As a way to penetrate the rich, complex psyches of children suffering from chronic illness, doctors have found great success with certain forms of play therapy — creative, freeform sessions where kids gets to interact with toys and props, alongside siblings, and express any fears they may hold about their illness.

Directly asking children how they feel can lead to frustrating, incomplete results. Parents and medical professionals must find more ingenious approaches, attacking problems obliquely and letting kids come to them. Published in Issues in Comprehensive Pediatric Nursing, a new study of children living in the Ronald McDonald House in Cincinnati, Ohio, found providing kids with medically themed toys helped them open up about their fears of making a full recovery.

Children were given toys such as stethoscopes, miniature hospital beds, ambulances, doctors’ bags, intravenous (IV) lines, and casts. Soon, they began to freely reveal the associations they had with each object. UC researchers observed the children at play, up to two times a month.

The team found that kids sometimes formed negative associations with doctors, painting them as evil. Some children also expressed fears over the routine, yet squeamish, process of having their blood drawn. Researcher Dr. Laura Nabors, expert in clinical child psychology, says such interactions can be leveraged as communication opportunities. Parents can help their child understand that doctors help, not hurt, people, and that their child’s body quickly replenishes any blood that was lost when drawn.

Also telling were the ways in which kids interacted with one another. A sibling, feeling seemingly left out from the illness, would mirror the sick child’s behavior, the researchers found.

“No one in the dramatizations died,” Nabors told Psych Central, “but in some cases, siblings would want to be sick, too, so that they could receive attention from their parents.” They also found “patients” in the dramatizations would seek help from their parents after they’d fallen ill. This suggested to researchers that children rely on their parents emotionally when coping with a chronic illness.

During one portion of the project, Nabors and her colleagues separated siblings from the children who were ill to observe each group independently. They found that in each group, separate narratives about treating an illness resulted in a happy ending, despite the healthy siblings demonstrating feelings of exclusion, as they believed the sick sibling had been receiving more attention from the parents.

“I really believe that young children are marked for resilience and that will be explored in our future research,” Nabors said, adding that a control examination of six healthy children, split equally among both genders, showed none of the same play tendencies as the children with illnesses.

“Their play was dramatically different,” she concluded, “without rich play experiences and themes indicating that they were working through traumatic experiences.”