Introduction

Mary is running around her hospital bed, playing with dolls, crayons and toy stethoscopes (or the real thing if she can get her hands on one). She giggles mischievously, tripping and falling as she evades her mother’s playful swipes and our attempts to examine her. Mary is a regular source of joy on the morning ward round and seemingly a picture of health. That is of course, apart from the two large-bore cannulae exuding from her chest, plunged deep into her malfunctioning heart. Assisting with every contraction, she depends on her ‘Berlin Heart’ (a type of ventricular assist device) to deliver the majority of her systolic output. Mary has dilated cardiomyopathy and has been on the ward for several months now, awaiting a heart transplant. No one knows when this will come.

All of you reading this article will have interacted with preschool-aged children and will be aware of how active they can and should be. You will also be aware of the challenges of keeping even a healthy child from injury. Risky play is an important source of activity for children, typically defined as a subset of play, evoking feelings of thrill and excitement associated with the risk of physical injury. This is sharply put into contrast when we consider Mary, heavily anticoagulated and attached to a fridge-sized, glorified pump by a long tube sewn directly into her left ventricle. She runs, climbs, falls, hops and dances around, unflustered and seemingly unrestricted in her movements, allowed to take risks despite her precarious medical situation. The play team …