CLINICAL REPORT

The Importance of Play in Promoting Healthy ChildDevelopment and Maintaining Strong Parent-ChildBond: Focus on Children in Poverty

abstractPlay is essential to the social, emotional, cognitive, and physical well-being of children beginning in early childhood. It is a natural tool forchildren to develop resiliency as they learn to cooperate, overcomechallenges, and negotiate with others. Play also allows children tobe creative. It provides time for parents to be fully engaged with theirchildren, to bond with their children, and to see the world from theperspective of their child. However, children who live in poverty oftenface socioeconomic obstacles that impede their rights to have play-time, thus affecting their healthy social-emotional development. Forchildren who are underresourced to reach their highest potential,it is essential that parents, educators, and pediatricians recognizethe importance of lifelong benefits that children gain from play.Pediatrics 2012;129:e204–e213

More than 15 million children in the United States younger than 18years live in poverty.1 These children experience disparities in edu-cation, health care, and socioeconomic resources.2–6 Children living inpoverty may also be deprived of the benefits of safe and creativeplaytime and access to age-appropriate extracurricular activities. Theimplications of play deprivation may be substantial, because play isessential to the social, emotional, cognitive, and physical well-being ofchildren beginning in early childhood.7 In addition, play offers anopportunity for parents to view the world from their child’s per-spective as they engage fully with their children during playtime; allfamilies deserve ready access to this bonding opportunity. Even be-fore the United Nations High Commission for Human Rights cited playas a right of every child, philosophers and psychologists, such asPlato, Piaget, and Friedrich Froebel, recognized the importance of playin healthy child development.8–10

This report addresses issues that may deprive children who live inpoverty from gaining the maximum benefit from play. Because itfollows an earlier report that focused on factors reducing freeplaytime for children whose families have resources, this reportaddresses issues specific to children from lower-income families.7

Although some of the factors covered in the previous report may alsoapply to children from lower-income and poor families, 3 issuesdisproportionately affect these children and merit special attention.First, access to recess and other in-school creative and physical

Regina M. Milteer, MD, Kenneth R. Ginsburg, MD, MSEd,and the COUNCIL ON COMMUNICATIONS AND MEDIA andCOMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD ANDFAMILY HEALTH

KEY WORDSchildren, development, parents, pediatrician, play, poverty

ABBREVIATIONSAAP—American Academy of Pediatrics

This document is copyrighted and is property of the AmericanAcademy of Pediatrics and its Board of Directors. All authorshave filed conflict of interest statements with the AmericanAcademy of Pediatrics. Any conflicts have been resolved througha process approved by the Board of Directors. The AmericanAcademy of Pediatrics has neither solicited nor accepted anycommercial involvement in the development of the content ofthis publication.

The guidance in this report does not indicate an exclusivecourse of treatment or serve as a standard of medical care.Variations, taking into account individual circumstances, may beappropriate.

All clinical reports from the American Academy of Pediatricsautomatically expire 5 years after publication unless reaffirmed,revised, or retired at or before that time.

www.pediatrics.org/cgi/doi/10.1542/peds.2011-2953

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PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

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outlets (eg, physical education, art,music), as well as after-school youthdevelopment programs are reduced.Second, out-of-school opportunities forplay may be compromised by a lack ofsafe play areas, because parks andplaygrounds are less abundant inlower-income areas and, in some cases,may be unsafe because of drug deal-ing, violence, and vandalism.11,12 Finally,because lower-income parents have todeal with additional social, emotional,and economic stressors of daily living,they may have less time, energy, andresources available to provide activeand creative playtime at the park,playground, or even in the home.

All children deserve the opportunity toreach their highest potential. The op-timal developmental milieu for childrenincludes academic enrichment, as wellas opportunities for physical, cognitive,social, and emotional growth offered inschool, home, and community settings.There are different forms of play—freeunstructured play, which uses unlim-ited creativity, and semistructuredplay, which is guided play with jointattention by parent and child. It is be-yond the scope of this report to defineand divide, but poverty may preventchallenges to both unstructured andguided play.

