We know of few systematically collected data that describe exactly how the amount and/or nature of play in young children has changed; there is indirect evidence that children are doing less of it, less without structure imposed by adults, and less of it outdoors. Between 1981 and 1997 children’s free playtime dropped by an estimated 25%, and this change appears to be driven by increases in the amount of time children spend in structured activities.² Within children’s unstructured time, there are sedentary and passive activities such as watching television, using the computer, and playing videogames that compete with active play. For example, compared with preschool children who watch less than 2 hours of television a day, those who watch 2 hours or more spend an average of 30 minutes less time each day playing outside.³

We start with the premise that children’s active, free play is disappearing and/or changing. Our purpose is not to explain why this has occurred or to describe what societal values it might reflect. Instead, we aim to demonstrate why play, and particularly unstructured outdoor play, needs to be restored to the lives of children. Play has the potential to improve all aspects of children’s well-being: physical, emotional, social, and cognitive. We argue that the current emphasis on increasing physical activity in young children to address the problem of obesity, while an important public health agenda, might be more successful if the exposure (physical activity or exercise) were promoted with different language (play) and if a different set of outcomes were emphasized (aspects of child well-being other than physical health).

WHY A DIFFERENT LANGUAGE?

Another reason to use the word play is that parents may view the term more positively. Adults thinking of exercise often imagine structured aerobic activity or sports.⁶ These images can evoke in some parents the upsetting memories of failed efforts at weight loss or maintenance.⁷ Furthermore, many adults have also had negative childhood experiences with exercise or sports. All these memories contrast greatly with joyous recollections of unstructured childhood play. Thus, if parents are to create opportunities and cues for their young children to be physically active, the term play may be the most motivating and positive term to use with parents.

A final problem with using the term physical activity is that the word "active" has varied interpretations for parents of young children. In the context of the obesity epidemic, the primary rationale for encouraging both adults and children to increase their physical activity levels is that energy expenditure will increase to match energy intake. A problem with this rationale is that it does not seem coherent to many parents who already perceive that their young children are very active. The recent surge in medical treatment for attention-deficit disorder, especially among preschoolers,⁸ may be a reflection of a widespread parental perception that their children are "too active." Parents will often use the term active to describe a young child who garners their attention by disrupting and distracting them in their own chores. Similarly, the active child might be one who moves busily, with gross motor quickness and curiosity, between novel objects and tasks. Depending on the child’s age and the intensity of the behavior, these characterizations of active children merely describe the behavior of healthy children. Thus, to the extent that it is healthy for children to be active, parents may fail to comprehend advice to increase their children’s level of physical activity. The term play might be more easily understood by parents than the term physical activity when suggesting that their children be more active.

WHY A FOCUS ON OTHER OUTCOMES?

In addition to these complex perceptions about weight, there are also complex perceptions of health. Although the inseparable nature of health and well-being has been emphasized for more than a half century,¹⁷ the artificial dichotomy between mind and body may inadvertently be exacerbated by calls to promote physical activity in children as a response to the obesity epidemic. A parent who is asked to consider how their young child is "doing" (as opposed to whether their child is "healthy") is more likely to think about whether their child is happy, calm, curious, sleeping well, and playing with other children than whether their child is sufficiently lean or active.

Parents are the primary mediators of gross motor play in their young children. To encourage parents to maximize the opportunity for their children’s play, we believe there should be more emphasis on the 3 a’s of child well-being than on the 2 f’s of physical health. That is to say, parents will be more inspired by the potential benefits of play arising in 3 domains of their child’s well-being—attention (cognitive), affiliation (social), and affect (emotional)—than in 2 domains of physical health—fitness and fatness.

ATTENTION

In animal experiments, rats and mice exposed to an enriched environment show improvements in learning and memory that are related to changes in brain neurogenesis.^20-22 An enriched environment is one in which there are more rodents in the cage, objects such as toys and tunnels to stimulate exploration, and a running wheel for exercise. For children the outdoors seems to providesuch an enriched environment. Outdoors is where free play and gross motor activity in young children are most likely to occur.^10-11,23-24

While playing outdoors a child is likely to encounter opportunities for decision making that stimulate problem solving and creative thinking because outdoor spaces are often more varied and less structured than indoor spaces. In addition, there are usually fewer constraints outdoors on children’s gross motor movement and less restriction on their range of visual and gross motor exploration. Together these factors that do not prescribe or limit activity induce curiosity and the use of imagination.^25-26

The problem solving that occurs in play may promote executive functioning—a higher-level skill that integrates attention and other cognitive functions such as planning, organizing, sequencing, and decision making. Executive functioning is required not only for later academic success but for success in those tasks of daily living that all children must master to gain full independence, such as managing their belongings and traveling to unfamiliar places. Parallel to these cognitive problem-solving skills are another set of skills that children require for social problem solving, and these skills may also be promoted by play.

