18 October 2006
It's all play, no fear (ST Mind Your Body, 18 October 2006)

- Play, instead of sedation, may help children handle uncomfortable medical tests better, reports Elaine Young

When two-year-old Nadiah Nazri had a sudden fit just after breakfast one morning in August, her mum took her to KK Women's and Children's Hospital (KKH) to see the neurologist.

'I was worried the fit had affected her brain,' recalls Madam Salama Latiff. Nadiah was given an appointment to undergo an electroencephalogram (EEG) test.

The doctor suggested the active toddler be sedated to make the 90-minute test easier, but Madam Salama was worried about side effects.

'When the play therapist called to suggest an alternative way, I thought we should try,' she says.

The play therapy department at the hospital uses toys, books, and breathing techniques to help children cope with long or painful procedures.

In January, the department discussed with neurologists how they could help children during EEGs. They then began a four-month project using play therapy as an alternative to sedation.

The pilot project is now a permanent procedure and was showcased at SingHealth's recent Annual Quality Convention, a staff event intended to enhance patient care.

There are two parts to the play intervention, explains play specialist Rachel Woon: Two days before the child's appointment, the department will call the parents to tell them what the procedure involves and give them a chance to ask questions.

Then, at the appointment, she coaches the family through the procedure. She says: 'We provide different types of toys to distract the child while the technologist is working on the head.'

EEG technologist Ng Yen Ling explains that 22 electrodes have to be attached to the head at precise points to record brain activity.

'Before play intervention, we had to restrain uncooperative children,' she says. 'Since play intervention, we no longer have to worry about restraints hurting the child.'

Sedation remains a last-resort measure, and side effects include vomiting and rashes.

'Play intervention can be used for all sorts of procedures or stressful events,' says Ms Woon.

The pilot project found that kids below four who received play intervention had a reduced need for sedation. Just over 60 per cent of children needed sedation before play was introduced. This fell to 12 per cent with play, says Ms Ng.

The EEG laboratory at KKH tests about four children a week.

Young children do not like people touching their heads, says Ms Ng, and that is where the struggles come.

Nadiah was no exception. She does not even like her long hair to be brushed or tied up, says her 36-year-old technical officer mum.

But not one tear was shed when she had her EEG a month ago. She was too busy watching a DVD.

Barney the dinosaur is also Nadiah's soother. She happily allowed Ms Ng to attach electrodes as if it were just another play day.

The only struggle came when it was time to part company with the large Barney she was clutching.

Says her mum: 'When she came in here for the first time, the cartoons on the walls make it look like a nursery, so she didn't feel frightened. It wasn't like she was coming in for tests at all.'