health and safety in early childhood education articles

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• Early Care and Education
• Preventing Infectious Diseases
• Safety, Health, and Injury Prevention
• Nutrition and Physical Activity
• Providing Support
• Resources for Early Care and Education Providers
• Emergency Preparedness

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Safety, Health, and Injury Prevention Recommendations

• Early care and education (ECE) providers play a major role in protecting children from injuries.
• They keep children safe and teach them strategies to prevent injuries.

Early care and education providers

ECE providers can help make sure that their programs are located in safe places, keep children safe from serious injuries and harm while in their care (such as by ensuring playground safety and water safety), and protect children from poisoning.

ECE providers also teach children foundational skills about staying healthy and safe and can provide tips to parents about keeping children healthy and safe. ECE providers can also watch for signs that children are not supported at home and protect children by connecting them to child protective services.

Keeping children safe from injury

• Preventing Adverse Childhood Experiences (ACEs) online training
• Keep Child Passengers Safe on the Road
• Drowning Prevention
• Heads Up Concussion Prevention
• Playground Safety Tips [PDF -226 KB]
• Safe Medication Storage

Keeping children healthy

• Childhood Lead Poisoning Prevention Program
• Children's Dental Health
• Tooth Brushing in Early Care and Education
• Choosing Safe Places For Early Care and Education
• Controlling Childhood Asthma and Reducing Emergencies
• School or Childcare Asthma and Allergy Action Plan
• Asthma-Friendly Childcare Checklist (English) and ( Spanish )
• Helping Babies Sleep Safely
• Tips for Supporting Students with Sickle Cell Disease [PDF – 970 KB]
• Sleep Recommendations
• Sun Safety: Guidelines for School Programs to Prevent Skin Cancer
• Outdoor Play and Safety for Children in ECE

Additional resources

• StopBullying.gov—Kid Videos

Early Care and Education Portal

As an early care and education provider, you are on the frontlines of public health. You are a valuable partner in promoting and safeguarding the health and wellbeing of our nation’s children and families.

Safety, Health, and Nutrition in Early Childhood Education

(7 reviews)

Jennifer Paris, College of the Canyons

Copyright Year: 2018

Publisher: College of the Canyons

Language: English

Formats Available

Conditions of use.

Learn more about reviews.

Reviewed by Jeanne Tardiff, Department Chair & Professor, Tidewater Community College on 6/20/24

This book is VERY comprehensive; it exceeded my expectations for covering my course learning objectives. The content is easy to follow and rigor is appropriate for my 100-level course. read more

Comprehensiveness rating: 5 see less

This book is VERY comprehensive; it exceeded my expectations for covering my course learning objectives. The content is easy to follow and rigor is appropriate for my 100-level course.

Content Accuracy rating: 5

Content is accurate and unbiased. The statistics provided were as up to date as possible and can be easily changed in the Google Document.

Relevance/Longevity rating: 5

The content is up to date and easily editable.

Clarity rating: 5

The text is easy to read and provides adequate context for any possible jargon or technical terminology.

Consistency rating: 5

The text is consistent and organized well. Students can easily locate information throughout each chapter.

Modularity rating: 5

The units are split in a logical manner and each chapter scaffolds from the prior chapter. The chapters break down into smaller sections that could be easily assigned as stand-alone requirements.

Organization/Structure/Flow rating: 5

The topics in this book are presented in a logical flow and they are easy to read. The relationship to the prior chapters are evident.

Interface rating: 4

The text does not show and significant interface issues. However, it would be helpful to include hyperlinks to each chapter in the Table of Contents.

Grammatical Errors rating: 5

The text contains no grammatical errors.

Cultural Relevance rating: 5

The book successfully promoted diversity, equity, and inclusion by both providing separate chapters/sections on culture/ability content and integrating it into the whole book.

This book exceeds my expectations in content; covering all of my course learning outcomes and more. It is very comprehensive; yet easy to read. It is of the perfect rigor for my 100-level health, safety, and nutrition class.

Although there is no index, I appreciate the "Resources for Further Exploration" websites at the end of each chapter. These could be used in many ways; specifically to support student work on accompanying assignments. On the OpenStax website, there appear to be no ancillary materials, but at the beginning of the book, a link for a Google Conversation can be found. This offers some great resources and allows instructors to collaborate. I especially value the video observation library. There was also a lot of information found in the many appendices in the back of the book.

This book integrates much diversity in ability, culture, and gender. For instance, children's mental health is covered in chapter 11. This is a growing topic that needs to be studied by early childhood educators. In addition, the book covered topics such as trauma and adverse childhood experiences. The book even includes general guidance on religious food choices for many cultures!

The beginning of each chapter identifies licensing standards that align with the chapter and that is helpful. It could easily be re-created with the adopters' state licensing regulations. It would be helpful to also align the NAEYC Standards for Professional Preparation in each chapter.

The sources used were all very credible and research-based. Not only so, but the content was developmentally appropriate in many ways. For example, in discussing biting, it explored other reasons for biting (communicating) than just something to admonish the child for. The book included much NAEYC content, which aligns perfectly with our NAEYC Accreditation.

Reviewed by Deb Merrigan, Instructor, Normandale Community College on 3/1/24

The text covers key topics related to child safety, health, and nutrition. Missing are index and glossary sections. In addition, key oral health components related to child safety, health and nutrition are not addressed. read more

Comprehensiveness rating: 2 see less

The text covers key topics related to child safety, health, and nutrition. Missing are index and glossary sections. In addition, key oral health components related to child safety, health and nutrition are not addressed.

The content appears to accurate and unbiased. This book provides a sufficient degree of depth and scope in the safety, health, and nutrition related to early childhood education.

The content appears to be up-to-date. One of the strengths of this book is that it is arranged in a way that to allow for necessary updates to be easily applied.

The text is written in lucid, accessible prose. It consistently provides adequate context for each topic discussed. In addition, definitions of terminology are provided within the chapters to provide adequate context and meaning.

Similar content is grouped together and the heading and body styles are consistent throughout the book. The text is divided into smaller reading sections that the reader will find easy to navigate.

The text maximized readability and minimizes distractions. A nice feature throughout the chapters are callout boxes that help draw attention to information and prompt the reader to think more about the content they have just read.

The structure of the text is consistent, logical, and efficient. The layout and design, broken down by sections on safety, health, and nutrition create an easy path for readers to follow. In addition, the Appendix section which houses forms, checklists, and other relevant information is organized in a logical flow by topics.

Interface rating: 5

The text navigation facilitates ease of movement throughout the book. Images, tables, and callout boxes are appropriate, meaningful and clear to the reader.

Grammatical Errors rating: 4

Overall, editing and proofreading errors are minimal.

Cultural Relevance rating: 4

The text aims to be sensitive to gender inclusiveness. Unless language was pulled from source content, the term child or adult is referred to with the pronoun they or them. In addition, efforts were made to use the terms caregivers or guardians to be inclusive of all families. Also, person first language is utilized.

Addressing oral health related to safety, health and nutrition is a key component missing in this book. For safety, needed is information on oral health signs of child maltreatment. For health and nutrition, a deeper dive into caries risk and prevention is needed. There is a brief mention in Ch. 1 on risks for dental caries (cavities) under the subheading Understanding Childhood Health Concerns. Consider listing information on risk factors for tooth decay and how untreated cavities can cause pain and infections that may lead to problems with eating, speaking, playing, and learning. In addition, what educators, caregivers, and staff can educate families and/or caregivers on cavity prevention related to oral home care and diet.

Reviewed by Dawn Hendricks, Instructor, Clackamas Community College on 2/17/22

The textbook is quite comprehensive and provides thorough information on all aspects of health, safety and nutrition in early childhood settings. Unfortunately, there is not an index, which would make navigating the book more efficient. ... read more

The textbook is quite comprehensive and provides thorough information on all aspects of health, safety and nutrition in early childhood settings. Unfortunately, there is not an index, which would make navigating the book more efficient. However, the table of of contents at the front is detailed, providing an outline of the four different sections and fifteen chapters of the book. There is a robust appendix at the end with helpful resources such as health and safety checklists.

The content is accurate and un-biased. Since the author of the book teaches at a community college in California, there are some California-specific references and information which not be relevant to programs in other states. However, that information could easily be omitted or passed over.