Free unstructured play, as well ascreative and physical outlets, con-tribute to social and emotional growth.This report offers guidance on howpediatricians can advocate for chil-dren by helping families, school sys-tems, and communities consider howbest to ensure play is protected andpromoted as the optimal developmentalmilieu for positive child and youth de-velopment is explored.

THE BENEFITS OF PLAY

It could be argued that active play is socentral to child development that itshould be included in the very definitionof childhood. Play offers more than

cherished memories of growing up,it allows children to develop creativityand imagination while developing phys-ical, cognitive, and emotional strengths.A previous manuscript described thebenefits of play in fuller detail.7

Play enhances physical health by build-ing active, healthy bodies. Physicalactivity beginning in early childhoodprevents obesity.13 In fact, play maybe an exceptional way to increasephysical activity levels in children and,therefore, may be included as an im-portant strategy in addressing theobesity epidemic.14,15

Play contributes to healthy brain de-velopment.16–18 Children engage andinteract with the world around themthrough play from a very early age.Even in the academic environment, playhelps children adjust to the schoolsetting, thereby fostering school en-gagement, and enhances children’slearning readiness, learning behaviors,and problem-solving skills.19–31 In ad-dition, play and recess may increasechildren’s capacity to store new in-formation, as their cognitive capacityis enhanced when they are offered adrastic change in activity.19,20

Play is essential to developing socialand emotional ties. First, play helps tobuild bonds within the family. Child-ren’s healthy development is mediatedby appropriate nurturing relation-ships with consistent caregivers.16

Play allows for a different quality ofinteraction between parent* and child,one that allows parents to “listen” ina very different, but productive, way.When parents observe their childrenplaying or join them in child-drivenplay, they can view the world throughtheir child’s eyes and, therefore, maylearn to communicate or offer guidancemore effectively. Less-verbal childrenmay be able to express themselves,

including their frustrations, throughplay, allowing their parents an oppor-tunity to better understand their needs.Above all, the intensive engagementand relaxed interactions that occurwhile playing tell children that theirparents are fully paying attention tothem and, thereby, contribute to astrong connection.17,32,33 Play alsohelps forge connections between chil-dren. It allows them to learn how toshare, to negotiate and resolve con-flicts, and to learn self-advocacy skillswhen necessary.34,35 It teaches themleadership as well as group skills thatmay be useful in adult life.

Play should be an integral componentof school engagement. School en-gagement is best realized when theeducational setting attends to the so-cial and emotional development ofchildren as well as their cognitivedevelopment. The challenge is to makeeach child feel competent in a schoolsetting, because the experience ofsuccess forms positive associationswith school attendance.9 Although wehope for each child to demonstrateacademic strengths, opportunities toexhibit social, physical, and creativestrengths optimizes the chances thatchildren will realize their areas ofstrength. Play, recess time, and classesthat foster creative aptitude andphysical fitness allow for peer inter-actions that contribute both to schoolengagement and social-emotionallearning. Social-emotional learningshould not be thought of as distinctfrom academic learning, because itcan creatively be integrated withacademic learning and has beenshown to enhance children’s ability tolearn.36–38

Play is a natural tool that children canand should use to build their resil-ience. At its core, the development ofresilience is about learning to over-come challenges and adversity. Asmentioned, children learn to deal with

*The word “parent” is used in this report torepresent the wide range of adult caregivers whoraise children.

