Balancing Healthy Child Development with Outdoor Risky Play

Play is essential for children’s development and for their physical, mental and social health.

The United Nations Convention on the Rights of the Child recognizes that the right to play is as fundamental as the right to be cared for and protected from violence. Children who engage in free play are also developing social and executive functioning skills that are critical for school readiness and lifelong achievement. Over the past few decades, family and social trends have increasingly prioritized the supervision and protection of children.

There has also been a shift in the balance of play: unscheduled free play outdoors has given way to planned and structured activities , including extracurricular and academic activities, in the lives of most children. Children spend more recreational time indoors (and often on screens) than playing outdoors with minimal supervision. Many Canadian organizations are now calling for a shift in strategies to keep children "as safe as necessary" rather than "as safe as possible" , and a more balanced approach to healthy, active living that also encourages benefits for the development of risk taking as injury prevention.

This statement for pediatric healthcare providers (PS) describes the concept and benefits of risky outdoor play , along with its challenges and nuances related to children’s developmental stage, their individual ability, and their social and medical context. Approaches are offered to promote open and constructive discussions with families and organizations. Pediatricians are encouraged to think about risky outdoor play as a strategy to help prevent and manage common health problems such as obesity, anxiety, and behavioral problems .

Risky play is defined by exciting and exciting forms of free play that involve uncertainty in the outcome and the possibility of physical injury.

Based on evidence collected over the past 15 years, primarily in children 1 to 13 years of age, risky play is often classified into several types of play (Table 1). These categories are deliberately vague because activities can differ widely depending on the child’s developmental stage (rather than age), past experiences, and personality.

More specifically, the “height play” category could involve:

• A little boy climbing and jumping from a chair.
   
• An older child who feels confident in his motor and physical skills by climbing a tree, several branches off the ground.
   
• A child of similar age, but with a different temperament, experience, and skill level climbing a small tree or stopping a few branches off the ground.

Although the game seems different, all three children participate in risky play because they feel excited, excited, and challenged by the chosen activity.

Risky play is most often associated with outdoor or nature activities because of the many challenging and creative play opportunities these environments offer. Play that involves loose natural pieces (e.g., gravel, sand, branches) or manufactured materials (e.g., tires, milk crates) that children can use in a variety of ways, without specific direction, also provides abundant opportunities for risky play.

Risk is inherent to free play . When children play spontaneously, they may choose to push boundaries and test boundaries. Risky play encourages creative and spontaneous play, first by eliminating dangers and then supporting risk-taking that the child chooses and controls and that are appropriate to her experience and ability.

The concept of risky play is a response, in part, to restrictive safety measures and programs that have been more widely implemented (and sometimes mandated) in child care settings, schools, and playgrounds in recent years. Given the developmental benefits of play-related risk taking (detailed below), some researchers advocate for safety rules that effectively prevent serious injury and death while also helping children develop coping strategies. risk management which are essential aspects of healthy and active growth.

The literature on risky play has highlighted the need for a balanced approach between risk and danger, where children’s overall health and well-being benefits by addressing both their developmental and injury prevention needs. Environments such as a busy road or rough water pose hazards that any responsible adult will recognize as dangerous. However, some activities, such as playing around the fire or rough play, offer a more nuanced relationship between risk and danger , especially when the characteristics of each child are taken into account.

The adult’s role is to identify hazards and eliminate or mitigate them, then appropriately supervise the type of activity, as well as the child’s skill level, personality, and developmental stage (which may also involve no supervision). The degree of autonomy children have can be determined by how well an adult knows the children while they play and their abilities. Adults should always be prepared to intervene when a child’s play becomes a danger to self or others. Preventing children from engaging in risky play experiences is different from intervening in a timely manner based on their skill level and self-confidence.

The risky game is not:

• Ignoring mandatory, evidence-based safety measures (e.g., use of helmets, car seats, life jackets, stair gates).
   
• Leaving children unsupervised in potentially dangerous situations (e.g., street play in traffic areas).
   
• Pushing children to take risks beyond their own comfort level.

Debate among researchers and decision makers about the appropriate balance between risk taking and injury prevention has led to the use of terms other than "risky" to qualify play. Examples include “outdoor play,” “nature play,” “active play,” “adventure play,” and “free” or “unstructured” play . These terms are defined in the “Play, Learn, and Teach Outdoors-Network (PlatO-Net) Terminology and Taxonomy .” This work standardizes terminology and recognizes that organizations will understand the role and consequences of risk-taking differently and may prefer to use a variety of terms to advance conversations about play. However, when children are free to play as they wish, risk is always present, albeit in different forms, and all descriptive terms imply some measure of risky play.

