Medical Play Observation

Medical play observation provides an invaluable window into the world of preverbal, young, or otherwise reluctant patients and their families. These observations can reveal a child's underlying feelings or concerns and be helpful in assessing interactions with family members, especially when professionals have questions about parenting, feeding, and/or attachment. The consultant should make observations about the patient's ability to engage in symbolic and age-appropriate play and about play themes that emerge.

To assess the parent-child relationship, the consultant should ask to observe parents interacting as they usually would at home for approximately 1520 minutes of unstructured parent-child or family play. The consultant might introduce this request by saying, "It can be a real challenge to parent a child who's not feeling well. I would like to see how it goes for you, and then we can brainstorm together about any suggestions I might have." Specific issues to observe during the session include the parents' ability to engage their child and read their child's cues, both verbally and nonverbally; their level of affection expressed toward their child; and their ability to address their child from a developmentally appropriate perspective. The parents' abilities to regulate their child's emotional responses, to set appropriate limits, and to handle separations are important to observe. Observation of the child should include capacity to relate, amount and extent of physical and eye contact, degree to which the child engages in or initiates play or speaks with the parents, and the child's affective involvement. The capacity for imaginative play and the thematic content of the play should also be noted.

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