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Deirdre E. Logan, PhD
Children's Hospital Boston
Boston, USA

Associate Editor:
Abbie L. Jordan, PhD
University of Bath
Bath, UK

Copyright © 2024,
Special Interest Group on
Pain in Childhood,
International Association
for the Study of Pain®,

ISSN 1715-3956

Information appearing in Pediatric Pain Letter is not reviewed by, and is not necessarily endorsed by, the Special Interest Group on Pain in Childhood, nor by IASP ®.

Vol. 26 No. 1

February 2024

Book Review

Empowering children through imagination to overcome pain

The Dream Machine

Amarante C (2023). Tellwell Talent, 126 pp. ISBN 978-0228846529
(Paperback: $16.00 USD). Link

Reviewed by Jana Kaoussarani

printable version (PDF)

TIt goes without saying that everyone is likely familiar with the concept of a time machine: a hypothetical invention that allows traveling through time and experiencing past or future events. Such an idea has been explored in books and movies for centuries, driven by people’s desire to change their present by correcting their past through time travel. However, we all know too well that instead of focusing on changing what has happened (or what will happen), a more realistic perspective would be to deal with present, undesirable events such as injuries and illness. This is particularly true for hospitalized children who experience a lot of pain. The book, The Dream Machine, suggests alternative, distracting ways for hospitalized children to deal with their acute and/or chronic pain by allowing their imagination to flourish upon being immersed in the story, enabling them to better tolerate pain.

The Dream Machine is an illustrated children’s book designed to help children aged five years and older, as well as their parents, to learn to deal with acute and chronic pain. The story mainly revolves around Skylar, an 8-year-old ski enthusiast and prodigy, who broke her femur in a ski accident. The story also involves Skylar’s 16-year-old sister, Ashling, who often deals with broken bones as she lives with a severe type of osteogenesis imperfecta, a chronic condition that makes one’s bones very fragile and weak causing them to break often (www.niams.nih.gov/health-topics/osteogenesis-imperfecta). Skylar is devastated upon hearing the most dreadful news: she will not be able to practice her favorite sport for some time due to her broken femur. Ashling tries to cheer Skylar up by playing a game called the dream machine. Ashling had invented this game when she was younger as a way for her to deal with her many broken bones; she believes the game can also help her younger sister. In that alternate world, Skylar’s dreams come true, her imagination runs wild, and she learns to deal with the pain of her injury. The game distracts Skylar from the pain she feels in real life while being transported to an imaginary world. Courage, perseverance, and human connection are powerful themes embedded throughout this light-hearted book.

The Dream Machine has 126 pages, of which the first 60 pages (divided into 7 chapters) pertain to the story itself, followed by 30 pages detailing useful information (e.g. how casts work, recovering from broken bones, how X-rays work, how to cope with pain) for parents with unwell children. A further 12 pages of educational activities are included. Although complex medical concepts are introduced, they are explained concisely using simple language. For example, Ashling describes her disease (osteogenesis imperfecta) in simple terms as a condition that affects the bones making them more fragile. She also explains the different types of this disease, hers being a severe type III. Of note, The Dream Machine was edited by Dr. Argerie Tsimicalis, a nurse scientist at the Shriners Hospitals for Children–Canada, ensuring credibility of the medical information provided.

When the story shifts to the dream machine’s world, the color palette changes from less saturated, dull blue surroundings (as is the case in this hospital setting) to many vibrant hues of lively and intense colors, allowing the reader to better follow the sequence of events. Following the story, there are multiple pages of information that range in breadth and depth from detailed explanations on osteogenesis imperfecta, hospital procedures, and techniques to advice for parents of children dealing with pain. To further charm young readers, the book includes a dozen pages of fun, educational activities such as coloring, mandalas, spelling practice, a search and spell, a word search, and origami. Overall, this book provides a comprehensive and engaging experience, with the story and supplementary sections catering to both parents and children. I have to say though that reading The Dream Machine pre-publication on a screen made it feel a bit long, but I am certain the feeling would be different holding a hard copy.

