DEPARTMENT Product Showcase

ChildrenÕs Books for Use

in Bibliotherapy
Anna Tielsch Goddard, MSN, RN, CPNP-PC

KEY WORDS Bibliotherapy-that is, the use of written materials to

Coping with chronic illness, medical childrenÕs books, death gain understanding and engage in problem solving
& dying, childrenÕs medical literature, bibliotherapy relevant to the personÕs therapeutic needs-has been ex-
plored as a successful method in communicating illness
to pediatric patients (Marrs, 1995; Thibault, 2004). The
Reading to children is central to their development. term ‘‘bibliotherapy’’
Books provide a safe medium for children to explore was first used by S. M. Reading to children
different concepts, feelings, and attitudes while allow- Crothers in 1916 to de-
ing them to better understand their environment, scribe the use of books
increases self-
community, and societal expectations. Reading to to help patients under- esteem, gives
children increases self-esteem, gives comfort, and may stand their health prob- comfort, and may
aid children in coping with difficult situations. lems and symptoms.
Communication of a medical diagnosis to children can Briggs and Pehrsson
aid children in
elicit questions and further discussion, especially in (2008) reported that coping with difficult
children with chronic diseases. Explaining the possibility librarians in the 1930s situations.
of a life-threatening condition to an ill child, as well as compiled lists of books
the nature of his or her diagnosis, is a difficult task for to assist clients with concerns similar to the bibliother-
trained clinicians, and it often evokes fear and anxiety apy lists used today. Thibault (2004) emphasizes that
in parents (Last & Veldhuizen, 1996). Grief, loss, and the key to bibliotherapy is using the story as a way to be-
death cause emotional distress and psychological gin a discussion of issues and should be used as a substi-
trauma that often leads to depression and anxiety tute for dealing with problems.
(Briggs & Pehrsson, 2008). For bibliotherapy to be successful, the child first
needs to identify with the characters in the story who
Section Editor are coping with similar issues (Gregory & Vessey,
Juanita Conkin Dale, PhD, RN, CPNP-PC 2004; Thibault, 2004). The reader then must become
ChildrenÕs Medical Center emotionally involved in the story and finally have
Dallas, Texas insight or a realization that the characters in the book
worked through solutions to their problems. The
Anna Tielsch Goddard, Pediatric Nurse Practitioner, Advanced
Practice Services, ChildrenÕs Medical Center Dallas, Dallas, TX.
child then may begin to understand that his or her
issues can be solved using a similar solution (Gregory
Conflicts of interest: The author has served on an NP/PA Advisory
& Vessey; Thibault, 2004; Tu, 1999).
Board Committee for Alcon Laboratories.
Children who receive open information about their
Correspondence: Anna Tielsch-Goddard, MSN, RN, CPNP-PC, diagnosis and prognosis at the initial stage of their dis-
Advanced Practice Services, ChildrenÕs Medical Center Dallas,
1118 Seminary Ridge, Garland, TX 75043; e-mail: tielscha@yahoo.
ease show significantly less anxiety and depression
com. (Last & Veldhuizen, 1996). The use of literature as a me-
dium for children to cope with their problems helps
J Pediatr Health Care. (2011) 25, 57-61.
them recognize that they are not alone as they relate
0891-5245/$36.00 to the story discussion (Tu, 1999). ChildrenÕs books
Copyright Q 2011 by the National Association of Pediatric allow children to share their feelings and can provide
Nurse Practitioners. Published by Elsevier Inc. All rights an opening to discuss other difficult topics such as
reserved.
a chronic illness in a family member, a friend, or them-
doi:10.1016/j.pedhc.2010.08.006 selves (Kurkjian & Livingston, 2005).

