Lancet 1954: Volume 264, Issue 6835, 28 August 1954, P 395-400 H OGILVIE PMID: 13184688 DOI: 10.1016/s0140-6736(54)90282-2
  3. www.mindfulleader.org/mbsr-training
  4. www.mindfulnessforteens.com/dr-dzung-vo

About the Author

I am a pediatrician and adolescent medicine specialist grounded in the biopsychosocial approach to patient care.  This requires a developmental focus when treating adolescent patients who are no longer children but not yet adults and may still require the involvement of their parents for complex health problems.  Mindfulness is central to my clinical and personal toolbox.

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