The information on health, safety and nutrition in the book is current and up to date. The statistics that are used and the research that is referenced is current within the past few years. Given the way the book is formatted into smaller chapters and sections, it would be relatively easy to update the book as needed to maintain its relevance.

The language level used in the book makes it accessible for community college students as well as potentially high school students. When educational jargon is used, brief explanations of the terms or concepts are provided.

Each of the fifteen chapters are consistent in terms of organization, structure and framework. This makes the contents very reader-friendly and inviting.

The main topics of the book, saftey, health and nutrition, each have their own section. These could easily be re-organized, given the sequence of a particular course. Within each of those three primary sections, there are chapters, which lend themselves to easily being re-organized or even omitted if need be.

The book is well-organized and presents the contents in a clear, logical sequence.

There were no discernible issues with the interface.

Grammatical Errors rating: 3

There were some grammatical errors and spelling typos in the book, particularly in the appendix. Appendix N particularly had several errors.

With the images, contents and examples, the book is inclusive of other cultures.

I do plan to use this book beginning in Fall 2022 in one of my courses. The course currently is "Nutrition, Music and Movement". However, given the comprehensive nature of this book, and the already existing need to re-design the course to align with other community colleges, I will be updating the course to "Safety, Health and Nutrition in Early Childhood".

We are also planning to translate this OER into Spanish.

Reviewed by Dawn Behan, Professor of Education; Director of Graduate Education Program, Mount Mercy University on 12/27/21

This textbook is quite thorough in the content areas of safety, health, and nutrition for early childhood students; however, it fails to include the necessity of teachers and child care providers being trained in CPR for children in early... read more

Comprehensiveness rating: 4 see less

This textbook is quite thorough in the content areas of safety, health, and nutrition for early childhood students; however, it fails to include the necessity of teachers and child care providers being trained in CPR for children in early childhood: infants, toddlers, and pre-schoolers, as well as K-3rd grade students. It begins with a comprehensive Table of Contents which describes the text’s four main sections: Section I, Introduction; Section II, Safety; Section III, Health; and Section IV, Nutrition. These sections are followed by a list of 16 appendices. Next, the Preface tells the reader about the following sections: Licensing of Source Content, Language Choices Throughout This Book (i.e., Terminology, Gendered Language, Family Structures and Forms, Person First Language), and Special Features Throughout the Book (i.e., Licensing Regulations, Pin It!, Pause to Reflect, Engaging Families, In the Classroom, and Resources for Further Exploration, and more). References are given on each page via footnotes. There is no Glossary or Index included in this text. Both would have been helpful in navigating this textbook. Although the author alludes to the difficulty in providing consistent terminology in the text, a glossary of terms would enhance an understanding of the vocabulary used in the text. Also, an index would be helpful in locating specific topics and information in the text, such as Trauma Informed Care, because only chapter headings are listed in the Table of Contents.

Content Accuracy rating: 4

The content appears to be accurate and current; however, most content comes from resources that are web-based. Thus, the absence of dates on these resources must be taken into consideration, and resources should be checked for currency of content. Nonetheless, most content that is from dated sources seems to be fairly recent (i.e., within the past 3-15 years). The content included in the text appears to be unbiased; the content used in this text is from sources noted in footnotes on each page of the text.

Because the content appears to be fairly up-to-date, the content should not be obsolete within a short period of time. The text is written and structured in a way that updates to the content should be relatively easy to implement.

The text is written in understandable language, and text boxes with examples, important information, and further resources are included and highlighted to add clarity to the text's vocabulary.

The text uses consistent language and consistent text features which allow the reader to identify information that can enhance their understanding of the content throughout the text. For instance, one text feature, Pin It! uses examples and focuses on specific information that relates to the topic in the chapter. A couple of other text features, Pause to Reflect and In the Classroom, provide suggestions on how to apply the content. The author does note the inconsistency of early childhood terminology, as the text was compiled from “hundreds of sources” (Paris, 2020, p. 6).

The text is divided into four sections, and each section is further divided into chapters (there are a total of 15). This text could easily be divided into four modules or by chapter for more specific, focused discussions. This text could be used for online, virtual, or Face-to-Face course delivery models.

Bolded sections, chapters, and subheadings; bulleted lists; text boxes; photos; figures; and tables are included to create an organized, structured flow throughout the text. These text features enhance the organization of the text content and complement the content information found in the regular (not bold) print.

This text is available on the internet and can be downloaded for reader preference. However, the reader needs to be aware there may be a charge on some websites if they choose to download more than the content presented for previewing the text. There did not appear to be any display features that may distract the reader.

There are a number of mechanical and grammatical errors throughout the text. The text requires major proofreading and editing to make it appear professional. There is a note on p. 3 of the text under the heading, “Have Feedback or Resources to Share?” about what to do if the reader sees a typo. There are too many to point out in this textbook.

The text is culturally neutral. Examples of this are the following, as noted in the text on pp. 6-7: the pronouns they or them was used as much as possible “to be more gender inclusive,” the word family was used in place of the word parents to be more inclusive of different family structures, and person- first language was used in an attempt to be respectful to students who encounter different living situations (e.g., poverty) or experience different personal characteristics (such as disabilities or medical conditions).

Overall, I liked this textbook. However, I would hesitate to adopt it for an education course due to all of the mechanical and grammatical errors in it.

Reviewed by Susan Driscoll, Adjunct Faculty, Massasoit Community College on 6/30/21

The text is well organized and comprehensive. read more

The text is well organized and comprehensive.

The information is accurate and current.

The text is relevant and will help students apply the information in their classrooms. If it is used in a state other than California, the state licensing regulations will need to be reviewed.

The text is easy to comprehend. It is well written.

The terminology is consistent and up-to-date.

The chapters are easy to break down into sections.

Organization/Structure/Flow rating: 4

The text is organized to make it easy to comprehend. Main ideas are highlighted in boxes and coded to help students organize the information. An index would be helpful.

I didn't have any issues.

The text is free from grammatical errors. There are forms in the appendix that do have some significant errors.

The text is culturally sensitive.

I have not used this text but will in the future!

Reviewed by jennifer kearns fox, faculty, Roxbury Community College on 6/30/21

The book is VERY comprehensive. It includes information on the following; Children’s Well-Being and Early Childhood Education, Safety (physical, social, emotional, environmental) and injury and illness prevention, basic first aide and safety... read more

The book is VERY comprehensive. It includes information on the following; Children’s Well-Being and Early Childhood Education, Safety (physical, social, emotional, environmental) and injury and illness prevention, basic first aide and safety information, abuse & neglect (I link to MA state agencies), overall health and wellness, caring for children with special needs, and nutrition. I recommend this book for a health safety nutrition class OR chapters for special needs courses or foundational courses in ECE. I find each chapter useful and relevant and in my courses use most chapters and include links to MA state agencies and NAEYC & Head start supports.

As stated above, the book is comprehensive and does include most pertinent information around supporting health, safety, and nutrition in ECE. Though I find it accurate I stress the importance of pairing this with local, state and federal resources. For example, I write this in June 2021. Much has changed in the landscape of the world and with this topic in regard to COVID, protocols, safe care, immunizations, etc.

Please see above. Comprehensive, relevant, accurate.

This text is very easy to use, read, and understand. I recommend it for PD, parents, college courses, and as a resource to child care settings.

This text is well organized and consistent.

Though this is well organized, I do use the chapters out of order. I do find that the organization and information is easy to pair with other chapters. For example, you can read chapter 5 after chapter 9.

See above. The organization is clear, logical, and easy to understand or reorganize for your work/purposes.

I used a phone and computer and could access the entire text. I do recommend using a computer. I used 3 browsers (chrome, explorer, and firefox) and had no issues accessing or moving between chapters.

I did not edit this book. There are no obvious errors. I was NOT looking for errors in a published OER text.

This book is culturally sensitive.

Reviewed by Sandra Scialabba, Instructor, Midlands Technical College on 4/25/21

This book is the most comprehensive one that I have found. It covers every aspect of safety, health, and nutrition as it relates to children from birth to 8 years old. It covers topics that are overlooked, or not as emphasized, in other textbooks,... read more

This book is the most comprehensive one that I have found. It covers every aspect of safety, health, and nutrition as it relates to children from birth to 8 years old. It covers topics that are overlooked, or not as emphasized, in other textbooks, such as car seat safety, using technology and media safely, what to look for on labels of art supplies to identify whether or not they have passed a toxicology review, taking into consideration developmental milestones and how they impact children's behaviors, reasons why toddlers bite, diagram explaining why the safest sleeping position for an infant is on his back, and feeding children who have special needs.

