Clinicians Should Prescribe Playtime, AAP Says

Norra MacReady

September 06, 2018

Play is so important to a child's physical and emotional development that pediatricians should write a prescription for it at every well-child visit during the first 2 years of life, according to a new clinical report from the American Academy of Pediatrics (AAP).

Few things beat the power of play, the authors say. It helps children build skills that promote executive function, enhances their ability to learn, and strengthens their resistance to stress.

Michael Yogman, MD, an assistant professor of pediatrics from the Department of Pediatrics, Harvard Medical School, Harvard University, and Mount Auburn Hospital, Cambridge, Massachusetts, and colleagues published the clinical report online August 20 in Pediatrics.

The report summarizes current knowledge about the wide-ranging impact of play and includes several recommendations for ways pediatricians can engage parents in discussions on its benefits.

Many pediatricians already make informal recommendations for play during well-child visits, says Carlos Lerner, MD, medical director, University of California, Los Angeles Mattel Children's Health Center. However, Lerner told Medscape Medical News, "[T]he new statement nicely summarizes the scientific evidence supporting this advice and raises the visibility of this issue." Although pediatricians often discuss a wide range of topics with parents, "this new statement will raise the priority of the message regarding the benefits of play."

Additional Recommendations

In addition to the endorsement of a play prescription, the AAP recommends suggesting that parents observe an infant's nonverbal cues during the first few months of life and respond in ways that will engage the child further.

For example, when the infant smiles the parent can smile back, to help the baby learn to recognize facial expressions as a unique form of communication. This is "a form of play that also teaches the infants a critical social-emotional skill: 'You can get my attention and a smile from me anytime you want just by smiling yourself,'" the authors write.

Clinicians should advocate for the protection of unstructured play time, which has many benefits, "including the development of foundational motor skills that may have lifelong benefits for the prevention of obesity, hypertension, and type 2 diabetes," the report authors explain.

Pediatricians should urge preschool educators to focus on playful rather than didactic learning by allowing students to "take the lead and follow their own curiosity" and to keep recess and physical activity in the daily schedule.

The authors encourage pediatricians to emphasize to policymakers, legislators, and school administrators how playful learning in the preschool curriculum contributes to "fostering stronger caregiver–infant relationships and promoting executive functioning skills."

The AAP also recommends pediatricians counsel parents to use play to help children meet age-appropriate developmental milestones. For an infant 0 to 6 months of age, this might mean presenting them with brightly colored toys and speaking to them frequently, whereas a child aged 4 to 6 years might enjoy singing and dancing, storytelling, and making up or acting out imaginary roles or scenes.

Benefits of Play Cannot Be Overstated

Play, defined as "an activity that is intrinsically motivated, entails active engagement, and results in joyful discovery," presents "a singular opportunity to promote the social-emotional, cognitive, language, and self-regulation skills that build executive function and a prosocial brain," the authors explain.  It should be voluntary and spontaneous, with no apparent external goals other than the desire to satisfy curiosity and have fun.

Expanding on this idea in a news release, Yogman explained it is hard to overstate the benefits of play "in terms of mitigating stress, improving academic skills and helping to build the safe, stable and nurturing relationships that buffer against toxic stress and build social-emotional resilience."

Along with improvements in executive function, language, and social skills, the documented benefits of play include enhanced math skills, more robust physical development, and better health, the authors write. They caution that the converse also may be true: Play deprivation may be "associated with the increasing prevalence of attention-deficit/hyperactivity disorder."

Nevertheless, they add, opportunities for play have dwindled over the last few decades. "From 1981 to 1997, children's playtime decreased by 25%. Children 3 to 11 years of age have lost 12 hours per week of free time. Because of increased academic pressure, 30% of US kindergarten children no longer have recess." Even when academics are the priority, however, new data on early brain development suggest "that learning is better fueled by facilitating the child's intrinsic motivation through play rather than extrinsic motivations, such as test scores," the authors write.

Providing a written prescription for play may be more a matter of the individual physician's style, said Lerner, who was not involved in the writing of this report. "I suspect some will indeed give actual prescriptions, but others will opt for other ways of emphasizing the message."

Any recommendation must always take the individual child into account, Lerner concludes. "Like other advice pediatricians give to parents, whether regarding play, literacy, eating, sleeping, friendships, et cetera, we tailor it to each child's unique characteristics and circumstances. Nevertheless, although the details vary, play in some manner is likely important for all children."

"The next time your child wants to play with you, say yes," Yogman said in the news release. "It's one of the best parts of being a parent, and one of the best things you can do for your child."

The authors and Lerner have disclosed no relevant financial relationships.

Pediatrics.  Published online August 20, 2018. Full text

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