PHILADELPHIA -- Alyia D'Ambrosio, 5, tied a rubber tourniquet on her patient's arm and searched for a vein.

"Got it!"

She inserted an IV needle -- a real needle -- into Chip, a cloth doll bigger than she is. Then she carefully cleaned the tip of a plastic tube with alcohol before adding a drug "for his heart infection." She knew it might not work.

"I'm going to do what I can," said Alyia, who has been through a dozen grueling operations to open intestines that were blocked at birth and have been cut to a fraction of their normal length.

Babies with her condition rarely live past infancy. Her prognosis -- even her next surgery -- is unknown.

"She was trying to figure out how to fix his 'heart condition.' She's not sure how the doctors are going to deal with hers," said Hilary Phillips, a child life specialist at Children's Hospital of Philadelphia, after Alyia's half hour of "medical play."

About 35 staffers help patients conduct such play at Children's Hospital.

The program is one of more than 400 similar efforts in the United States and Canada, according to the American Academy of Pediatrics.

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The idea is to lessen the terror that children may feel before a procedure. Research shows that structured play can reduce stress.

"Play is a child's work," said Elana Tenhuisen, child life director at Children's Hospital. "That's how they learn about the world that they're involved in."

Children make puppets out of tongue depressors. They put bandages on dolls and wear sterile "bunny suits" before an operation, just as the surgeons do. Specialists say that working with a petrified child before a minor procedure can help avoid sedation.

For kids who are hospitalized over long periods, guided play can promote natural growth and development and make their world a little more normal.

For Alyia D'Ambrosio, play sessions once or twice a week made the six surgeries, constant tests, multiple X-rays and weekly catheter cleanings almost bearable.

Usually the child care specialist would lead her to a small playroom filled with board games, books, videos, cloth dolls, and a tray overflowing with gauze, Band-Aids, tubes, surgical caps and stethoscopes..

They would talk about her latest medical experience, then Alyia would don a surgical cap and begin to play.

Besides working with her on medical play, Hilary Phillips would often help prepare Alyia for surgeries.

"When there is going to be a procedure," said her mother, Linda D'Ambrosio, "Alyia will say, 'Hilary's going to take me! Call Hilary!'"

A week before she was released, unexpected intestinal bleeding sent the girl to the operating room.

"They paged Hilary," her mother said, "and they actually waited. Hilary came running."

The child care specialist caught up with the little girl in the pre-op area, she said, then they both got into bunny suits and went into the operating room together.