www.jpedhc.org January/February 2011 57

 Books also provide structured communication
BOX 1. Criteria for selecting childrenÕs
between two individuals, which is particularly helpful
literature
when dealing with difficult subject matter. Bibliother-
apy has been used to open communication between  Provides motivating and challenging experiences
children, parents, and teachers (Amer, 1999; Gregory  Is suitable for age, ability, and maturity
& Vessey, 2004). The use of bibliotherapy in clinical  Elicits critical and personal responses
domains has increased in recent years in order to  Represents a range of literacy structures
promote therapeutic gain (Amer, 1999; Gregory &  Entails proper use of language
Vessey, 2004; Mazza, 2003; Pehrsson, Allen, Folger,  Broadens understanding of diversity
McMillen, & Lowe, 2007). Narratives outside the  Develops sensitivity and understanding of differences
childÕs individual situation provide story lines that aid Adapted from Newfoundland Canada Department of
in the understanding of his or her own personal Education. (2008). Criteria for selecting childrenÕs literature.
feelings and help children realize that they are not Selecting childrenÕs literature: An annotated bibliography.
alone in their situation (Heath, Sheen, Leavy, Young, Retrieved from http://www.ed.gov.nl.ca/edu/k12/
& Money, 2005; Pehrsson et al., 2007). With the curriculum/documents/english/biblio46/criteria_for_
correctly chosen book, story characters can provide selecting_childrens_literature.pdf
an exemplar to guide the patient through distress or
challenges (Pehrsson et al., 2007). trauma, sudden loss, and loss of a pet), and illness. Ti-
Research also has shown that the use of story charac- tles can be found at www.compassionbooks.com.
ters as models for the patient can foster self-efficacy Monroe County Public Library (2008) provides an
and coping skills (Early, 1993; Jasmine-DeVias, 1995). extensive list of books for children concerning diseases,
Gregory and Vessey (2004) explored the use of disorders, and learning differences. Topics include at-
childrenÕs books as a successful intervention strategy tention deficit disorder (ADD), attention deficit hyperac-
for school nurses to help students with bullying. They tivity disorder (ADHD), acquired immune deficiency
found that through the use of bibliotherapy, children be- syndrome (AIDS), autism, cancer, cerebral palsy, use
gan to communicate their own experience with bullying of a wheelchair, braces, or crutches, and mental retarda-
and have been able to develop coping strategies to deal tion, to name a few, and include differentiation of picture
with teasing and harassment (Gregory & Vessey, 2004). books, chapter books, and early childhood designa-
Before speaking with children about their illness, the tions. This book list can be found at www.monroe.lib.
parents or caregivers should prepare themselves and ap- in.us/childrens/booklists/disabilitybib.html.
proach the subject slowly and cautiously so as not to over- Magination Press publishes psychology-based chil-
whelm the child. Books need to be carefully matched to drenÕs books covering a broad range of pediatric topics
the childÕs various problems and developmental level from starting school and family growth to serious
so the child can identify with the fictional character psychological, clinical, and medical issues including
and follow the events of the storyline (Kurkjian & depression, anxiety,
Livingston, 2005); this ultimately will emotionally involve bullying, and death. Monroe County
the child in the story (Gregory & Vessey, 2004). The child These books are writ-
then will be able to express his or her feelings under safe ten by doctoral pre- Public Library
conditions and through the characters. Insight occurs pared psychologists provides an
when the readers become aware that their problems are and other experts who extensive list of
not entirely unique and can be solved or addressed as work with children.
they were in the book (Gregory & Vessey, 2004). Magination Press, affili- books for children
ated with the American concerning
BOOK LISTS Psychological Associa- diseases, disorders,
Books for children should be developmentally appro- tion, includes a ‘‘Note
priate, well written, and appealing to the child to Parents’’ by certified and learning
(Thibault, 2004). Many resources are available that doctoral-level psychol- differences.
carefully select and review titles for different situations, ogists working in the
and most of the lists provide annotation of the story field offering parenting tips and explaining issues in
topic. Different criteria should be considered for select- the context of the book. These literary works explore
ing childrenÕs literature (see Box 1). feelings over different experiences and how to achieve
Compassion Books (2010) offers books that help a practical yet comprehensive resolution. Publications
children and young adults through serious illness, can be found for young children (ages 4 to 8 years
death, loss, and grief. They provide a compilation of old), middle school readers (ages 9 to 13 years old),
more than 400 titles on a variety of topics organized and nonfiction books and workbooks for older children
for children, teens, and adults. Different categories in- (ages 9 to 13 and 13 and above). Many of their books
clude bereavement, losses (including divorce, suicide, have won the ‘‘Moonbeam ChildrenÕs Book Award for

