Background: Hospitalization in early childhood often triggers significant fear, anxiety, stress, and distress due to parental separation, unfamiliar environments, and medical procedures, which can hinder recovery and emotional stability. Play, a natural mode of self-expression, supports children’s physical, emotional, social, and cognitive development and serves as a non-pharmacological intervention that promotes coping and relaxation. Aim: This systematic review aims to evaluate the efficacy of play-based interventions in reducing separation anxiety among hospitalized children, below five years of age. Methods: A systematic review was conducted through comprehensive searches of PubMed, Scopus, CINAHL, ProQuest, and Wiley Online Library databases for English-language articles published between 2015–2025. Search terms included Play-based interventions, Therapeutic play, Separation anxiety, Hospitalized children, Children under five years, and Pediatric anxiety. The searches were carried out from September 2023–July 2025 and studies were critically reviewed and synthesized. Results: n = 20 were included in the review. These studies reveal that the play-based interventions significantly reduce separation anxiety in hospitalized children by enhancing emotional adjustment and fostering coping strategies. It also decreases pain during invasive and noninvasive procedures, the preoperative period, postoperative pain, additionally it provides distraction of mind in cast removal, improves positive emotions in children with leukemia and emotional well-being of children and decreases separation anxiety in hospitalized children. Conclusion:Studies strongly support that play interventions significantly enhance the well-being of hospitalized children. Play therapy in pediatric setting is essential for improving emotional adjustment and promoting holistic recovery in this vulnerable population through structured and unstructured play activities. Pediatric nurses should possess adequate knowledge of the benefits of therapeutic play and organize training programs ensuring integration care in clinical setting.

Keywords:Children under five years, hospitalized children, pediatric anxiety, play-based interventions,
separation anxiety, therapeutic play

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1. Godino-Iáñez MJ, Martos-Cabrera MB, Suleiman-Martos N, Gómez-Urquiza JL, Vargas-Román K, Membrive-Jiménez MJ, et al. Play therapy as an intervention in hospitalized children: A systematic review. Healthcare (Basel). 2020 Jul 29;8(3):239. doi: 10.3390/healthcare8030239.
2. Obeidat H, Alsharydeh EA, Constantino RE. The effects of preoperative recreational activities on children's anxiety level during the perioperative period. Int J Rural Dev Environ Health Res. 2020;7(3):58–67.
3. Li CHW, Chung KOJ, Ho YK, Kwok CMB. Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC Pediatr. 2016;16:36. doi: 10.1186/s12887-016-0570-.
4. Bajpai A, Illayaraja BS, Muninarayanappa NV, Nageshwar V. Assessment of anxiety among hospitalized children. Indian J Public Health Res Dev. 2017;8(2):113–6. doi: 10.5958/0976-5506.2017.00093.6.
5. Silva SGT, Florino CMF, Damiao C, Campos LM, Rosato LM. Influence of therapeutic play on the anxiety of hospitalized school-age children: Clinical trial. Rev Bras Enferm. 2017;70(6):1244–9. doi: 10.1590/0034-7167-2016-0353.
6. Effectiveness of art therapy on level of anxiety among hospitalized children. Int J Sci Res. 2023 May;12(5):707–9. Available from: https://www.ijsr.net/archive/v12i5/SR23509084536.pdf.
7. Harnilawati, Asrianto. The effect of application of play therapy on the anxiety level of hospitalized preschool children at RSUD Haji Provinsi Sulawesi Selatan. Int J Sci Technol Manag. 2(6):1989–94.
8. El Berry KI, Osman ZA, El Malky MI, El Nagar MA, Ebrahem SM. The effect of play techniques on separation anxiety among preschool children. Int J Novel Res Healthc Nurs. 2018 Jan-Apr;5(1):227–35. Available from: noveltyjournals.com.
9. Nezhad ZM, Pakdaman F, Goodarzi MA. Effectiveness of child-centered group play therapy and narrative therapy on preschoolers’ separation anxiety disorder and social-emotional behaviours. Early Child Dev Care. 2023;193(6):841–53. doi: 10.1080/03004430.2023.2167987.
10. Wong LC, Ip YW, Kwok CMB, Choi CK, Ng WKB, Chan HWC. Effects of therapeutic play on children undergoing cast-removal procedures: A randomised controlled trial. BMJ Open. 2018;8(7):e021071. doi: 10.1136/bmjopen-2017-021071.
11. Paul M, Das N, Sahoo P. Effectiveness of play therapy during hospitalization in reducing anxiety among 6-12-year-old children. J Adv Res Psychol Psychother. 2020;3(3-4):8–14. doi: 10.24321/2581.5822.202008.
12. More R. Effectiveness of play therapy on anxiety among hospitalized children at selected hospitals. Int J Sci Res. 2019;8(2):176–80. Available from: https://www.ijsr.net/archive/v8i2/ART20195659.pdf.
13. Martín-Villena MC, Gonzalez-Díaz A, Gomez-Urquiza JL, Suleiman-Martos N, García-Lara R, Ibarrondo-Crespo R, et al. Effects of play therapy in children with cancer: A systematic review and metanalysis. Heliyon. 2025 Jul 14;11(7):e43618. doi: 10.1016/j.heliyon.2025.e43618.
14. Silva DMDR, Austregesilo CS, Ithamar L, Lima DSL. Therapeutic play to prepare children for invasive procedures: A systematic review. J Pediatr (Rio J). 2017 Jan–Feb;93(1):6–16. doi: 10.1016/j.jped.2016.06.005.
15. Hiwale S, Ganvir DV. Assess the effectiveness of group play therapy preschool children on reduction of separation anxiety disorder. Int J Sci Res. 2019;8(6):157–60.
16. Kaur G. A study to assess the effectiveness of play therapy in reducing anxiety level among hospitalised children aged 6-12 years. Int J Innov Res Adv Stud. 2017;4(11).
17. Chhillar R, Dabas P, Dular SK. An RCT on effectiveness of play therapy on anxiety among hospitalized children in selected hospital, Greater Noida. Eur J Mol Clin Med. 2020;7(11):6653. Available from: https://www.ejmcm.com.
18. Davidson B, Satchi SN, Venkatesan L. Effectiveness of play therapy upon anxiety among hospitalised children. Int J Adv Res Ideas Innov Technol. 2017;3(5):441–4.
19. Vyas DY, Mikin J, Thakkar B, Bamaniya D, Chaudhari H, Patel N, et al. Play therapy to reduce the anxiety among hospitalized children. Int J Sci Res. 2021 Jun;10(6). doi: 10.36106/ijsr.
20. Ramdaniati S, Hermaningsih S, M M. Comparison study of art therapy and play therapy in reducing anxiety on pre-school children who experience hospitalization. Open J Nurs. 2016;6(1):46–52. doi: 10.4236/ojn.2016.61005.
21. Dalei SR, Nayak GR, Pradhan R. Effect of art therapy and play therapy on anxiety among hospitalized preschool children. J Biomed Sci. 2020;7(2):71–6. doi: 10.3126/jbs.v7i2.34006.
22. Bhoi PP, Das N, Sahoo P, Bhakti Swarupa S. Effectiveness of art therapy vs play therapy on level of anxiety among hospitalized children: A randomized controlled trial. Turk J Physiother Rehabil. 2022;32(3):39552–62.
23. Gazestan ME, Heydari A, Makvandi B, Moradimanesh F. The effect of group therapy on anxiety in children diagnosed with leukaemia. Prev Care Nurs Midwifery J. 2021;11(2):49–55. doi: 10.52547/pcnm.11.2.49.

