Play should be a core feature of children's healthcare in forthcoming plans for the future of the NHS, according to a new report which argues that play "humanises" the experiences of child patients.
The report, by University of Cambridge academics for the charity Starlight , calls for play, games and playful approaches to be integrated into a 'holistic' model of children's healthcare – one that acknowledges the emotional and psychological dimensions of good health, alongside its physical aspects.
Both internationally and in the UK, health systems have, in recent decades, increasingly promoted play in paediatric healthcare. There is a growing understanding that making healthcare more child-friendly can reduce stress and positively improve younger patients' experiences.
Despite this recognition, play often remains undervalued and inconsistently integrated across healthcare contexts. For the first time, the report compiles evidence from over 120 studies to make the case for its more systematic incorporation.
In the case of the UK, the authors argue that the Government's forthcoming 10-year health plan for the NHS offers an important opportunity to embed play within a more holistic vision for childhood health.
The report was produced by academics at the Centre for Play in Education, Development and Learning (PEDAL) at the Faculty of Education, University of Cambridge. Starlight, which commissioned the review, is a national charity advocating to reduce trauma through play in children's healthcare.
Dr Kelsey Graber, the report's lead author, said: "Play and child-centred activities have a unique capacity to support the emotional and mental aspects of children's healthcare experiences, whether in hospital or during a routine treatment at the GP. It won't directly change the course of an illness, but it can humanise the experience by reducing stress and anxiety and enhancing understanding and comfort. Hospital-based play opens up a far more complete understanding of what it means for a child to be a healthy or well."
Adrian Voce, Head of Policy and Public Affairs at Starlight, said: "With the government promising to create the healthiest generation of children ever as part of its new long term health plan, this compelling evidence of the benefits of play to children's healthcare is very timely. We encourage ministers and NHS leaders to make health play teams an integral part of paediatric care."
The report synthesised evidence from 127 studies in 29 countries. Most were published after 2020, reflecting intensified interest in children's healthcare interventions following the COVID-19 outbreak.
Some studies focused on medically-relevant play. For example, hospital staff sometimes use role-play, or games and toys like Playmobil Hospital to familiarise children with medical procedures and ease anxiety. Other studies focused on non-medical play: the use of activities like social games, video games, arts and crafts, music therapy and storytelling to help make patients more comfortable. Some hospitals and surgeries even provide "distraction kits" to help children relax.
In its survey of all these studies, the report finds strong evidence that play benefits children's psychological health and wellbeing. Play is also sometimes associated with positive physical health; one study, for example, found that children who played an online game about dentistry had lower heart rates during a subsequent dental procedure, probably because they felt more prepared.
The authors identify five main ways in which play enhances children's healthcare based on the available body of evidence:
- Reducing stress and discomfort during medical procedures: Play is sometimes associated with physiological markers of reduced distress, such as lower heart rates and blood pressure. Therapeutic play can also ease pain and anxiety.
- Helping children express and manage emotions. Play can help to alleviate fear, anxiety, boredom and loneliness in healthcare settings. It also provides an outlet for emotional expression among all age groups.
- Fostering dignity and agency. In an environment where children often feel powerless and a lack of personal choice, play provides a sense of control which supports mental and emotional wellbeing.
- Building connection and belonging. Play can strengthen children's relationships with other patients, family members and healthcare staff, easing their experiences in a potentially overwhelming environment. This may be particularly important for children in longer term or palliative care.
- Preserving a sense of childhood. Play helps children feel like children, and not just patients, the report suggests, by providing "essential moments of happiness, respite and emotional release".
While play is widely beneficial, the report stresses that its impact will vary from child to child. This variability highlights a need, the authors note, for informed, child-centred approaches to play in healthcare settings. Unfortunately, play expertise in these settings may often be lacking: only 13% of the studies reviewed covered the work of health play specialists, and most of the reported activities were directed and defined by adults, rather than by children themselves.
The report also highlights a major gap in research on the use of play in mental healthcare. Just three of the 127 studies focused on this area, even though 86% emphasised play's psychological benefits. The report calls for greater professional and academic attention to the use of play in mental health support, particularly in light of escalating rates of mental health challenges among children and young people. More work is also needed, it adds, to understand the benefits of play-based activities in healthcare for infants and adolescents, both of which groups were under-represented in the research literature.
Embedding play more fully in healthcare as part of wider Government reforms, the authors suggest, could reduce healthcare-related trauma and improve long-term outcomes for children. "It is not just healthcare professionals, but also policy leaders who need to recognise the value of play," Graber said. "That recognition is foundational to ensuring that children's developmental, psychological, and emotional health needs are met, alongside their physical health."
The report, Playing with children's health? will be published on the Starlight website on 31 March: https://www.starlight.org.uk/