58 Volume 25  Number 1 Journal of Pediatric Health Care

 BOX 2. Selected bibliography from Magination Press

 Sometimes IÕm Scared by Jane Annunziata, PsyD, & Marc Nemiroff, PhD
– Outlines steps children can use to overcome everyday fears
 I Want Your Moo: A Story for Children about Self-Esteem by Marcella Bakur Weiner, EdD, PhD, & Jill Neimark
– Illustrates self-esteem and confidence through relatable animal characters
– A ‘‘Note to Parents’’ reviews strategies for helping children overcome a lack of confidence
and self-esteem
 Uncle WillyÕs Tickles: A ChildÕs Right to Say No by Marcie Aboff
– A child is uncomfortable with the way his uncle likes to play and strategizes how to deal with the situation
– A ‘‘Note to Parents’’ discusses touching by other people and that your body belongs to you
 Sammy the Elephant & Mr. Camel: A Story to Help Children Overcome Bedwetting by Joyce C. Mills, PhD,
and Richard J. Crowley, PhD
– Overview of enuresis and the ridicule, rejection, and stress it may cause young children and their parents through sym-
bolism and a friendship between an elephant and a camel; themes include encouragement and confidence building
– A ‘‘Note to Parents’’ discusses enuresis and gives tips on helping their children remain dry
 Clouds and Clocks: A Story for Children Who Soil by Matthew Galvin, MD
– A child with encopresis receives interventions from a physician and therapist while exploring the feelings
and causes of soiling
 Otto Learns About His Medicine: A Story about Medication for Children with ADHD by Matthew Galvin, MD
– A metaphor for ADHD helps the reader understand the disorder and treatment involved; a child with a motor that runs
too fast goes to a mechanic so that he is able to focus and become organized
– A ‘‘Note to Parents’’ discusses ADHD treatment, medications, and possible side effects
 Tibby Tried It by Sharon and Ernie Useman
– A young bird deals with physical disability, ridicule, bullying, and overcoming diversity and challenges
 My Big Fat Secret: How Jenna Takes Control of Her Emotion and Eating by Lynn R. Schechter, PhD
– An overweight middle school student deals with bullying and overeating as a way to deal with her emotions; themes
include identifying emotional triggers, becoming healthier, and creating an action plan to deal with overeating
 Full Mouse, Empty Mouse: A Tale of Food and Feelings by Dina Zeckhausen, PhD
– Two mice deal with stressful events by eating to soothe emotions and not eating altogether
 Lions ArenÕt Scared of Shots: A Story for Children about Visiting the Doctor by Howard J. Bennett, MD
– A child is afraid of receiving vaccines at her doctorÕs office and uses her imagination to calm her fears
– A ‘‘Note to Parents’’ includes advice and tips for helping children feel comfortable and brave with routine checkups,
sick visits, shots, and other medical procedures
 Why Are You So Sad? A ChildÕs Book about Parental Depression by Beth Andrews, LCSW
– An interactive book for children with parents who are experiencing depression that explains depression and treatment
in terms kids can understand, provides reassurance that parents can get better, explores feelings related to parental
depression, and helps children express their feelings around these situations; practical tips are included for helping
children deal and cope with a parentÕs depression
 You Can Call Me Willy: A Story for Children About AIDS by Joan C. Verniero
– An 8-year-old with AIDS discusses her life, her illness with its symptoms, and the side effects of the treatment; themes
throughout the story include bullying, a diagnosis of AIDS, and fears related to the disease, as well as coping
mechanisms

