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Simple prescription: Pediatricians have role in promoting healthy development through play :

August 20, 2018

Imagine if pediatricians could write a prescription to help patients during the first two years of well-child visits that would boost social-emotional, cognitive, language and self-regulation skills.

Research shows they can, and the “prescription” to write is simple: “Play with your child every day.”

An updated AAP clinical report outlines how play is a fundamental part of children’s healthy development.The Power of Play: A Pediatric Role in Enhancing Development in Young Children from the Committee on Psychosocial Aspects of Child and Family Health and the Council on Communications and Media is available at and will be published in the September issue of Pediatrics.

Importance of play

Developmentally appropriate play promotes the skills a child needs throughout life and boosts learning. In addition, safe, stable and nurturing relationships borne out of play can be a buffer against stress and encourage resilience.

“Play is really brain-building, and we tried to give examples of how play enhances the structure and function of the brain,” said Michael W. Yogman, M.D., FAAP, a lead author of the report and chair of the Committee on Psychosocial Aspects of Child and Family Health. The report suggests pediatricians can link prescriptions for play with books they give out for programs like Reach Out and Read.

Data continue to document the value of play for children, making this a compelling issue in society, according to psychologist-researcher Kathy Hirsh-Pasek, Ph.D., another lead author. She is a professor in the psychology department at Temple University and a senior fellow at the Brookings Institution.

“I think we’re continuously learning that play is really essential for kids — it’s not just an afterthought or an accessory,” Dr. Hirsh-Pasek said.

While difficult to define, play is intrinsically motivated, entails active engagement and results in joyful discovery. Ideally, play is fun and spontaneous, often creating an imaginative private reality with elements of make-believe. There is object play, physical play, outdoor play and social or pretend play — alone or with others.

Children’s play can be enhanced with items like wooden spoons, blocks, balls, puzzles, crayons, boxes and other objects. Let kids take the lead in playing, Dr. Yogman suggested; there is no need to purchase fancy toys. “Sometimes simple objects with the least accoutrements allow kids to really be creative about how they’re using them.”

Parents have an opportunity to “re-experience the joy of their own experiences in childhood play,” Dr. Yogman said, “and to notice the kind of nonverbal cues that their kids display during those … experiences, which are really critical to improving their interactions and their relationships with their children.”

Playful learning in early education

A societal push for academic achievement has led to a focus on structured activities starting in preschool with a corresponding decrease in playful learning, according to the clinical report. While preschoolers do benefit from learning content, programs have added many more didactic components than they did 20 years ago.

However, the skills children learn through play compared with the more didactic curriculum in school “are as — or more — important for their success later in life,” Dr. Yogman said. These skills are the ability to collaborate, solve problems and think creatively.

Overcoming barriers

Free play and recess need to remain integral in a child’s day. But cultural shifts, such as parents working full time, fewer safe places to play and mounting digital distractions can limit opportunities.

However, real-time social interactions are superior to digital media for home learning, if parents or caregivers engage with kids by reading, watching, playing alongside children and talking with them.

For children with special needs, community partnerships can offer opportunities. Boston Children’s Museum, where Dr. Yogman served as board chair, opens on some mornings only for families who have kids with special needs.

The push to play also includes getting kids to play outside more often and have access to safe parks. In Philadelphia, Dr. Hirsh-Pasek and colleagues have launched initiatives such as Playful Learning Landscapes, which combine urban rejuvenation with interactive learning installations. At a bus stop, for example, a giant puzzle encourages parents and kids to engage and interact, prompting the kind of language that builds early skills in science, technology, engineering and math.

“We know from research that when you use this kind of language in play, it’s helping kids academically and socially for school,” Dr. Hirsh-Pasek said. “When it’s fun and you’re motivated, children pay more attention and do better in school. … We’re not replacing school, we’re augmenting it with organic, playful activities, right there on the street, right there at the bus stop, right there in the supermarket.”

A simple trip to the grocery can turn into playful learning, Dr. Yogman said, “giving kids the opportunity to, say, count the apples in the supermarket. Those are the kinds of joyful experiences for kids as opposed to just sitting tacitly in their shopping cart.”

Suggestions for pediatricians

  • Write a “prescription for play” at well-child visits in the first two years of life.
  • Encourage parents to respond with smiles to infants’ nonverbal behavior.
  • Advocate for the protection of children’s unstructured play time. Benefits include development of foundational motor skills.
  • Advocate with preschool educators to focus on playful rather than didactic learning; put a premium on building social-emotional and executive function skills; and protect time for recess and physical activity.
  • Emphasize importance of playful learning in preschool curricula, and communicate the message to policymakers, legislators, educational administrators and the public.
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