Background: Hospitalization in early childhood often triggers significant fear, anxiety, stress, and distress due to parental separation, unfamiliar environments, and medical procedures, which can hinder recovery and emotional stability. Play, a natural mode of self-expression, supports children’s physical, emotional, social, and cognitive development and serves as a non-pharmacological intervention that promotes coping and relaxation. Aim: This systematic review aims to evaluate the efficacy of play-based interventions in reducing separation anxiety among hospitalized children, below five years of age. Methods: A systematic review was conducted through comprehensive searches of PubMed, Scopus, CINAHL, ProQuest, and Wiley Online Library databases for English-language articles published between 2015–2025. Search terms included Play-based interventions, Therapeutic play, Separation anxiety, Hospitalized children, Children under five years, and Pediatric anxiety. The searches were carried out from September 2023–July 2025 and studies were critically reviewed and synthesized. Results: n = 20 were included in the review. These studies reveal that the play-based interventions significantly reduce separation anxiety in hospitalized children by enhancing emotional adjustment and fostering coping strategies. It also decreases pain during invasive and noninvasive procedures, the preoperative period, postoperative pain, additionally it provides distraction of mind in cast removal, improves positive emotions in children with leukemia and emotional well-being of children and decreases separation anxiety in hospitalized children. Conclusion:Studies strongly support that play interventions significantly enhance the well-being of hospitalized children. Play therapy in pediatric setting is essential for improving emotional adjustment and promoting holistic recovery in this vulnerable population through structured and unstructured play activities. Pediatric nurses should possess adequate knowledge of the benefits of therapeutic play and organize training programs ensuring integration care in clinical setting.

Keywords:Children under five years, hospitalized children, pediatric anxiety, play-based interventions,
separation anxiety, therapeutic play

🔒 This is a subscription article

Full text is available to subscribers and institutional members. Please choose an option below to access it.

