Therapeutic Play in Paediatric Oxygen Therapy: A Review of Its Effects on Fear, Anxiety, and Behaviour
Keywords:
therapeutic play; paediatric; oxygen therapy; nebulizer; anxiety; fear; behaviour; inhalation therapy.Abstract
Background: Children undergoing oxygen-related respiratory treatments (nebulization, high-flow nasal cannula [HFNC], mask oxygen) frequently experience fear, procedure-related anxiety, and distress-driven behavioural problems. Non-pharmacological interventions, particularly therapeutic play, are widely used by paediatric nurses to reduce these negative responses.
Objective: To review and synthesize the evidence on the effect of therapeutic play on fear, anxiety, and behavioural responses in children undergoing oxygen therapy or inhalation treatments.
Methods: We performed a targeted literature search (PubMed, MEDLINE, CINAHL, Scopus and Google Scholar) for interventional and review studies addressing therapeutic play associated with inhalation or oxygen delivery in children. Key searches included terms such as “therapeutic play,” “nebulizer,” “high-flow nasal cannula,” “oxygen therapy,” “children,” “anxiety,” “fear,” and “behaviour.” We included randomized controlled trials (RCTs), quasi-experimental studies, and systematic reviews up to mid-2025. Evidence was synthesized narratively and key study characteristics tabulated.
Results: Several RCTs and quasi-experimental studies report that therapeutic play interventions — e.g., use of toy nebulizers/masks, dramatic therapeutic play, distraction cards, “pop-it” toys, and nurse-led play sessions — reduce procedure-related fear and anxiety and improve acceptance/adaptation to inhalation/oxygen devices. A 2023 RCT found significantly lower fear and anxiety and better mask acceptance when toy nebulizers and masks were used as therapeutic play. Recent 2024–2025 studies extend findings to HFNC and nurse-led play interventions showing reductions in state anxiety and improved behavioural responses. Systematic reviews/meta-analyses of therapeutic play in hospitalized children consistently report reductions in anxiety and improved coping and behaviour during medical procedures.
Conclusions: Therapeutic play is a low-risk, effective adjunct to usual care for reducing fear, anxiety and problematic behaviours in children receiving inhalation or oxygen therapies. While results are consistently favourable, heterogeneity in play methods, outcome measures and follow-up limits pooled effect estimation. Future multi-centre RCTs with standardized intervention protocols and validated anxiety/behaviour scales are recommended.