AFFILIATION

There is a large body of scientific literature that demonstrates the health-promoting effects in adults of various forms of social connection.³⁴ However, little attention has been paid to those influences in early life that allow children to enter adulthood with the abilities to develop and to maintain social connections. These abilities arise through early influences on the developing brain that can be cultivated through unstructured free play. Although many abilities may contribute to achieving social connections, we maintain that empathy, which can be defined as recognizing the emotions of self and others and conveying that recognition, is an ability that emerges in early childhood, is the key to meaningful affiliation, and arises, in part, from the experience of free play.

AFFECT

Therefore, it seems likely that free play in young children can improve emotional well-being. In focus groups with low-income mothers of preschool children, most mothers felt that improvements in their children’s mood and mental health were the most immediate benefits of physical activity in their children.⁴⁴ Furthermore, by joining their children in gross motor play, parents may also be able to increase their own physical activity and receive, for themselves, some improvement in mood.

Because improved mood may be the most immediate and visible benefit of play, it is also the benefit most likely to reinforce play. If playing with a child makes both the parent and child feel better, play will be sustained without any public health prescription. Indeed, many adults who exercise regularly report doing so because it makes them feel better and it relieves stress. Even the lives of young children are full of emotional stresses. These stresses, experienced by the child’s brain, result in a number of physiologic responses in the body, collectively referred to as "allostatic load,"⁴⁵ that can impair children’s health.⁴⁶ Gross motor play may be an important mechanism to dampen allostatic load. A smile on the face of a playing child reflects multiple physiologic processes in the body that can improve health. Learning at a critical period in development that play and movement relieves stress and enhances mood may help children sustain physical activity patterns over their lifetime.

CONVEYING THE MESSAGE ABOUT PLAY

If we wish to get young children physically active through play, those efforts should extend beyond parents and the household. With an increasing number of parents working outside the home, many children younger than 5 years spend time in preschools or center-based day-care facilities.⁵⁰ The Head Start Program reaches almost 850 000 US preschool children and has a core mission to address child well-being from a holistic perspective.⁵¹ Preschools and day-care centers are ideal venues to consider incorporating guidelines for the amount of time and settings, particularly outdoor settings, available for unstructured, gross motor play.⁵² In all of these settings it needs to be emphasized that these activities are necessary for optimal brain development in children.

Fostering outdoor play will also require broader environmental and policy changes that cannot be implemented by individual pediatricians or parents acting alone. Developing safe outdoor play spaces is one intervention that must be addressed at the community level. Even where playgrounds are available, their use could differ according to neighborhood safety.^53-54 To enhance the safety of playgrounds, the equipment should be appropriate for the range of developmental capabilities in young children, have protective surfaces, and be free of litter, broken glass, and illegal activity. Creating community coalitions to build and to maintain playgrounds can increase not only the number and safety of outdoor play spaces for children, but it can also foster social connections in the community, create spaces that are attractive for both children and their parents, and give community members a sense of ownership for these spaces.⁵⁵ The streets and yards around young children’s homes can also be socially enriching and cognitively stimulating spaces in which children can play,⁵⁶ but traffic is a safety threat to many children outside of their homes.⁵⁷ Various traffic calming interventions in residential areas are one promising way to reduce children’s injury risk while playing outdoors.^58-59

In an effort to resurrect free play, we should enthusiastically promote it on its traditional merits—that play allows children to experience the joys of movement, creativity, and friendship. Though it seems urgent to emphasize that play improves energy balance, we may get further in obesity prevention by realizing that modern neurobiology supports grandmother’s conventional wisdom and that the brain will naturally reinforce behaviors that make it healthy.

AUTHOR INFORMATION

Accepted for Publication: July 15, 2004.

Acknowledgment: We are grateful to Patsy H. Burdette and the late Jessie L. Hill for sharing their wisdom about the important role of play in the lives of children.