Why play helps your child cope with stress

This page is general information, not medical or mental health advice. DNLH is not a crisis line or a counseling service.

Why does play help with stress?

Children often do not have the words for what they feel. Play is how they say it. When a child builds, pretends, draws or runs around, they are working through feelings and trying out ways to feel in control.

The American Academy of Pediatrics (AAP) explains it this way in its clinical report on play:

• Play builds safe, steady relationships, and those relationships help protect children from the harm of severe stress.
• Shared joy during play helps regulate the body's stress response. When you laugh together and pay close attention to each other, your child's body calms.
• Play matters even more when a child faces hard times. The AAP says that in the presence of childhood adversity, play becomes even more important.
• Play builds thinking skills, like focus, planning and self control.

That is why pediatricians are encouraged to "write a prescription for play." You do not need toys from a store. You need time and attention.

What does a stressed child look like?

Stress shows up differently by age. The National Child Traumatic Stress Network (NCTSN) and the AAP describe common signs:

• Young children: clinging, sleep problems, losing skills they had (like using the toilet or talking), and playing out the same scary scene again and again
• School age children: worry about safety, headaches or stomachaches, trouble focusing, guilt, or acting out
• Any age: changes in sleep, eating, mood or behavior, and not wanting to go to school

Some going backward is normal after a scary time, and often temporary. Steady routines, comfort and play help children find their footing again.

How do I do "special time" at home?

Special time is short, regular, one on one play where your child leads. An AAP handout on brief mental health interventions suggests:

1. Set aside 10 to 15 minutes, two to three times a week. More is fine. Steady matters more than long.
2. Name it after your child. "It's Roberto's Time."
3. Put phones away. Set a timer so your child knows it will happen and when it ends.
4. Let your child choose the activity. Within safe limits, they are the boss.
5. Follow their lead. Join their game. Do not teach, test or fix.
6. Give it every time. Special time is not a reward for good behavior, and it is not taken away for bad behavior.

The handout also lists PRIDE skills to use during special time:

• Praise: "You worked so hard on that tower."
• Reflect: repeat what they say. Child: "The dog is hungry." You: "The dog is hungry."
• Imitate: do what they do. If they stack blocks, you stack blocks.
• Describe: like a sports announcer. "You're putting the red car in the garage."
• Enjoy: show you are having fun.

If you have more than one child, try to give each one their own time, even if it is short.

What can we play with what we have?

You do not need money or a big home. These are our own ideas by age, not a clinical program:

Toddlers and preschoolers (about 1 to 5)

• Pots, spoons and plastic cups for "cooking" or drumming
• Hide a toy under a towel and find it
• Blocks, boxes or pillows to build a house or fort
• Bubbles, or blowing out pretend candles (slow breathing that feels like a game)
• Dolls or stuffed animals acting out bedtime, school or a trip to the store

School age children (about 6 to 12)

• Drawing, coloring or making a comic about their day
• Card games, board games or games from your home country
• Tag, ball games, jump rope or dancing to music
• Building with cardboard, tape and markers
• Making up a story together, one sentence each

Calming games

• "Smell the flower, blow out the candle" for slow breaths
• Squeeze and relax: squeeze hands tight like lemons, then let go
• Freeze dance: dance, then stop when the music stops

For more calming ideas, see Simple grounding exercises to calm fear and stress.

What if my child plays out scary things?

It can be hard to watch your child play "police" taking someone away, or make a toy family hide. This kind of play is common. The NCTSN lists repetitive play about a frightening event as one of the ways young children react. It is often how they try to make sense of it and feel stronger.

What helps:

• Stay calm and stay near. You do not have to stop the game.
• Describe without judging. "The little bear is scared. The mama bear is holding him."
• Gently add safety. Let a helper character arrive, or ask, "What would help the bear feel safe?"
• Answer real questions honestly in simple words, when your child asks. See How to help your children when they are afraid of immigration raids for words to use by age.

When is it more than play?

These are our suggestions, not a medical checklist. Ask your child's doctor or a counselor for help if:

• The scary play stays the same for weeks and seems to make your child more upset, not less
• Your child stops playing or seems stuck, flat or very sad most days
• Sleep, eating, school or friendships keep getting worse
• Your child talks about wanting to die, or hurts themselves or others

The AAP says to call your pediatrician if changes worry you, or if your child was close to a frightening event.

When you call for help, ask for a therapist who works with young children and families.

Where can my child get help?

In California, children under 19 can get full scope Medi-Cal regardless of immigration status. See Child mental health help in California for how to start.

Contact them to confirm hours, languages and openings. Being listed here is not a referral or a promise of service.

• Your child's pediatrician or clinic. Ravenswood Family Health Network pediatrics (East Palo Alto and nearby): (650) 330-7400.
• BrightLife Kids (statewide California): free coaching for families with children 0 to 12, in English and Spanish with interpreters in other languages. Coaching, not therapy. brightlife.kids
• San Mateo County ACCESS Call Center (San Mateo County residents with Medi-Cal or no insurance): (800) 686-0101, TTY 711.
• East Palo Alto Community Counseling Center (San Mateo County): 2415 University Avenue, Suite 301. (650) 363-4030.
• Santa Clara County Behavioral Health Services (Santa Clara County residents): (800) 704-0900, 24/7. Press 1 for the youth crisis team (ages 4 to 20).
• Other California counties: DHCS list of county mental health plans.
• Your child's school or child care. Ask about a counselor or family support staff.

How do I take care of myself too?

Children read your mood. When you are scared, they feel it. You do not have to hide every feeling. It can help to say, "I'm feeling worried today, and I'm going to take care of us." Then take care of yourself too: rest when you can, talk with someone you trust, and get support. See Mental health care without fear.

Questions parents ask

I work long hours. Is 10 minutes really enough? Yes. Short, steady play counts. The AAP handout suggests 10 to 15 minutes a few times a week.

Can screen time count as play? Not really. The AAP report says time with screens can take the place of real play, and children learn better from people than from devices.

My child does not want to play with me. Sit nearby and describe what they are doing. Try again tomorrow. Some children need a few tries.

Can grandparents or older siblings do special time? Yes. Any caring adult can give a child this time.

Is there something I can print?