Exploring Play in Pediatric Palliative Care: A Scoping Review of Play Among Children Living With Life-Limiting and Life-Threatening Conditions

Abstract

Abstract: Background: Children with life-limiting (LL) and life-threatening (LT) conditions often face reduced opportunities for play, despite its vital role in supporting coping, autonomy, emotional expression, and a sense of normalcy. Frequently overlooked in medical settings, play is a fundamental aspect of childhood. However, medical interventions commonly restrict or disrupt play. A holistic pediatric palliative care (PPC) approach should enhance quality of life (QoL) by addressing not only medical needs but also the broader psychosocial needs of children and families, including access to play. This scoping review aimed to explore existing research on play in the context of children living with LL/LT conditions. Methods: A scoping review following the six-step approach of Arksey and O’Malley was undertaken. We searched six electronic databases to identify studies focusing on play in the context of LL/LT conditions in childhood. Inspired by content analysis by Ringnes & Thørrisen, we identified key categories relating to children living with LL/LT conditions and play. Results: Seven reports were included. Six categories were identified: 1) Impact of play on children´s well-being, 2) Condition-related limitations on play participation, 3) Environment and equipment in play, 4) Social dynamics of play and play companions, 5) Facilitating and supporting play, and 6) Digital devices in play. Conclusion: This scoping review identified seven reports on play in children with LL/LT conditions. Play supported well-being through emotional relief, normalcy, and communication. Most research focused on hospitals, though caregivers highlighted the need for play at home. Children valued any engaged playmate, including healthcare staff. Despite its importance, play remains under-researched, especially for children with complex needs. Future research should broaden the diagnostic scope and explore integration of play beyond hospital settings. Keywords: Pediatric palliative care (PPC), play, well-being Word count: 16 612