The power of play

We all know what we mean by play, don’t we? I thought I did, but the Shorter Oxford English Dictionary gives 24 different meanings for the verb ‘to play’. We may all mean somewhat different things when we talk about child play. We recently invited a young couple for lunch, with their 3-year-old daughter and 2-year-old son. My wife had me clean the toys in the old family toy box (our children are young adults). The visiting children pounced on the toys and played happily all afternoon, with the minimum of squabbling about a toy they both wanted. New toys certainly, but I was impressed, as always, with the power of play and impressed with my wife’s habitual foresight. Our young children always had toys to occupy them on long journeys, and spent endless hours donning old clothes from our dressing-up box. The intensity with which children often play suggests that for many it is their work. ‘To a small child, play is work, thought, art and relaxation’. I have always viewed children’s play as critical for learning to distinguish make-believe from reality. Children enjoy play, but do they need to play? Does their play serve any deeper purpose? Donald Winnicott (1896–1971), an enormously influential child psychoanalyst, would surely have answered yes. In his short, wonderfully readable book, ‘The child, the family and the outside world’, and in a series of essays that extend his thoughts on play, Winnicott suggests one reason children need to play is to deal with aggression, through play rather than at the moment of rage. Another reason he says is to cope with anxiety. Children gain experience and enrich themselves through play and fantasy and thus ‘gradually enlarge their capacity to see the richness of the externally real world’. Winnicott sees play as creative, life-affirming, and ‘always exciting because it deals with the precarious borderline between the subjective and that which can be objectively perceived’. Although adults can increase the range of experiences by providing materials and ideas, Winnicott suggests not providing too many materials, because children are good at and enjoy finding objects and inventing games. Winnicott followed Melanie Klein’s influence in psychoanalytic play therapy to provide toys during psychoanalytic sessions and to interpret the meaning of children’s play. There is a rich literature, including important contributions from Freud, Piaget and Bowlby among many others, on the meaning and value of children’s play and the need to give children time to play. The US Academy of Pediatrics has published a clinical report on the importance of play, which laments the reduction of time for free play provided for many children in kindergartens and schools and at home, because of television, computers and video games. Many of us believe that imaginative play is essential for normal cognitive, emotional and social development. Occasionally, however, our deeply held beliefs are challenged. In ‘Battle hymn of the tiger mother’, Yale law professor Amy Chua describes how she and her Jewish husband raised their two American daughters the ‘disciplined Chinese way’. No playdates, no sleepovers or computer games. By age 3, Sophia was learning the piano, reading Sartre, doing mathematics and could write 100 Chinese characters. The girls had toys but little time to play with them it seems, and Amy threatened to destroy their toys if the girls did not practice their musical instruments. Sophia performed solo at Carnegie Hall aged 14. Lulu, however, rebelled and at 13 cut her hair and refused to play the violin. The girls’ strict upbringing has been described by many as abusive but defended by others, including Lulu, who at age 18 said it had made her more independent. Most paediatricians, I believe, would share my horror that these girls seem to have had so little time for normal play. A literature search did not reveal much classical ‘evidencebased’ scientific evidence for play. This is not surprising, because it is scientifically and ethically difficult to study play in randomised controlled trials. Play therapy is often used to prepare children for heart surgery, but I could find no studies evaluating the benefits. A systematic review of studies of treatment programmes for child neglect found randomised controlled trial support for imaginative play training, while play therapy was beneficial in treating children with emotional difficulties, especially when parents were included in therapy. If we usually require ‘hard’ evidence to support other health interventions, does that mean that the need for evidence is inappropriate in the case of child play, that randomised controlled trials need to be done, or that the tiger mother approach is equally valid? Personally, I am convinced by close observation of children, by personal experience and by reading authors like Winnicott of the importance and the power of play for normal child development.