> Physical health

Studies that assessed children’s independent mobility (i.e., their level of freedom to travel and play in their neighborhood without adult supervision) or modifying play environments by adding loose parts, natural materials, and opportunities for risk-taking , showed an increase in levels of moderate to vigorous physical activity per day and a decrease in sedentary time.

Risky play may also help support lifelong participation in physical activity, a concept known as "physical literacy ," which assumes that individuals have the cognitive, affective, and physical skills to ensure physical activity-related behaviors throughout life. lifetime. Physical literacy interventions have been shown to improve various physical activity and health outcomes and reduce the likelihood of injury in sports settings.

A recent study demonstrated that outdoor play with loose parts provides children with opportunities to develop risk assessment and fundamental movement skills through repeated movements, which are both components of physical literacy.

Risky gambling can also help modulate the immune system . A study published in 2020 showed that adding plants and natural or loose items (e.g., logs, barrels, tires) to a daycare yard for digging and climbing led to increased skin bacterial diversity and altered gut microbiota in children (through changes in plasma cytokine levels and T-reg cell frequencies).

> Mental and socio-emotional health

In addition to the positive effects of adding loose materials to the environment, increasing risks and challenges on school playgrounds can be positive for children’s mental health. A study on rough play found that allowing this form of play at school led to more reports of pushing, but fewer reports of bullying.

Rough play can help build resilience and conflict resolution skills in children. Studies have also associated rough play with better problem-solving scores in children. After a three-month school-based intervention that provided opportunities for risky play, teachers reported lower conflict sensitivity and higher self-esteem and concentration among fourth-grade children.

Literature appears to support opportunities for children to recognize and test their limits and face new challenges. Theoretical articles have suggested that children who engage in risky play will increase their social-emotional skills and sense of belonging. In addition, the ability to communicate, cooperate and reach agreements with others improves in situations where children can test and overcome their own limits.

Risky play helps facilitate children’s exposure to fear-provoking situations by providing opportunities to experiment with uncertainty, associated physiological arousal, and coping strategies, which can significantly reduce children’s risk for high anxiety.

> Balance the benefits of taking risks with the possibility of injury

Injuries sustained during risky play are typically minor soft tissue injuries, such as abrasions, bruises, and lacerations. Studies on the incidence of risky play-related injuries have tended to focus on the height of playground equipment, the surface, and fall-related injuries, with inconsistent results.

A study conducted in New Zealand found that the frequency and severity of fractures (mainly in the distal part of the forearm) are not related to the height of playground equipment. However, a systematic review of risk factors for playground injuries associated falls from playground equipment of more than 1.5 m with increased odds of fractures.

Head injuries and concussions are particularly concerning in children and young people. While both types of injuries are increasing in sports settings and on playgrounds, data on incidence during risky outdoor play is lacking but believed to be low anecdotally.

Some experts have attributed playground injuries to uninteresting play structures. Low structures for all age groups and unnatural surfaces under play structures (e.g., synthetic surfaces instead of grass or sand) can lead to inappropriate use of equipment and increased risk taking. Bored children may resort to playing indoors or in front of screens, which also has health consequences.

> Reframe risk perceptions

Protecting children from harm while ensuring their access to the opportunities and benefits of risky play can be a challenge for parents, child care settings, and public policy makers. Adults are responsible for providing safe physical spaces and emotionally supportive environments that can also invite and optimize opportunities for spontaneous risky play. Such opportunities may include supervising children less closely (for example, allowing a child to climb higher, without a hand to catch him or her at arm’s length to break a fall). Ensuring that there is time in the child’s schedule for free play, encouraging play with natural, loose pieces (e.g. sticks, branches or stones), and allowing rough play are key conditions.

Communication and language around risk taking is another factor that parents and educators may need to adapt to support risky play. Warnings such as "Be careful," "Are you sure this is a good idea?", "Slow down," and "Not too loud" are often heard when supervising children. While caring adults usually want to say "I love you" or "I care about you ," children who are warned repeatedly can learn to hear: "You don’t trust me . "

Harmless precautions, repeated often over time, can convey fear even when there is little or no danger present. Furthermore, these "mottos" offer no guidance for managing play in a risky situation, which can (again, if used repeatedly over time) negatively influence children’s confidence in their own abilities and decrease the attractiveness of active play.

Some experts have suggested that parents practice pausing for 15 to 30 seconds to observe children’s "play state" before intervening. The duration of this pause depends on each child, the situation and the activity being observed.

Primary Author(s) Émilie Beaulieu MD MPH FRCPC, Suzanne Beno MD FRCPC; Canadian Pediatric Society, Injury Prevention Committee Injury Prevention Committee

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