Facts are accurate, and current. The resources used are current and up to date.

The book has covered the objectives needed for an early childhood program. It will be easy to add up dates as needed. At this particular time, the only thing I can think of to add is information about COVID-19. The only reason I would choose not to use this book is that it is specific to the licensing regulations in California, which is overseen by the Community Care Licensing Division of the California Department of Social Services. Since I am an instructor in South Carolina, I would need to revise each section in every chapter that correlates to licensing regulations to correlate to the specific licensing regulations provided by The Division of Early Care and Education through the Department of Social Services in South Carolina.

This book is easy to read and understand. Students will not have any trouble comprehending the content. It is easy to understand how to put the safety, health and nutritional information into practice in a variety of child care settings.

The terminology used is not only consistent, it is also current and relevant for today's society and student.

This book is easy to breakdown into sections for class reading and homework assignments. It will be easy to include in an online format, such as D2L, because it is already divided into short chapters.

I would recommend that the Table of Contents have a Section V: Appendix A-P The Appendix is currently included in Section IV: Nutrition Throughout the book, some of the references to the Appendix aren't worded consistently with the title of the document. For example: Page 102 refers to "checklists" in Appendix E, however, there is only one checklist. Page 232 refers the reader to Appendix J for more information on illnesses, however, it should refer the reader to Appendix M. Page 243 refers the reader to Appendix K, however, it should refer the reader to Appendix J. There are other examples like these that need to be revised.

No interface issues noticed.

No grammatical errors noticed.

The text is culturally sensitive. The pictures and examples used, as well as the relevant content provided throughout the book, show diversity with respect to races, ethnicities, and backgrounds. The book is sensitive to using "people first" language and recognizes that what constitutes a family is going to be different for each child. Some examples include: Chapter 7 highlights the culture of sleep, referring to the ways and places that people sleep. Some people sleep inside, outside, in beds, on hammocks, on mats, on the floor, alone, with children, only at night, etc. This chapter also highlights that Developmental Screening Tools need to be culturally sensitive. Chapter 11 highlights that culture influences every aspect of human development, including mental health. Chapter 15 highlights that menu planning needs to take into consideration cultural and religious beliefs.

The special features included throughout the book are especially helpful. These features are easily identifiable through the use of color-coded "callout boxes" containing symbols. They include: Licensing Regulations Pin It! Pause to Reflect Important Information Quotes Engaging Families In the Classroom Resources for Further Exploration

I highly recommend this book if you are an instructor in California. If you are an instructor in any other state, you will need to make revisions that reflect your particular state licensing regulations.

Table of Contents

Preface Section I: Introduction

• Chapter 1: Children’s Well-Being and Early Childhood Education

Section II: Safety

• Chapter 2: Preventing Injury & Protecting Children’s Safety
• Chapter 3: Creating Safe Indoor Environments
• Chapter 4: Creating Safe Outdoor Environments
• Chapter 5: Caring for Minor Injuries and Preparing for and Managing Emergencies
• Chapter 6: Child Maltreatment

Section III: Health

• Chapter 7: Promoting Good Health & Wellness
• Chapter 8: Prevention of Illness
• Chapter 9: Supportive Health Care
• Chapter 10: Children with Special Health Care Needs
• Chapter 11: Children’s Mental Health

Section IV: Nutrition

• Chapter 12: Basic Nutrition for Children
• Chapter 13: Protecting Good Nutrition and Physical Wellness 
• Chapter 14: Providing Good Nutrition
• Chapter 15: Menu Planning and Food Safety

Ancillary Material

About the book.

Early childhood is a critical time in development. Many outcomes, both positive and negative, have their beginnings in these years. It is vital that children’s health and safety be protected. High-quality early care and education programs can play a valuable role in improving outcomes for children.

About the Contributors

Jennifer Paris  is a full-time faculty member of the Early Childhood Education Department. She previously taught Child Development courses as an adjunct for Rio Hondo College in Whittier for 11 years, MiraCosta College in Oceanside for 6 years, and Cerritos College in Norwalk for 3 years. Her special interests include OER (open educational resources) and online teaching. She has cared for and taught children of all ages and had experiences throughout her schooling in campus Child Development lab schools.

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Healthy Young Children, Sixth Edition

You are here

About the book .

• The need for increased safety measures and training  
• The latest nutrition and physical and mental health standards and guidelines  
• The importance of creating and updating health and safety policies and procedures  
• The impact of the COVID-19 pandemic on children, families, healthcare professionals, early childhood educators, and early learning programs  
• Recommendations for making family connections  
• Tips for health and safety actions that can be implemented quickly  
• A test bank of over 150 questions for instructors   
• A full and extensive list of references (available online)   

Table of Contents

• Part Editors, Chapter Contributors, and Content Reviewers
• Introduction and About the Book
• Chapter 1: Health and Safety for Children and Early Childhood Educators | Julia Luckenbill, Shaun‑Adrián Choflá
• Chapter 2: Healthcare Professionals and Educators Work Together to Support Healthy and Thriving Children | Kristen Copeland, Amy L. King, Mary Beth Pero
• Chapter 3: Enrollment, Health Documentation, Assessments, and Screenings | Multiple Contributors
• Chapter 4: Health Education for Nutrition and Oral Health | Nicole Hackman, Madiha Jamil
• Chapter 5: Physical Activity | Brittany Massare, Abigail Myers
• Chapter 6: Social‑Emotional and Mental Health | Banku Jairath, Ruth E. Gardner
• Chapter 7: First Aid and Injuries | Terri McFadden
• Chapter 8: Understanding Common Illnesses and Conditions | Terri McFadden
• Chapter 9: Preventing and Managing Infectious Diseases | Abbey Alkon, Timothy R. Shope
• Chapter 10: Inclusion of Young Children with Special Healthcare Needs and/or Medical Complexity | Alicia Haupt, Stacey Cook
• Chapter 11: Child Maltreatment: What It Is and What to Do | Nikki Gambhir
• Chapter 12: Emergency and Disaster Preparation and Planning | Jennifer Nizer, Manjula Paul, Louis A. Valenti
• Chapter 13: Creating a Safe Environment | Jennifer Nizer, Manjula Paul, Louis A. Valenti

Appendix B.2

Caring for Our Children Standards by Chapter (online only)

Chapter references (online only)

To access the test banks that accompany the sixth edition of  Healthy Young Children , please complete this form. You'll be able to download the resources after you complete the form.

Book Details

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The importance of health and safety in early childhood

Health, safety, and nutrition in early childhood education are of utmost importance when it comes to operating a high-quality childcare center. While health and safety might seem like basic elements of a good childcare facility, these factors can support the cognitive development of preschoolers . Whether you are a parent searching for the right childcare center for your child or a daycare operator, health and safety should be one of your top priorities. 

Cleanliness

A clean childcare center looks good to prospective families. It also creates a safe environment for the children and educators. Clean surfaces help prevent the spread of illness, which is common in an early childhood setting.

Achieving a clean space boils down to having a consistent routine. Ensure that the physical environment is tidy and disinfected on a daily basis is key. Here are some supplies that are useful to have on hand:

• Lysol wipes
• Water and hydrogen peroxide mixture
• Hand sanitizer

It is also helpful to encourage frequent hand washing among children as well as staff to stop the spread of germs.

Additionally, any employees involved in preparing meals and snacks should be properly certified in food handling. Proper food handling can avoid cross-contamination and illness.

A health and safety curriculum for early childhood

Safety extends into nearly all aspects of a childcare facility and its day-to-day operations. Safety should be at the forefront of an educator’s mind at all times.

From the layout of the rooms and placement of desks to the materials used in craft making, safety should be a consideration. Creating a safe environment will prevent unnecessary mishaps.

Another good way to maintain a clean classroom is to incorporate tidying into the daily routine with the children. Budget some time to clean up after each activity. This will reduce the work educators have to do after class and teach children good habits that will carry on into the future.

Unfortunately, children getting hurt in the classroom is a very common thing. It goes without saying that all educators should have up-to-date first aid training and CPR qualifications.

