Exploring children's right to make choices and engage in playful activities in restricted environments through music and singing.
Birmingham Children’s Hospital (BCH) is a leading UK specialist paediatric centre, offering expert care to 90,000 children and young people from across the country every year. The hospital provides care and treatment for the most complex heart conditions, chronic liver and kidney disease, cancer, serious burns, epilepsy, neurology and cystic fibrosis. It is also home to Europe’s largest single site paediatric intensive care unit, a 24-hour accident and emergency service, regional major trauma centre and new mental health service for 0-25 year olds.
Children attend for a range of reasons and can stay for short, medium or long term depending on the type and severity of their condition. Although the hospital promotes a respectful and participatory ethical approach to care and treatment for children, one result of chronic and long-term illness is a reduction in children’s ability to make everyday choices about their world, combined with stress and restricted play opportunities. Ensuring that children’s well being and education is not disrupted is a priority alongside delivering their health and medical care. For this reason, there is both play and education provision on-site. Included in this is a fully-equipped school, a play centre and a Singing Medicine project.
The Singing Medicine project is an award-winning project that is delivered weekly to all wards and in-patient areas at BCH by Ex Cathedra vocal tutors, including children who are very ill. Singing Medicine has been delivered at BCH every Friday since November 2004. The project brings all the benefits of play through singing to children staying in hospital using a repertoire of songs written by the vocal tutors themselves with additional well-known singing games. In an environment where children can feel they have lost control over their lives singing games offer children ways of making decisions.
The games also support areas of children’s learning and can be adapted to meet children’s individual needs as required. The deep breathing required by singing enables participants to reconnect with core muscles, and helps increase lung capacity. Singing activities often include some movement to increase physical mobility, and vocal tutors are often approached by physiotherapists to work with a child in a particular way in order to increase the development of particular muscles in conjunction with exercises they have set. Working in child or family groups singing sessions relieve boredom, offer a distraction from the ward around them, and reduce social isolation. Singing with others promotes human bonding and oxytocin, supporting children’s relationships with caregivers. This in turn can lead to an increase in wellbeing in a situation where psychological deterioration can lead to deterioration in health.
This research study aimed to explore the views and perceptions of parents and professionals who care for and support children who participate in the Singing Medicine project as part of the wider Play Department offer to children and their families. A further aim was to understand how the application of Froebelian principles can help us to understand and conceptualise children’s rights and wellbeing in the context of their family and community in restricted environments such as a Children’s Hospital. Froebelian principles are:
- The integrity of childhood in its own right.
- The relationship of every child to family, community and to nature, culture and society.
- The uniqueness of every child's capacity and potential.
- The holistic nature of the development of every child.
- The role of play and creativity as central integrating elements in development and learning.
- The right of children to protection from harm or abuse and to the promotion of their overall wellbeing.
Research questions included:
- What are the views and perceptions of parents on the role of music and singing in children’s wellbeing, right to make choices and decisions and engage in playful activities during their Hospital stay?
- What are the views and perceptions of professionals who work in the Hospital on the role of music and singing in children’s wellbeing, right to make choices and decisions and engage in playful activities during their Hospital stay?
- How can the application of Froebelian principles help us to understand the children’s rights and wellbeing in the context of their family and community in restricted environments such as a Children’s Hospital?
Method of Research
The research approach involved a qualitative interpretive design. Interviews were undertaken with parents of children who are currently visiting their child during their stay at the Hospital and professionals who are providing support and care for the child/family. Non-participant researcher observations of musical play sessions were also undertaken on three occasions where it was not considered to intrude on children’s privacy or interfere with their enjoyment of the sessions.
The aim was to select a maximal variation sample of children / families aged birth to eight from diverse social and cultural heritages and with a diverse range of healthcare experiences to participate. Similarly, as broad a range of professionals were invited to participate. In practice, opportunity sampling was adopted as it proved difficult to identify parents who agreed to participate and had sufficient time to participate in an interview on visiting their child in Hospital.
Themes that arose from interviews included the important characteristics of the Singing Medicine vocal tutors; contribution to children’s emotions; contribution to child/family experiences of hospital; contribution to children’s development and learning (including neurodevelopment); spiritual and cultural dimensions; contribution to medical care (including contribution to the wellbeing of health professionals), contextual aspects of the project and contribution to family life, patterns and structures. The potential contribution to children’s neurodevelopment is an important finding since it was mentioned by participants that neurodevelopment is an aspect of healthcare provision often omitted due to the understandable need to focus on acute care and patient survival and recovery.
From observations there was evidence of choices for children; following children’s lead; facilitating medical care; building memorable moments for families and focusing on children’s holistic development. From the focus group discussion with vocal tutors it was noted that there are important characteristics of and values held by the vocal tutors that relate to valuing children and families interests and strengths and empowering them, as well as ensuring that the project brings a positive dimension to their hospital experience.
These findings demonstrate the benefit of participating in the project for children, their family members and health professionals supporting them. The findings can be mapped against all six of the Froebelian principles promoted by the Froebel Trust. The project values childhood by promoting children’s right to play and relax, whilst at the same time valuing children’s interests, identities, capacities as well as medical fragility. The project adopts a family-centred model of operation that values the bonds and connections between children and significant others in their lives. Connecting children to the outside world of nature, culture, community and society through singing games is evident throughout the findings. The central role of play and creativity is transmitted from the playful approaches adopted by the vocal tutors. Protection from harm and promotion of wellbeing is facilitated by the training provided for and characteristics of the vocal tutors, as well as the contribution of the singing games to children’s (and families) sense of happiness and wellbeing.
The findings can be considered in light of significant evidence from the APPGAHW on the benefits of the Arts more broadly and singing and music specifically in health settings, and also in light of the United Conventions on the Rights of the Child. In particular Article 31 which states that every child has the right to relax, play and take part in a wide range of cultural and artistic activities and Article 12 which states that every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. This right applies at all times, for example during immigration proceedings, housing decisions or the child’s day-to-day home life.