Pretend play relates to many areas of adaptive functioning in child development including creativity, coping, and emotion regulation. Though pretend play interventions have been employed in medical settings for decades, there are few empirical studies of such interventions in the literature. A review of literature involving pretend play in medical settings indicates that pretend play interventions are effective in inpatient and outpatient settings for preventing and reducing anxiety and distress. Pretend play also has effects on pain, externalizing behavior, and adaptation to chronic illness. Such effects have been demonstrated in the short term; however they have not been shown to be stable in the long term, indicating that intermittent refresher sessions may be necessary. The sparse empirical literature regarding pretend play in medical settings spans a large number of journals and years, and conclusions are limited by methodological issues including measurement, treatment fidelity, research design, statistical procedures, and potential confounding variables. Despite these limitations, existing evidence suggests that play is a helpful intervention and that future research that addresses these limitations is warranted.