An app with staff management  can give you an overview of your educators’ certification schedules to make sure you’re on top of things. Keeping track of this ensures that your staff will know the necessary steps to take should an incident happen.

A first aid kit should also be accessible at all times in case of emergency. All kits should be checked for expired supplies and restocked frequently.

When it comes to field trips, always bring along a travel first aid kit. It is always better to be overprepared!

Ensuring that children receive nutritious meals at their childcare center is often a top concern for parents. During the early childhood years, it is very important that little ones get the right balance of nutrients for their  growth and development .

A healthy meal plan should be customized to the age group of the children in your care. It should also take personal allergies and nutritional requirements into account.

Though your licensing body may outline standards for health, safety, and nutrition in early childhood education, remember that these are simply the minimum requirements. A successful center will aim to exceed these standards to offer the best possible learning environment for the children in their care.

Thorough documentation is key to maintaining a safe environment. See our guide to make sure you’re not missing any important moments!

Related Posts

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• Developing an Emergency Disaster Plan for Child Care Centers
• Preparing Kids for Emergencies
• What Child Care Safety Policies Do I Need to Be Compliant?
• How to Effectively Track Health Info At Preschool

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Ron is the Co-Founder of Lillio a social-purpose business that helps early childhood educators improve learning outcomes for children.

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Ron Spreeuwenberg

February 27th, 2020

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The role of playgrounds in promoting children’s health – a scoping review

Jasper schipperijn.

1 World Playground Research Institute, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark

Cathrine Damsbo Madsen

Mette toftager, danielle nørager johansen, thea toft amholt.

2 Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Hovedvejen 5, 2000 Frederiksberg, Denmark

Charlotte Skau Pawlowski

Associated data.

All data extracted from the 247 included publications can be found in Additional file 2. Furthermore, all publications included in this scoping review can be found in a searchable database on the website of the World Playground Research Institute. See https://playgroundresearch.org/article-database/ For selected publications and topics, short summaries were created as ‘briefs’, which are also available on the website, see https://playgroundresearch.org/research-briefs/

Active outdoor play is important for children’s health and development, and playgrounds provide good places for play. However, the importance of playground use for health and well-being is unclear. Our scoping review aims to create an overview of all research on playground use and health benefits for children.

Scopus, Web of Science, SportDiscus, and PsycInfo were searched using two search blocks, focusing on 'playground' and 'children' respectively, for publications from 2000 to November 2023. The primary inclusion criterion was examining the relationship between playground use and positive physical, mental, or social health outcomes. Only papers published in English were reviewed. For each publication, we synthesized and condensed the results, categorizing them by playground setting, reported health outcome, participant age group, study design, methodologies, publication's country, year, and ‘stage of evidence’.

Data from 247 studies were extracted and nearly 80% of these publications were descriptive or exploratory studies. Fifty-two were intervention studies. Adding playground markings to schoolyards led to increased physical activity. Greening schoolyards had mainly positive effects on social and mental health. In Early Childhood Education and Care, renewing play structures had a positive effect on physical activity in three publications. All Public Open Space interventions we found were different, with mixed effects on health outcomes.

Conclusions

The existing evidence provides good arguments for policy makers, city planners and school-leaders to invest in adding playground markings in schoolyards as this will likely result in more physical activity. The evidence for the health benefits of investing in new play structures indicated that tailoring the playground to local needs is important as ‘one size does not fit all’ and playgrounds need to be designed as engaging and interesting places for children’s play if they are to generate health benefits. Investing in ‘greening’ playgrounds is likely to result in social and mental health benefits for children, but does not always result in more physical activity.

The research field needs more efficacy and effectiveness studies, and in particular replication and scale-up studies to demonstrate which type of playground interventions are successful.

The review protocol was registered at Open Science Framework ( https://doi.org/10.17605/OSF.IO/UYN2V ).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-024-01618-2.

Every child has the right to rest, relax, play and to take part in cultural and creative activities’, as stated in article 31 of the United Nations Convention on the Rights of the Child [ 1 ]. The Convention recognizes that play is not an optional extra for children, it is fundamental to their physical, social and mental development and intrinsic to their health and happiness in the present moment. Play is considered fundamental for child development as play helps children develop social, academic, and personal competences [ 2 ]. The Millennium Cohort Study in the United Kingdom demonstrates that independent outdoor play is associated with increased moderate-to-vigorous physical activity (MVPA) and reduced sedentary time [ 3 ]. With global concerns about inadequate children's physical activity levels, only 27%–33% of children meet physical activity recommendations [ 4 ], the World Health Organization recommends children to sit less and play more to grow up healthy [ 5 ]. Following the World Health Organization definition of health [ 5 ], this means that children should thrive mentally, socially as well as physically to be healthy.

Recent decades have witnessed a decline in children's outdoor play, likely due to safety concerns, both from increased car traffic on residential streets, as well as lower levels of contact between neighbours, leading to delayed initiation of independent outdoor play [ 6 ].

A large review [ 7 ] showed that parental attitude, behaviour, support and practice are main factors influencing children’s outdoor play. Furthermore, the same review emphasised that it is important to focus on increasing outdoor play time where children can be spontaneous and creative, stimulating freely chosen and self-directed play, while focusing less on adult-led activities. Playgrounds are likely perceived as safe places for children’s play, and on average children spent more time playing at playgrounds than in any other place [ 6 ]. However, play is not only happening in children’s free time. Among the 38 OECD (Organisation for Economic Co-operation and Development) countries, on average 87% of children aged 3–5 are enrolled in Early Childhood Education and Care (ECEC) [ 8 ] and therefore ECEC centres are important settings for play. For school-aged-children, schoolyards are crucial locations for active play, contributing with up to 40% of children’s daily physical activity [ 9 ].

Numerous reviews, focusing on specific playground settings, age groups, and health parameters, have explored playground-related health outcomes. Most reviews focused on physical activity in schoolyards (e.g. Clevenger and colleagues [ 10 ]) or ECEC (e.g. Martin and colleagues [ 11 ]). A recent review and meta-analysis showed that physical activity interventions in schoolyards had a positive effect on increasing accelerometer-assessed MVPA in school-aged children [ 12 ]. Reviews have also been published on playground benefits for other physical health outcomes such as motor skills (e.g. Pawlowski and colleagues [ 13 ]), weight status (e.g. Williams and colleagues [ 14 ]) or social (e.g. Moore and colleagues [ 15 ]) and mental (e.g. Vella-Brodrick and colleagues [ 16 ]) health outcomes. Finally, some reviews looked at health benefits of using playgrounds in public open spaces (e.g. Audrey and colleagues [ 17 ]).

Because children’s play behaviour is likely to have many similarities across different playground settings, lessons learnt in one setting could potentially be applicable in other settings. Furthermore, playground interventions often have the potential to influence more than one health outcome. Having a comprehensive understanding of the overall health benefits of children’s use of playgrounds in different settings can help policy makers and city planners determine if they should prioritise investing in playgrounds. It can also help health authorities, general practitioners and paediatricians decide if they should recommend parents to take their children to playgrounds regularly.

The objective of this scoping review is to identify and assess the available evidence on the health benefits of children’s use of playgrounds. More specifically, we will: 1) identify all research on playground use and health benefits, 2) assess the stage of evidence of all included publications, and 3) summarise the health effects of intervention studies of playground use.

The scoping review was conducted in accordance with the JBI methodology for scoping reviews [ 18 ]. The review protocol was registered at Open Science Framework (10.17605/OSF.IO/UYN2V) in May 2022 and the PRISMA guidelines for scoping reviews were followed in designing, conducting, and reporting the results. The search was updated in November 2023.

Information sources and search strategy

In May 2022, we initiated a systematic search in four electronic databases: Scopus, Web of Science, SportDiscus, and PsycInfo. Collaborating with a research librarian, authors tested and refined search terms. To ensure comprehensive coverage, a sensitive search strategy was devised with two blocks—one containing synonyms for 'playground' and the other for 'children'. The search terms for Scopus are outlined in Table ​ Table1. 1 . Slight adaptations were made for each database's specific requirements. The updated search looked at the same four databases to include articles from 2022 and 2023. Prior to full-text screening of new articles, 2022 publications assessed in the original search were excluded as "Already included or excluded".