Juvenile Fiction’’ including ‘‘Mind over Basketball: Coach a metaphor for death through transformation and ad-
Yourself to Handle Stress’’ and ‘‘Circle of Three: Enough dresses feelings of sadness, fear, anger, and compassion.
Friendship to Go Around?’’ A selected list of topics and Annunziata discusses talking to children about death
books through Magination Press are included in Box 2. and dying and includes detailed exercises to help chil-
dren cope with pain and fear. Gentle Willow was written
RECOMMENDED READING with the premise that ‘‘although there are not medical
Several books that are good examples of bibliotherapy cures for many illnesses, we can still provide a loving
use for children with chronic conditions are listed below. atmosphere in which healing can occur on an emotional
and spiritual level of life’’ (Mills, 2004, p. 1).
Gentle Willow: A Story for Children about Dying The story follows a small squirrel named Amanda
Gentle Willow (Mills, 2004) (Figure 1) was written by whose closest friend in the forest, a willow tree, is ‘‘look-
child psychologist Joyce Mills with a ‘‘Note to Parents’’ ing and feeling different.’’ Amanda tries to get tree
by Jane Annunziata, PsyD. Gentle Willow addresses wizards, which the reader would identify as the care
children who may not survive their illness and other providers, doctors, nurses, or other clinicians, to help
children who are in the patientÕs life. The book presents Willow. After becoming angry and frustrated when the

www.jpedhc.org January/February 2011 59

 FIGURE 1. Gentle Willow: A Story for Children FIGURE 2. Little Tree: A Story for Children with
about Dying by Joyce Mills, PhD. Reproduced Serious Medical Problems by Joyce Mills, PhD.
with permission of the American Psychological Reproduced with permission of the American
Association. Psychological Association.

tree wizards cannot make Willow better, Amanda learns the emotional feelings that come with physical illness.
that the tree wizards can help her feel comfortable Fear, confusion, helplessness, and hopelessness are
through songs, stories, and giving her love. The wizards common themes used as a metaphor of healing.
remind WillowÕs friends of all the memories and gifts she Little Tree experiences a severe wind storm in which
has provided the forest and that they are only saying her branches are broken and her leaves are lost, which
goodbye to Willow as ‘‘they know her today.’’ When is an analogy for a child who is experiencing bodily
Willow becomes scared, Amanda reminds her of when harm or illness. When the bad storm is over, Amanda
the yellow butterfly friend was once a caterpillar and is Squirrel goes for help to the tree wizards, again the sym-
now in a different form and body. bolic health care clinicians. The tree wizards carefully
Annunziata advises parents not to lie to the child or inspect every aspect of Little Tree. They provide her
provide unrealistic optimism but not to take away all with care to make her feel better and repair what they
possibilities of hope either. She emphasizes that the can, representing different psychological and medical
child should not be deprived of discussing fears about approaches to treatment. Amanda Squirrel learns how
dying and to place all emphasis on helping the child to provide comfort to her friend through ‘‘magic happy
cope with the realities of getting through each day. breath’’ and other relaxation exercises. As Little Tree
Although religion and God are absent in the bookÕs heals, she deals with questions of why this incident
words and story, parents who wish to instill belief in happened to her, coupled with feelings of anger and
life after death and heaven in their children can very frustration about her new appearance. Little TreeÕs
easily transpose different thoughts and suggestions of discomfort with her new appearance provides a vi-
their faith throughout key moments in the storyline. gnette for children with serious medical problems,
Authors discuss that some families may find it helpful such as amputation or other bodily dysmorphism.
to talk about religious beliefs for comfort.
A Friend like Simon: A Story about Autism
Little Tree: A Story for Children With Serious Published by Special Stories Publishing, the Special
Medical Problems Stories Series are designed to teach children about
The Little Tree story (Mills, 2003) (Figure 2) is about special needs and the importance of accepting others
a friend mentioned in Gentle Willow and addresses who are different from themselves. A Friend like Simon:

60 Volume 25  Number 1 Journal of Pediatric Health Care

A Story about Autism (Gaynor, 2009) is narrated by Heath, M. A., Sheen, D., Leavy, D., Young, E., & Money, K. (2005).
a young student, Matthew, who befriends another Bibliotherapy: A resource to facilitate emotional healing and
growth. School Psychology International, 26, 563-580.
student, Simon, who is very different from his other class- Jasmine-DeVias, A. (1995). Bibliotherapy: Books that can play a role
mates. The story carefully introduces the reader to Simon in helping children work through some of the effects of abuse
and all of his textbook autistic characteristics. Matthew and neglect. New England Reading Association Journal, 31,
continues to invite Simon to play or have lunch with 2-17.
the other students even though Simon often is echolalic Kurkjian, C., & Livingston, N. (2005). The right book for the right child
for the right situation. Reading Teacher, 58, 786-795.
or nonresponsive to him, and Matthew points out to the Last, B., & Veldhuizen, V. (1996). Information about diagnosis and
other students that it is okay to be different. In the book prognosis related to anxiety and depression in children with
a classic childhood bully allows the reader the safety of cancer aged 8-16 years. European Journal of Cancer, 32,
watching both Matthew and Simon react to rejection 290-294.
and harassment. The story line is appropriate for a variety Marrs, R. (1995). A meta-analysis of bibliotherapy studies. American
Journal of Community Psychology, 23, 843-870.
of age ranges, but it can be used for the school-age child Mazza, N. (2003). Poetry therapy: Theory and practice. New York:
as both a therapeutic and teaching tool. The close of the Brunner Routledge.
book provides a ‘‘note for grownups’’ on autism with Mills, J. (2004). Gentle willow: A story for children about dying (2nd
identifying symptoms and explanation of the diagnosis. ed.). Washington, DC: Magination Press.
Mills, J. (2003). Little tree: A story for children with serious medical
problems (2nd ed.). Washington, DC: Magination Press.
REFERENCES Monroe County Public Library. (Updated 2008 May 22). Books
Amer, K. (1999). Practice applications of research. Bibliotherapy: Us- for children concerning diseases, disorders, and learning
ing fiction to help children in two populations discuss feelings. differences. Retrieved from the Monroe County Public Library
Pediatric Nursing, 25, 91-95. website: www.monroe.lib.in.us/childrens/booklists/disabilitybib.
Briggs, C. A., & Pehrsson, D. E. (2008). Use of bibliotherapy in the html
treatment of grief and loss: A guide to current counseling Newfoundland Canada Department of Education. (2008). Criteria for
practices. AdultSpan Journal, 7, 32-42. selecting childrenÕs literature. Selecting childrenÕs literature: An
Compassion Books. (2010). The books of Compassion Press. Re- annotated bibliography. Retrieved from http://www.ed.gov.nl.
trieved from Compassion Books website: www.compassion ca/edu/k12/curriculum/documents/english/biblio46/criteria_
books.com for_selecting_childrens_literature.pdf
Crothers, S. M. (1916). A literary clinic. Atlantic Monthly, 118, 291-301. Pehrsson, D. E., Allen, V., Folger, A., McMillen, P., & Lowe, I. (2007).
Early, B. P. (1993). The healing magic of myth: Allegorical tales and Bibliotherapy with preadolescents experiencing divorce. The
the treatment of youngsters of divorce. Child and Adolescent Family Journal, 15, 409.
Social Work Journal, 10, 97-106. Thibault, M. (2004). ChildrenÕs literature promotes understanding
Gaynor, K. (2009). A friend like Simon: A story about autism. Dublin, (The University of North Carolina at Chapel Hill, School of
Ireland: Mark Mitchell Publishing and Consultancy. Education). Retrieved from www.learnnc.org/lp/pages635?
Gregory, K. W., & Vessey, J. A. (2004). Bibliotherapy: A strategy to style=print
help students with bullying. The Journal of School Nursing, Tu, W. (1999). Using literature to help children cope with problems.
20, 127-133. Bloomington, IN: ERIC Clearinghouse.

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