Art therapy is becoming part of the care for children in hospital for severe disease, be it cancer or a chronic condition. Expressions of sick children are revealed in their art, mostly in drawings and other handicrafts. They provide a way for adults to know how they are experiencing their world inside the hospital, the relationship with their families and with the staff, pain, anxiety, nostalgia, dreams, and wishes. The language of children is unsophisticated and can be understood through their drawings. Children use symbols and images to represent elements in circumstances they are trying to understand. The purpose of this chapter is to show how art can be the easiest way for sick children to communicate, and how it can become their own therapeutic agent through a self-healing mechanism.
Keywords: Art Therapy for Sick Children; Children’s Communication through Art Therapy; Drawings in Hospital Care
“Anyone who has viewed Picasso’s powerful painting of the effects of war on the Spanish town of Guernica is aware of the power visual imagery has in depicting trauma, violence and acts of aggression.” (Cathy Malchiodi 1997) 
Leukemia could be considered a traumatic event that disrupts everyday life due to the frequent hospitalizations that are needed. In some cases, this involves moving from familiar surroundings in order to be near a hospital, which results in the loss of familiar objects, school and peers. The sick child may perceive the anxiety felt by his/her parents that are linked to the diagnosis, the prognosis and the uncertainty of how effective therapy will be . Art is a natural form of self-expression for children - it is one way that allows them to interact with, and understand their environment. Observing sick children while they play and draw has only recently been considered important, both during hospitalization and in the out-patient clinic. Psychological treatment, research and therapy in children is usually dependent upon drawings and other handicrafts. If we are going to provide total care to any sick child, it is indeed important to also consider their future, and to prevent late effects linked to the disease, to therapy and to stress.
Through art therapy, children learn to manage difficult emotions such as fear and anger, and they also learn coping responses through visual images, especially when they have difficulties verbalizing these situations . In such a troublesome situation a child uses verbal communication cautiously, at times he/she feels fear and embarrassment around strangers and around his/her own parents, especially when they are speaking with the health care professionals. Children are afraid of making a poor impression and of being rejected by adults; of being considered inadequate and liar. Inside a hospital a child feels like a stranger because of the uneasiness that accompanies his/her new experience. He/she usually does not receive suitable explanations, though good communication is essential in order to establish any type of alliance. This includes both the therapeutic alliance and the agreement between patients and caregivers that lead to mutual fulfillment. Diagnostic and therapeutic ends are always kept in mind when dealing with sick children. Learning how to communicate with each child is pivotal for good and safe health care.
Nonetheless, since the need to communicate still remains, body language or other forms of expression are put into use, creating a graphic and pictorial form of communication [4,5]. Their need for truth unfolds through artistic signs. Art therapy is the preferred and ideal means of communication with children. They express themselves through drawings, using them as a stage to dramatize their requests, needs, wishes, anxieties, and joys. The language of children is unsophisticated. They use symbols and images to represent elements in circumstances they are trying to understand. The opportunity to express themselves through drawings makes the sick children their own therapeutic agent through a self-healing mechanism .The use of the common language of art may facilitate the development of a relationship with the therapist. This result can be achieved with the help of nonverbal tools, such as play, drawings and other handicraft activities in order to establish a positive therapeutic alliance with the caregivers.
Drawing is an accepted, indeed, preferred activity in hospitals since it is a simple, easy game for children, and it does not disturb life in the ward. The spontaneous drawings can be collected and preserved. Perception of the disease, as well as fears and hopes emerge. The comments written by each adolescent and school-aged child or by the play worker allow us to acquire a better understanding of the painter’s meaning and feelings . Some very interesting data may emerge from longitudinal studies because each child makes several paintings over the course of the year, in different health and emotional states such as disease onset, remission, off-treatment, and relapse. In most cases, drawings and other handicrafts help us to understand and appreciate the improvement in the child’s feelings that comes from the environment, from the psychosocial support closely linked to the achieved results, and from the overall help strategy developed within the Department for the whole family. Loneliness, jealousy, envy over the mother’s special care for the sick brother /sister, worries, and even fantasies of monstrous creatures are frequent feelings that young siblings experience. Observing their drawings is fascinating. A family-centered approach is important for them in order to ensure adjustment and coping, and to avoid post-traumatic stress, and the onset of side effects linked to an unknown internal psychological distress .
As Jung suggests, consciousness can be reached more quickly through handiwork than through intellect . Therefore, we strongly recommend taking art therapy into consideration and including it in the total care of children affected either by cancer or by other severe diseases that require long periods of hospital treatment. In these circumstances, drawings and other handicrafts, accompanied by comments could certainly provide us with a better understanding of the child’s anxieties and feelings.
Traveling back home (with the sword). D. four years old