Search terms for Scopus

Eligibility criteria

Playgrounds were defined as places designed or designated to facilitate play . We included both indoor and outdoor playgrounds, public playgrounds, school playgrounds, ECEC playgrounds, as well as private playgrounds, and playgrounds requiring payment. Publications that exclusively focused on unfixed equipment or sports facilities, were excluded, as were studies exclusively focusing on organising play activities, and studies on temporary playstreets.

The primary inclusion criterion was examining the relationship between playground usage and positive physical, mental, or social health outcomes. Studies focusing on negative health outcomes (like injuries and bullying), environmental exposures (such as pollution, pesticides, sun exposure), playground availability, quality, safety, or security were excluded.

All children and adolescent populations (aged 0–17 years) were considered, irrespective of gender, health status, or physical abilities. Peer-reviewed articles published in English from January 2000 to November 2023 were included, while guidelines, conference abstracts, protocols, book chapters, PhD dissertations, reviews, and methodological papers were excluded. The year 2000 was chosen as a start year to balance being comprehensive with the relevance of publications to inform future research. An initial pilot screening in June 2022 ensured a consistent understanding and application of the inclusion criteria among authors.

Selection process

All publications were imported into Endnote 20.0.1, and duplicates were removed, before transferring all data to Covidence for screening of titles and abstracts. The full texts of the included publications were independently assessed by two authors between August and October 2022. Any discrepancies arising from decisions about inclusion or exclusion of a publication were addressed through discussions moderated by authors JS or CSP. The process was repeated in November 2023 for the updated search.

To assess the sensitivity of our search strategy, one author (CDM) examined if we had overlooked potentially relevant publications by screening the reference lists of ten randomly selected included full-text publications for any potentially relevant additional publications. This process took place in January 2023 and did not result in additional publications being identified.

Data extraction process and data items

Data were extracted from all included publications by two student assistants and one of the authors (CDM), and cross-checked by JS, CSP, and MT to ensure accuracy and consistency. We extracted data on authorship, country of origin, World Bank country income level [ 19 ], year of publication, research aim, number of participants involved, setting, health outcomes examined, study design, methodologies employed, and key findings.

Synthesis of extracted results

We encountered multiple publications from the same study and therefore our reporting is structured per publication rather than per study. For each publication, we synthesized and condensed the results, categorizing them by playground setting, reported health outcome, participant age group, study design, methodologies, publication's country, year, and ‘stage of evidence’.

Health outcomes were categorised as: physical health (subdivided in physical activity, motor skills, and weight status), social health (e.g. interactions with peers, social network), or mental health (e.g. well-being, self-esteem, and cognitive health outcomes).

The playground settings were categorised into four main contexts: 1) ECEC (i.e. day-care, kindergarten, and pre-school), 2) School (i.e. primary, elementary, middle, and/or secondary school), 3) Public open spaces (e.g. parks, squares with public playgrounds), and 4) Healthcare (e.g. hospitals, rehabilitation centre, or facilities for children with special needs).

The broad target population of children and adolescents (aged 0–17) was divided into the following age groups: 0-2yrs (toddlers), 3-5yrs (early childhood), 6-12yrs (middle childhood), and 13-17yrs (adolescents).

Following Bauman and Nutbeam [ 20 ], we assume that there are multiple stages of evidence in relation to the evaluation of health promotion programs. Various types of descriptive and exploratory studies are primarily used to define the problem (stage 1), before developing possible solutions that are tested in feasibility and pilot studies (stage 2), followed by efficacy and effectiveness studies (stage 3), and replication studies studying the implementation and effectiveness of interventions in a different context (stage 4), before scale-up studies (stage 5), and eventually monitoring studies of fully implemented health promotion programs can take place (stage 6). For each included publication the ‘stage of evidence’ was assigned independently by authors JS and CSP, and initial inconstancies were discussed and resolved.

For publications reporting results from intervention studies, we described and categorised the main intervention components, and summarised the findings by classifying the effect of playground use on health outcomes as: positive, negative, or showed no effect. If a publication reported on the same outcome measured with multiple methods or for multiple sub-groups, with a conflicting direction of the effect, the outcome was labelled as 'inconclusive'.

Publication selection

The initial search across the four databases yielded a total of 66,279 potentially relevant publications. After removing duplicates, the titles, and abstracts of 42,110 publications were screened, and 2,389 publications were selected for full-text screening. Following the full-text screening process, 215 publications met the inclusion criteria and were included in this scoping review. The search update resulted in 8,831 potentially relevant publications. After duplicates were removed 5,490 publications remained for title/abstract screening of which 5,330 were excluded, leaving 160 for full-text screening, resulting in 32 additional publications that met the inclusion criteria. In total, data extracted from 247 publications formed the basis of this scoping review. A full reference list of all 247 publications can be found in Additional file 1, and data extracted from all 247 publications can be found in Additional file 2. See Fig.  1 for the PRISMA flowchart of our selection process.

PRISMA flowchart

Publication characteristics

Three-out-of-four (75.7%) of the 247 included publications were published after 2012. Almost all publications reported on studies in high-income countries (92.7%), 117 were from Europe (47.4%), 81 were from North America (32.8%), and 33 were from Oceania (13.4%). Eighteen publications were from low- and middle-income countries (LMIC), whereof three were from Africa, five from Central and South America, and eight from Asia. Out of the 247 publications, 22 included 0–2-year-old children (8.9%), 107 included 3–5-year-old children (43.3%), 169 included 6–12-year-old children (68.4%), and 42 included 13–17-year-old children (17.0%). Only 11 of the 247 publications (also) included children and adolescents living with disability.

Most publications ( n  = 195, 78.9%) reported results from descriptive or exploratory studies, 31 (12.6%) presented results from feasibility or pilot studies, 20 (8.1%) were based on efficacy and effectiveness studies, and one was based on a replication study. More than half of the publications ( n  = 130, 52.6%) reported on studies that took place in a schoolyard playground, 63 were in an ECEC playground (25.5%), 54 (21.9%) in a public open space, and three studies took place on a playground in connection with a healthcare centre (1.2%). See characteristics of included publications in Table  2 .

Characteristics of included publications. N  = 247

a One publication can include multiple geographical locations, settings, population and age groups, outcomes, and methods. For that reason, the numbers in each of these categories do not sum to the overall number

Results reported in the included publications

Physical activity was the primary outcome in 192 publications, followed by social health ( n  = 54), mental health ( n  = 30), motor skills ( n  = 15), and weight status ( n  = 12), see Table  3 . A full overview of the results reported in all included publications can be found in Additional file 2.

Number of publications reporting on each health outcome, grouped by settings and by evidence stage. N  = 303 health outcomes in 247 publications

ECEC  Early Childhood Education and Care 

a One publication can include multiple outcomes, and multiple settings. For that reason, the numbers in each row, for each outcome, for each stage of evidence, do not necessarily sum to the overall numbers

Effects of using playgrounds – results from intervention studies

Presenting and summarizing all results from 247 publications in one review paper is not feasible, so we have chosen to focus on the stronger (stage 2 and higher) evidence presented in 52 intervention studies. Five focused on the health effects of free outdoor play, while 24 explored the impact of new playground structures—sometimes with additional elements like markings, loose equipment (e.g. balls, rackets, bats, skipping ropes), activities (e.g. sports or games), or staff training (e.g. on how to encourage children to be physically active during recess). The added play structures varied widely in type and budget. Playground markings were studied in 16 publications, and eight examined the effect of (access to) nature, often through greening school playgrounds. Additionally, six publications explored unique interventions, such as removing benches, lowering schoolyard density, opening the schoolyard after school hours, or comparing sports fields with playgrounds.

Most intervention studies were conducted in the school setting (one repetition, 17 efficacy and effectiveness, and 14 feasibility and pilot studies). The primary intervention components studied were play structures (16 publications) and playground markings (14 publications), often combined with each other, or integrated with organised activities or loose equipment.