1. Godino-Iáñez MJ, Martos-Cabrera MB, Suleiman-Martos N, Gómez-Urquiza JL, Vargas-Román K, Membrive-Jiménez MJ, et al. Play therapy as an intervention in hospitalized children: A systematic review. Healthcare (Basel). 2020 Jul 29;8(3):239. doi: 10.3390/healthcare8030239.
2. Obeidat H, Alsharydeh EA, Constantino RE. The effects of preoperative recreational activities on children's anxiety level during the perioperative period. Int J Rural Dev Environ Health Res. 2020;7(3):58–67.
3. Li CHW, Chung KOJ, Ho YK, Kwok CMB. Play interventions to reduce anxiety and negative emotions in hospitalized children. BMC Pediatr. 2016;16:36. doi: 10.1186/s12887-016-0570-.
4. Bajpai A, Illayaraja BS, Muninarayanappa NV, Nageshwar V. Assessment of anxiety among hospitalized children. Indian J Public Health Res Dev. 2017;8(2):113–6. doi: 10.5958/0976-5506.2017.00093.6.
5. Silva SGT, Florino CMF, Damiao C, Campos LM, Rosato LM. Influence of therapeutic play on the anxiety of hospitalized school-age children: Clinical trial. Rev Bras Enferm. 2017;70(6):1244–9. doi: 10.1590/0034-7167-2016-0353.
6. Effectiveness of art therapy on level of anxiety among hospitalized children. Int J Sci Res. 2023 May;12(5):707–9. Available from: https://www.ijsr.net/archive/v12i5/SR23509084536.pdf.
7. Harnilawati, Asrianto. The effect of application of play therapy on the anxiety level of hospitalized preschool children at RSUD Haji Provinsi Sulawesi Selatan. Int J Sci Technol Manag. 2(6):1989–94.
8. El Berry KI, Osman ZA, El Malky MI, El Nagar MA, Ebrahem SM. The effect of play techniques on separation anxiety among preschool children. Int J Novel Res Healthc Nurs. 2018 Jan-Apr;5(1):227–35. Available from: noveltyjournals.com.
9. Nezhad ZM, Pakdaman F, Goodarzi MA. Effectiveness of child-centered group play therapy and narrative therapy on preschoolers’ separation anxiety disorder and social-emotional behaviours. Early Child Dev Care. 2023;193(6):841–53. doi: 10.1080/03004430.2023.2167987.
10. Wong LC, Ip YW, Kwok CMB, Choi CK, Ng WKB, Chan HWC. Effects of therapeutic play on children undergoing cast-removal procedures: A randomised controlled trial. BMJ Open. 2018;8(7):e021071. doi: 10.1136/bmjopen-2017-021071.
11. Paul M, Das N, Sahoo P. Effectiveness of play therapy during hospitalization in reducing anxiety among 6-12-year-old children. J Adv Res Psychol Psychother. 2020;3(3-4):8–14. doi: 10.24321/2581.5822.202008.
12. More R. Effectiveness of play therapy on anxiety among hospitalized children at selected hospitals. Int J Sci Res. 2019;8(2):176–80. Available from: https://www.ijsr.net/archive/v8i2/ART20195659.pdf.
13. Martín-Villena MC, Gonzalez-Díaz A, Gomez-Urquiza JL, Suleiman-Martos N, García-Lara R, Ibarrondo-Crespo R, et al. Effects of play therapy in children with cancer: A systematic review and metanalysis. Heliyon. 2025 Jul 14;11(7):e43618. doi: 10.1016/j.heliyon.2025.e43618.
14. Silva DMDR, Austregesilo CS, Ithamar L, Lima DSL. Therapeutic play to prepare children for invasive procedures: A systematic review. J Pediatr (Rio J). 2017 Jan–Feb;93(1):6–16. doi: 10.1016/j.jped.2016.06.005.
15. Hiwale S, Ganvir DV. Assess the effectiveness of group play therapy preschool children on reduction of separation anxiety disorder. Int J Sci Res. 2019;8(6):157–60.
16. Kaur G. A study to assess the effectiveness of play therapy in reducing anxiety level among hospitalised children aged 6-12 years. Int J Innov Res Adv Stud. 2017;4(11).
17. Chhillar R, Dabas P, Dular SK. An RCT on effectiveness of play therapy on anxiety among hospitalized children in selected hospital, Greater Noida. Eur J Mol Clin Med. 2020;7(11):6653. Available from: https://www.ejmcm.com.
18. Davidson B, Satchi SN, Venkatesan L. Effectiveness of play therapy upon anxiety among hospitalised children. Int J Adv Res Ideas Innov Technol. 2017;3(5):441–4.
19. Vyas DY, Mikin J, Thakkar B, Bamaniya D, Chaudhari H, Patel N, et al. Play therapy to reduce the anxiety among hospitalized children. Int J Sci Res. 2021 Jun;10(6). doi: 10.36106/ijsr.
20. Ramdaniati S, Hermaningsih S, M M. Comparison study of art therapy and play therapy in reducing anxiety on pre-school children who experience hospitalization. Open J Nurs. 2016;6(1):46–52. doi: 10.4236/ojn.2016.61005.
21. Dalei SR, Nayak GR, Pradhan R. Effect of art therapy and play therapy on anxiety among hospitalized preschool children. J Biomed Sci. 2020;7(2):71–6. doi: 10.3126/jbs.v7i2.34006.
22. Bhoi PP, Das N, Sahoo P, Bhakti Swarupa S. Effectiveness of art therapy vs play therapy on level of anxiety among hospitalized children: A randomized controlled trial. Turk J Physiother Rehabil. 2022;32(3):39552–62.
23. Gazestan ME, Heydari A, Makvandi B, Moradimanesh F. The effect of group therapy on anxiety in children diagnosed with leukaemia. Prev Care Nurs Midwifery J. 2021;11(2):49–55. doi: 10.52547/pcnm.11.2.49.