In terms of story themes and emotions, The Dream Machine showcases different themes as the story progresses and highlights many challenging events and emotions in an athlete’s career, especially when experiencing an injury that entails pain and mental stress. Courage, perseverance, determination, representation of women in sports, as well as the importance of coping mechanisms and family support are the main underlying themes. Predominantly, family support and a healthy connection between siblings, as the one between the two sisters, are repeatedly portrayed. Also, all sorts of emotions are disclosed as Ashling continues to manage her chronic pain while helping Skylar overcome her acute pain. Skylar is portrayed as being terrified and feeling excluded after her accident; she will not be able to practice the sport she adores and compete with her team in the next ski season. Feeling sad and angry, Skylar does not know how to deal with her disappointment, and she is very aware of the fact that it will take her months to get back to the same mobility she had before the incident. This is when the dream machine comes to the rescue.

The illustrations created by Dave Reed are simply fascinating. My favorite is that of a landscape filled with candy, along with its colorful rainbow waterfall, sweet marshmallows, popsicles, and chocolate toppings, all complementing each other in a joyous manner. The characters in the book are a combination of humans (e.g. Skylar, Ashling, the physician) and cartoon like creatures (e.g. Skylar’s stuffed animals that come to life while playing the dream machine, riding a gigantic eagle). More importantly, the illustrations are more than just decorative; they intertwine with the narrative and help better understand the themes and concepts explored. The vibrant colors bring the story to life, becoming more saturated as the characters are immersed into the dream machine, thereby amplifying the fantastical aspect of the storyline. The cartoonish style, soft lines, and fine details give the artwork a dream-like feel, which draws young readers into the story’s universe. The characters’ expressive faces and body language allow for a deeper understanding of the story. The artist does an appreciable job illustrating the various ambiances and backgrounds. The images’ style and colors provide readers with a multisensory experience. Personally, I felt completely immersed in the story and fully enjoyed the adventure.

The story takes place in the Canadian city of Montreal, a culturally diverse environment where many cultures coexist. People with different ethnicities are shown, demonstrating either an intentional effort for inclusion and diversity by the author or perhaps a mere representation of the multicultural background of the Montreal cosmopolitan area. Foremost, part of the story includes Irish folklore, as evident from illustrations of a leprechaun character. Additionally, Muslim women are portrayed in the field of medicine as practicing healthcare professionals, negating the unfounded image of the oppressed veiled Muslim woman. Skylar’s doctor is pictured wearing a hijab, a head covering worn by Muslim women to express their religious beliefs.

As an athlete myself, this book speaks to me on so many levels. I, too, have experienced many injuries and setbacks in my main competitive sport (artistic gymnastics) that I have practiced for more than a decade. I speak from experience and can confirm that, even now at the age of 18, the psychological dread of being incapable of executing certain elements in gymnastics has lingered with me longer than any physical injury. I know exactly how Skylar feels as I have dealt with acute pain myself. Thinking back to my earlier days, I would have liked to play a game like the dream machine to learn to manage my pain and truly believe that tomorrow would be a different reality. This virtual concept can help not only young athletes suffering from an injury, but also children experiencing all sorts of pain. The healing power of the imagination cannot be undermined.

The Dream Machine is a captivating, must-read children’s book that explores the power of imagination and resilience in the face of adversity while providing educational content for children and parents. This book can be appreciated by young children (aged 5 and up) and by parents of sick children. As American fantasy and science fiction writer Patricia A. McKillip once said: “Imagination is the golden-eyed monster that never sleeps. It must be fed; it cannot be ignored." (www.goodreads.com/quotes/503997). This quote beautifully complements the essence of The Dream Machine, reminding us that embracing our imagination can make adverse life events just a tiny bit more bearable.

Jana Kaoussarani
College de Bois-de-Boulogne, Montreal, QC, Canada
email: kaoussaranijana[at]gmail.com

Cite as: Kaoussarani J. Empowering children through imagination to overcome pain. Book review: The Dream Machine. Pediatric Pain Letter 2024;26(1):5-8. ppl.childpain.org