Play structures in the schoolyard

Numerous school-based studies investigated the impact of renovating schoolyards with new play structures, greatly varying in type and size. The Danish SPACE study [ 21 ] and 'Activating Schoolyards' project [ 22 ] both included several new innovative play structures and landscaping developed after consulting school children, but results varied. Positive associations between the perceived schoolyard and physical activity were found in the SPACE study [ 21 ] while the Activating Schoolyards study reported increased activity for the least active children [ 22 ] but mixed effects in a sub-sample of all children [ 23 ]. In a Swedish study, adding play structures and landscaping during the renovations primarily attracted already active children, with less active ones being spectators [ 24 ]. The 'Camden active spaces' project in London showed insignificant effects on physical activity levels after renovating schoolyards in a deprived area where each school received a unique playground design, e.g., including new AstroTurf games pitches, climbing frames, trampolines, monkey bars, and outdoor gyms, which were designed based on themes emerging from consultations with children [ 25 ]. A study with a small (2000 Euro) intervention budget in the Netherlands [ 26 ] and a large natural experiment in Cleveland, USA [ 27 ], did not demonstrate significant effects on accelerometer-measured physical activity, but the Cleveland study did show a significant increase in schoolyard use. Conversely, a study in Denver, USA, showed increased physical activity levels after renovating schoolyards as part of the ‘Learning Landscapes’ program. Each schoolyard had unique attributes, but also common elements including areas with age-appropriate play equipment, asphalt areas for structured games such as basketball and tetherball and a grassed multipurpose playfield, typically with a track. All of the schoolyards had a central gathering space with a shade structure. Trees were planted in hard surface and grassed areas to increase shade [ 28 ]. In a small study at a school in Leadville, Colorado showed a positive effect after a renewal process added six swings, a mesh climbing structure, slides, and a spinning carousel. A new outdoor basketball court, walkways, boulder retaining walls, and grass-covered open play area were also constructed. Additional loose equipment was provided during post-observations, including balls, hula hoops, and cones for creating a course [ 29 ].

In a study focusing on eight boys with autism spectrum disorder, moving to a new playground designed for enhanced social interactions significantly increased group play and social interactions [ 30 ].

Playground markings in schoolyards

Feasibility and pilot studies examining the impact of adding playground markings in schoolyards were conducted in the UK [ 31 , 32 ] the USA [ 33 ] and Spain [ 34 ] all demonstrating positive effects on physical activity. Typically, the markings consisted of a combination of game-related marking (e.g. hopscotch or 4-square), fantasy element (e.g. castles, dragons, snakes or animals), educational markings (e.g. clock faces or letter squares), or mazes and trails. In an efficacy and effectiveness study in the Northwest of England, Ridgers and colleagues reported a positive effect on recess physical activity after 6 weeks, a significant effect after 6 months, and no significant effect after 12 months [ 35 , 36 ]. A study in Mexico City [ 37 ] found a positive effect on physical activity with basic and comprehensive interventions involving markings, loose equipment, and organised activities. The Australian Transform-Us! intervention showed a significant mid-intervention effect on recess physical activity [ 38 ]. A French study by Baquet et al. [ 39 ] reported a positive effect of playground markings on physical activity after 6 and 12 months. Crust and colleagues [ 40 ] found no influence on children’s physical self-perception but observed positive effects on physical activity and pro-social behaviour with added markings. Benthroldo et al. [ 41 ] in Brazil did not find a significant effect on self-reported physical activity after adding markings and loose equipment to public schools. Finally, a repetition study in France [ 42 ] reported a significant positive effect on accelerometer-measured physical activity using the same markings intervention as Ridgers and colleagues [ 35 , 36 ] in the UK.

Natural elements (greening) in the schoolyard

Adding more natural elements (greening) in schoolyards was investigated in five feasibility and pilot studies. Barton et al. [ 43 ] compared loose equipment provision with a nature-based orienteering intervention, showing greater physical activity increase in the schoolyard than the orienteering area. Amicone et al. [ 44 ] found improved attention and perceived restorativeness in a green schoolyard compared to a paved surface schoolyard. Wood et al. [ 45 ] compared physical activity levels in the schoolyard versus the school field, finding children were less active (accelerometer measured) in the schoolyard than the school sports field.

A Los Angeles County pilot study [ 46 ] reported increased physical activity after replacing asphalt with green space at three time points. Similar schoolyard renovations in Chicago [ 47 ] led to heightened physical activity and prosocial interactions. A Dutch study [ 48 ] replacing pavement with greenery on schoolyards showed positive effects on attentional restoration, social well-being, and increased accelerometer-measured physical activity for girls.

Early Childhood Education and Care (ECEC)

In ECEC settings, nine publications reported on feasibility and pilot intervention studies, while two reported on efficacy and effectiveness studies. Three studies examined the feasibility of free outdoor play. MacArthur et al. [ 49 ] compared 15-min of unstructured outdoor play with 15-min of active video games using an Xbox 360 Kinect, showing inconclusive results on accelerometer measured physical activity. Tandon et al. [ 50 ] found no significant impact when comparing free outdoor play to teacher-led play. Lundy and Trawick-Smith [ 51 ] found a positive association between naturalistic playground play (i.e. free play, as opposed to adult-directed play) and on-task behaviour for boys, as well as children of low socio-economic status.

Canadian research [ 52 ] on increasing nature and risky play opportunities (play classified as: rough and tumble, height, mastery, unstable, speed, risk of getting lost) in ECEC settings showed significant decreases in accelerometer-measured physical activity and inconclusive results for social behaviours. A San Diego study observed increased activity levels after renovating a university ECEC outdoor playground, but no change in accelerometer-measured activity levels [ 53 ]. A large Belgian study [ 54 ] showed no increase in accelerometer-measured recess physical activity with added markings or loose equipment. Conversely, a Belgian pilot study [ 55 ] that varied recess times so that the number of children in the playground during recess was smaller, showed increased accelerometer-measured physical activity. A Japanese pilot study [ 56 ] reported a significant increase in accelerometer-measured physical activity by changing the layout of an ECEC playground to separate playground elements more, and make sure that play in one area did not disturb play in another area. Lastly, a natural experiment in Perth, Australia [ 57 ] showed significant increases in accelerometer-measured physical activity after renovating six ECEC outdoor playgrounds compared to unchanged ones.

Webster et al. [ 58 ] found no effect of adding playground markings and staff training on fundamental motor skills or physical activity in a US pilot study. And a small Norwegian study [ 59 ] on nature's impact on motor skills yielded mixed results.

Public open space

Our search yielded eight feasibility and pilot studies on playgrounds in public open spaces and one publication reporting on efficacy and effectiveness. The REVAMP natural experiment in Melbourne, Australia, found a positive impact on observed physical activity with the construction of a large playscape with many different play structures and landscaping [ 60 ]. A study in Sydney, Australia, showed increased physical activity for boys, but not girls, in a renovated park playground with added play structures [ 61 ]. Farley et al. [ 62 ] observed enhanced neighbourhood physical activity after opening a schoolyard for use after school hours in a low-income neighbourhood in New Orleans, USA. Roemmich et al. [ 63 ] found increased physical activity for both children and parents after removing park benches around a playground in another US study. A Danish study by Pawlowski et al. [ 64 ] evaluated the effect of co-creating a new neighbourhood playground with local 10–11-year-olds but did not observe an increase in playground use and activity levels. Molenberg et al. [ 65 ] evaluated adding 13 new activity and play spaces to low-income neighbourhoods in the Netherlands but did not show a significant effect on physical activity.

Tortella et al. [ 66 ] reported significant improvement in four out of six gross motor skills in a study of a new playground in Northern Italy designed to enhance fundamental motor skills. However, in a subsequent study [ 67 ], comparing free play and partly structured activity at the new playground showed no difference in motor skills between the two groups. Yang et al. [ 68 ] observed increased peer interactions after adding a play structure in a large park in Taipei, Taiwan.

We set out to review and synthesise evidence on the health benefits of children's playground use. After assessing over 47,000 titles and abstracts, we extracted data from 247 included publications. Nearly 80% of these publications were descriptive or exploratory studies (evidence stage 1). Fifty-two were intervention studies, with 31 reporting on feasibility or pilot studies (stage 2), 20 reporting on efficacy and effectiveness studies (stage 3), and one reporting on a replication study (stage 4). Physical activity was the predominant health outcome studied, followed by social and mental health. Most intervention studies were conducted at schools, followed by ECEC, and Public Open Spaces. Three studies, all descriptive or exploratory (stage 1), were conducted in healthcare settings. Over 90% of all publications included were conducted in high-income countries, which limits the generalisability of currently available evidence.

