The impacts of unstructured nature play on health in early childhood development: A systematic review

Background Nature play is growing in popularity as children's play spaces are transforming from traditional playgrounds into more nature-based play spaces with considerable financial and resource investment from government bodies. This has resulted in the re-development of children's play spaces to incorporate more natural elements such as trees, plants and rocks. Despite this, it is unclear whether there is empirical evidence to support claims that play in nature is beneficial for child health and development. Aim To conduct a systematic review examining the impacts of nature play on the health and developmental outcomes of children aged 2-12 years. Methods Seven electronic databases were searched (MEDLINE, ERIC, Embase, PsycINFO, The Cochrane Library, The Joanna Briggs Institute and Emcare) from inception to July/August 2018 (search updated July/August 2019). The Inclusion criteria were children aged 2-12 years with no health/developmental conditions. The exposure/intervention of interest was unstructured, free play in nature. Critical appraisal of included studies was conducted using the McMaster Critical Appraisal Tool. Descriptive synthesis was then undertaken using the NHMRC FORM Framework. Results Out of 2927 articles identified, 16 studies met the inclusion criteria. The nature play exposure/intervention was heterogeneously described, and a plethora of outcome measures were used. Nature play had consistent positive impacts on physical activity outcomes and cognitive play behaviours (imaginative and dramatic play). However, there remain some concerns regarding the quality of the evidence base, heterogeneity in intervention description and parameters in the outcome measures used. Conclusions While the positive impacts of nature play were encouraging in terms of physical activity and cognitive development, nature play stakeholders should focus on producing a universal definition for nature play, the development of standardised outcome measures and the conduct of robust research designs. Implications of these findings suggest the need for the development of standardised guidelines to inform practice and policy in the design of children's play spaces in different contexts.