The longitudinal analysis of data from the Gateshead Millennium Cohort Study revealed that the total volume of physical activity already starts declining by age 7 in the UK for both boys and girls, and, unlike many other studies, that this decline did not intensify during adolescence [ 69 ]. This emphasises the importance of implementing physical activity promotion interventions during primary-school age. One successful intervention, tested in various countries, is the addition of playground markings [ 31 – 42 ]. Renovating schoolyards with new play structures, though varied in budget, and yielding mixed results, also showed several positive effects [ 21 , 22 , 24 , 28 – 30 ]. Greening schoolyards had positive effects on physical activity [ 46 – 48 ], as well as social and mental health [ 44 , 47 , 48 ].

In ECEC, providing more space per child had a positive impact on physical activity in a pilot study [ 55 ]. However, greening an ECEC playground had a negative effect on physical activity but a positive effect on social health [ 52 ]. In contrast to schools, adding playground markings in ECEC did not increase physical activity [ 58 ]. Renewing play structures in ECEC had a positive effect on physical activity in three publications [ 55 – 57 ].

All Public Open Space interventions we found were different, and even though many added play structures, they were not directly comparable, and results were mixed. Opening schoolyards for use by neighbourhood children outside of school hours increased activity levels [ 62 ], as did the construction of a large playscape in a park [ 60 ].

Our scoping review underscores the evidence supporting health benefits from playground use, but the effectiveness of interventions varies by setting, health outcome, and intervention component. Schoolyard markings, a cost-effective intervention, exhibit predominantly positive effects on children’s physical activity, warranting a logical next step—a scale-up study (evidence stage 5) like the one planned for the Australian 'Transform-Us!' program [ 70 ]. However, evidence for mental and social health outcomes is less abundant, highlighting the need for more comprehensive schoolyard studies. The diverse interventions adding play structures to schoolyards resulted in unclear health effects, necessitating studies that describe the interventions, and the program theory behind them, in (much) more detail, and include robust implementation measures so that the mechanisms can be better understood.

Motor skills in preschool-aged children from high-income countries are insufficient [ 71 ], impacting physical activity and weight status negatively across the lifespan [ 72 ]. Only three feasibility and pilot studies (stage 2) have explored how ECEC playgrounds influence motor skills. Larger scale (stage 3) studies are needed to provide evidence towards recommendations for motor skill development in ECEC. The planned scale-up of the Play Active intervention [ 73 ] in Australia will hopefully be able to provide stage 5 evidence of the health effects of a multi-component ECEC intervention.

The evidence for health benefits related to playgrounds in public open space playgrounds is less convincing with 47 out of the 55 included publications being based on descriptive and exploratory (stage 1) studies. Stage 2 and 3 intervention studies with a robust design, encompassing multiple health outcomes, are needed before evidence-based recommendations can be established.

Based on the playground descriptions and illustrations included in the publications we assessed, there is a very large variation in playground design Various publications mentioned that interventions need to be tailored to local needs and possibilities, ‘one size does not fit all’ when designing playground interventions, and evaluation studies need to take this tailoring process into account. A good playground renovation most likely needs to start with a thorough assessment of the current situation, to make sure that the additional play structures add variation and provide new opportunities for children that were not already catered for. Most studies mentioned consulting children before redesigning, and some studies actively involved children in the co-design of places to play. In general, involvement and co-design was mentioned as something positive but a Danish study [ 64 ] that specifically focused on evaluating the co-design process showed a negative effect on the use and activity after renewal. Furthermore, the fact that playgrounds can be designed in many ways, needs to be studied in more detail. For example, a pilot study found that the spatial layout of playground affects the pattern of play activity and the physical activity levels of young children [ 56 ].

Strengths and limitations

A scoping review is useful to map the literature on evolving or emerging topics and to identify gaps [ 74 ]. We followed the JBI methodology and PRISMA guidelines for scoping reviews for a robust, rigorous, and transparent review protocol [ 75 ], thus the risk of bias in our review methodology is low. However, despite an extensive assessment alignment process, reviewing 47,600 titles and abstracts as a team may have caused some inconsistencies in the selection process. A strength is that the search procedure was developed by a research team of experts in the research field of playground usage in collaboration with a librarian with extensive expertise in search strategies for scoping reviews. To capture as much relevant research as possible, four different databases were searched. However, given the large number of publications retrieved, we questioned if we should have created a third block containing health outcomes to narrow-down our search, but a search that is too narrow may compromise the breadth and depth of the review and is not suggested in the literature around scoping reviews [ 74 ]. Also, in accordance with doing scoping reviews, no strict quality assessment of included publications was performed since we wanted to cover all knowledge on the subject regardless of the design and quality of the study to create an overview of the research field. We did, however, assess the ‘stage of evidence’ for all publications, which, in our opinion, gives a good indication of how strong the evidence presented is. We did not include studies’only’ focusing on playground use or factors influencing playground use without measuring a health outcome. In future, these studies are also important to review to understand the mechanisms behind increasing playground use. Furthermore, while we used an inclusive definition of health, we did not include studies with relevant non-health outcomes, e.g. learning outcomes.

Finally, we only included positive physical, mental, or social health outcomes, assuming that almost all new or renovated playgrounds are safe, while challenging and fun for children. For a full overview of all health effects of using playgrounds, also negative health outcomes (like injuries and bullying), and environmental exposures (such as pollution, pesticides, sun exposure), should be assessed.

This scoping review builds on data extracted from 247 publications, demonstrating that there is a lot of research on the health benefits of playgrounds. However, most publications (nearly 80%) were based on descriptive or exploratory studies. We did include 52 intervention studies, but the majority were feasibility or pilot intervention studies, indicating that the research field needs more efficacy and effectiveness studies, and in particular replication and scale-up studies. However, the existing evidence already provides good arguments for policy makers, city planners and school-leaders to invest in adding playground markings in schoolyards as this will likely result in more physical activity. The evidence for the health benefits of investing in new play structures indicated that tailoring the playground to local needs is important as ‘one size does not fit all’ and playgrounds need to be designed as engaging and interesting places for children’s play if they are to generate health benefits. Investing in ‘greening’ playgrounds is likely to result in social and mental health benefits for children.

Providing available playgrounds are safe, health authorities, general practitioners and paediatricians can recommend parents to take their children to playgrounds regularly as using playgrounds will increase physical activity levels and stimulate social interaction with other children.

Acknowledgements

We would like to acknowledge student assistants Jonatan Villebro and Kasper Nørgaard Christensen and research librarian Lasse Østengaard for their contributions to this scoping review.

Abbreviations

Authors’ contributions

JS, Conceptualization, Methodology, Writing—Original Draft, Formal analysis, Validation, Supervision, Funding acquisition. CDM, Methodology, Software, Investigation, Formal analysis, Data Curation, Visualization, Writing—Original Draft, MT, Conceptualization, Methodology, Investigation, Formal analysis, Validation, Writing—Review & Editing. DNJ, Investigation, Writing—Review & Editing. IL, Writing—Review & Editing. TTA, Conceptualization, Methodology, Investigation, Writing—Review & Editing. CSP, Conceptualization, Methodology, Investigation, Formal analysis, Validation, Writing—Review & Editing.

Open access funding provided by University of Southern Denmark This study was funded by KOMPAN, a large international playground equipment company. KOMPAN had no influence on the methods, results, or conclusions of this scoping review.

Availability of data and materials

Declarations.

Not applicable.

Author JS is a member of the Editorial Board of International Journal of Behavioral Nutrition and Physical Activity. JS was not involved in the journal’s peer review process of, or decisions related to, this manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Early childhood education and care

This page is about the risks early childhood education and care workers face and provides resources about how to prevent injuries from occurring.

The early childhood education and care sector includes educators, administrators and licensed providers who work in family day care, preschool, and outside school hours care services.

Early childhood education and care workers face many risks in the workplace, including:

• slips, trips and falls
• hazardous manual tasks such as bending, twisting and exerting high or unexpected force when lifting moving or carrying objects
• psychosocial injuries, where aspects of the job such as role demands, relationships with colleagues, bullying and harassment can cause a stress response.

Psychosocial injuries in the early childhood education and care sector

Work health and safety includes being both physically and psychologically healthy. At work you can be exposed to psychosocial hazards.

SafeWork NSW has produced this video to assist educators and managers in the sector.

SafeWork NSW has also developed the  Code of practice for managing psychosocial hazards at work .

If you're experiencing bullying or other psychosocial hazards in your workplace you may raise the issue with SafeWork NSW by completing our request for service form . We can provide assistance within the scope of our legislative responsibilities. Read about how we can help or call us on 13 10 50 for more information.

Musculoskeletal disorders in the early childhood education and care sector

The most common workplace injuries can occur when performing routine tasks.

Risk identification resources have been developed to support businesses, employers and workers identify hazards in the workplace and prevent injuries from occurring.

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Contact SafeWork NSW to arrange a workplace visit by one of our trained Inspectors. Our Inspector will conduct a hazard identification inspection with your workers and managers, and recommend changes to existing practices or the work environment to reduce the risk of injury.

Case studies

Start a conversation about safe workplace behaviours, mentally healthy workplaces, and how to get help to create a safe work environment.  The following videos can be used in your next work health and safety meeting with staff, as part of the consultation process to identify risks, hazards and potential solutions suited to your specific workplace.

This video highlights the physical demands of caring for people, particularly in a childcare environment, and how you can reduce the risk of injury by making small changes.

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For all other SafeWork NSW events, visit our events calendar .

Safety information for your sector

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Managing harms

Safework nsw activities and commitment, when to notify safework nsw, codes of practice and your legal obligations, translated resources.

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Related information

The nature of the work in this sector presents specific hazards for workers. It is important you know what the hazards are in your workplace so you can assess the risks they pose.

Find a list of common hazards and learn how to manage the risks below.

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Manual tasks

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Read about what SafeWork NSW is doing to prevent injury and improve health outcomes:

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If there is a serious injury, illness, dangerous incident, or death relating to staff, customers or visitors to your worksite or your place of employment (even if it's off-site) , you must report it to us immediately.

Incidents can be notified 24 hours a day, 7 days a week by calling 13 10 50 . If you're unsure of whether to notify, use Safe Work Australia's  Incident notification information sheet to help you decide. Read more about notifying SafeWork NSW .

Hazardous chemicals

Exposure to chemicals is 100% preventable. Without the proper controls chemical exposure can cause cancer, respiratory illnesses, skin and eye irritations, as well as fire and explosion-related injuries.

Our  Hazardous Chemicals Code of Practice (PDF, 1171.43 KB) to help you manage hazardous chemicals in the workplace.

For many businesses, manual tasks are an important part of getting the job done. Some of these tasks can be hazardous and are often the most common cause of workplace injuries.

Our  Hazardous manual tasks Code of Practice (PDF, 1499.23 KB) can help you create a safer work environment.

Psychosocial hazards at work

NSW businesses need to manage exposure to psychosocial hazards and risks to psychological and physical health and safety at work.

Our Managing psychosocial hazards at work code of practice can help you manage psychosocial hazards at work.

Managing the work environment and facilities (remote and isolated work)

Download SafeWork NSW's  Code of Practice for Managing the work environment and facilities (PDF, 422.29 KB) .

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Visit our translated resources hub for other print, web and multimedia resources.

Manager’s toolkit

The WHS Manager's Toolkit provides the health care and social assistance sector with key resources to help them manage health and safety in their workplace .

View the toolkit here

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• The Healthy Older Worker Toolkit (PDF) – Centre for Work Health and Safety

MSU Extension Child & Family Development

Understanding the process of early childhood developmental evaluations: part 5.

Kevin Zoromski <[email protected]> , Michigan State University Extension - July 31, 2024

Become familiar with early childhood developmental evaluation, ways to request an evaluation for your child, how the process works, preparing for the first meeting and the evaluation process.

Have you ever wondered about your child’s overall development? Many parents and caregivers do a great job following along with, and even tracking, how their children are doing with their speech and language, motor skills and social skills. However, there are early childhood professionals who can track your child’s developmental milestones while looking for any delays that may be happening. This article series will focus on developmental evaluations and how you can request, prepare for, and ultimately participate in an online or in-person early childhood developmental evaluation.

In the previous article in this Michigan State University Extension series, we discussed important tips to prepare for the actual evaluation and preparing to welcome or meet with an early childhood professional for possibly the first time. In this fifth article, we will focus on what actually happens during a developmental evaluation, including what areas of development will be screened, how long you can expect for the evaluation, and what participation may be asked of you and your child.

The day has arrived, it is time for an early childhood professional to conduct the developmental evaluation and check your child’s progress in multiple areas including, but not limited to, gross-motor , fine-motor , speech/language , problem solving , social and emotional and coping skills. Depending on the specific evaluation conducted, these titles may be slightly different and other categories can be included. The domains suggested and described here are part of the Infant Toddler Developmental Assessment (IDA) and The Ages and Stages Questionnaire (ASQ ). For this article, we will be focusing on the process for the six areas mentioned.

Before the professional begins the evaluation, they may have some paperwork to complete as well as take time to discuss concerns you may have regarding your child. You can expect an in-person evaluation to take around 1.5 - 2 hours, depending on how your child responds to the evaluator’s tasks. The online ASQ typically takes no more than half-an-hour, depending on the age range you are checking.

We will start with examples for how the evaluator will check your child’s motor development. Gross motor activities may include seeing how your child sits and crawls, stands, tosses a ball, walks, climbs onto a chair, kicks a ball, stands on one foot, jumps, walks upstairs and balance on each foot. Fine motor activities may include watching hand motions, grasping a toy, holding a small block, picking up very small objects, tossing a ball, building a tower with small blocks, holding a crayon, stringing beads, coloring and cutting paper with scissors.

For speech and language, the evaluator will use typical types of activities to check progress. These include: watching for a vocal response, seeing if they vocalize to people, if they are laughing and squealing, making vowel sounds, saying “mama, dada, baba”, using “dada” and “mama” as names, playing pat-a-cake, responding to “no”, imitating words and sounds, naming objects, identifying body parts, following 2-3 step a directions, naming pictures, using more than 20 words, using 2-3 word sentences consistently, responding to simple questions and/or can using the name of familiar objects. The caregivers will answer many of these questions, as children may not perform skills on demand. From agesandstages.com , this is known as “parent reporting.”

A problem solving skill assessment will involve activities such as: uncovering a toy, exploring toys, putting one object inside another, finding a toy behind a screen, building a tower of 3-4 cubes, carrying or hugging a doll/stuffed toy, playing with life-sized objects (broom for example), knowing the use of three objects (typically household items), building a tower of 6- 12 cubes, solving a puzzle with 3-10 pieces, copying a circle and imitating another’s activities.

A social and emotional development review often requires a good deal of parent reporting via questions asked by the evaluator. Can the child express pleasure and discomfort, are they showing pleasure when being social, can they be comforted, do they laugh and squeal, how do they react to strangers, are there many recognizable emotions, will they show some anxiety when separating from caregivers, do you see affection towards familiar adults, do they show pride in new tasks (such as clapping, laughing), are you noting a good range of feelings, and are they expressing emotions in an appropriate way?

Finally, a coping assessment will often involve activities and questions for caregivers such as: will they look around their environment, are they comforting themselves, are they initiating social contact, do they push away an unwanted object or person, are they using toys to relieve stress, will they look for a hidden object, do they show pleasure in new skills, will they try to do things for themselves, have they begun to play cooperatively, do they use speech to ask for help, will they try to defend themselves, and can they recover from small hurts on their own?

Once the assessment has concluded, the evaluator will walk you through their first impressions. Know that it does take time for the evaluator to complete a final review and you will often receive a copy of the assessment within the timeframe they share with you (often within 14 days is a reasonable expectation). At this point, do not be afraid to ask questions or relay your concerns once again as this is a time when you are at the beginning of a new process and increasing knowledge is one of the best ways to begin advocating for your child and family.

You can learn more about child development, find parent and caregiver webinars and view family activities by visiting the Michigan State University Extension Child and Family Development webpage and the MI Stronger Family Facebook page.

This article was published by Michigan State University Extension . For more information, visit https://extension.msu.edu . To have a digest of information delivered straight to your email inbox, visit https://extension.msu.edu/newsletters . To contact an expert in your area, visit https://extension.msu.edu/experts , or call 888-MSUE4MI (888-678-3464).

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Supporting parents and caregivers in ensuring young children learn to grow, thrive and contribute in a complex and changing world.

Early childhood development resources for early childhood professionals.

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The Joy of Teaching and Learning in Preschool

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