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social challenges and navigate peerrelationships on the playground. Inaddition, even small children useimaginative play and fantasy to take ontheir fears and create or explore aworld they canmaster. Play allows themto create fantasy heroes that conquertheir deepest fears. It allows them topractice adult roles, sometimes whileplaying with other children and some-times while play-acting with adults.34,39–41 Sensitive adults can observethis play and recognize the fears andfantasies that need to be addressed;however, in many cases, play itselfhelps children meet their own needs.As they experience mastery of theworld they create, children developnew competencies that lead to en-hanced confidence and the resil-ience they need to address futurechallenges.34,42

FACTORS THAT REDUCE PLAY FORCHILDREN IN POVERTY AND THEPOTENTIAL IMPLICATIONS

Reduced Access to Play inSchools

There has been a national trend overthe past decade of reducing playtime asan integral part of the school day. Thistrend is most easily observed in thereduction and, in some cases, elimina-tion of recess; however, there are moresubtle changes throughout the schoolday that reduce children’s opportunityto play. First, the approach to earlyeducation that naturally incorporatedplay into the school day is shiftingtoward a more academically orientedinstructional approach as new stan-dards for reading readiness havechanged for even kindergarten stu-dents.9 Second, in many districts,there is less school time allocated tothe creative arts and physical educa-tion.9,43,44 These subjects contributeto a well-rounded education for a vari-ety of reasons but share some ofthe benefits of play. They allow for

a break from the standard academicsubjects, foster creative and physicalexpression, and teach relaxation andstress-reduction skills that will last alifetime.9,13 Finally, even after-schoolactivities have shifted away from playand physical activity and toward beingan extension of academics and a spacefor homework completion.43 This re-port focuses on reduced recess for il-lustrative purposes.

Many of these trends are dispropor-tionately affecting underresourcedschool districts because of targetedefforts to reduce significant academicdisparities. It is a national imperativethat all children are given the oppor-tunity to reach their academic poten-tial, and efforts to reduce disparitiesbetween children with varying levelsof resources are urgently needed.It remains important, however, thatwhat is known about child develop-ment, including social and emotionallearning, remains at the forefront ofconsideration as policies to raise ac-ademic standards and performancefor children are created and imple-mented. Play, in all its forms, needs tobe considered as the ideal educationaland developmental milieu for childrenis created. Because poorer childrenare most dramatically affected bythese policies, stakeholders must re-main vigilant in ensuring that childrendo not inadvertently suffer from thediminution of play in their lives whileexploring potential solutions to benefitthem academically.

A report by the National Center forEducation Statistics revealed thatchildren who attend schools with highminority and high poverty rates inurban settings are more likely to havereduced recess time as compared withtheir peers in more affluent suburbanareas.44–46 Twenty-eight percent ofschools with students who have thehighest poverty rates had no recessat all.

The No Child Left Behind Act of 2001,designed to decrease the achievementgap of disadvantaged students, allo-cated additional educational resour-ces and enrichment programs whiledecreasing recess time to allow moreformal educational encounters.47 At itsinception, child development experts,including educators and pediatricians,voiced caution about the demise ofplaytime for young children with theproposed increased curriculum timeof the program.9 The experts sup-ported the Alliance for Childhood re-commendations that children fromlow-income families be afforded timeto learn how to play and time to play.9

Perhaps in recognition of the impor-tance of the social and emotionaldevelopment, as well as academicsuccess of children who live at orbelow the poverty line, the US De-partment of Education in 2009 an-nounced the Race to the Top Program,an education initiative that financiallyrewards school districts that supportimproving social, cognitive, physical,and emotional school readiness ofdisadvantaged students. In bids toreceive the rewards, school districtsmust demonstrate focused programsthat prepare students in the core aca-demic subjects and other subjects thatcontribute to the development of well-rounded students, such as physicaleducation and the arts.48 Thus, childrenwho might otherwise not be affordedopportunities for physical activityand enrichment programs outside ofthe school day have designated timeto enhance their total development.

The disparity between access to recessbetween middle-income and lower-income districts may be explained byfactors other than recess time beingtransferred to reading and math in-struction. It has been suggested thatreduced recess in poorer areas isreflective of adult concerns that it isnot safe for poorer children to have

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unstructured time; yet, it has not beenproven that recess is unsafe. A time toplay is different from the environmentin which play occurs. When childrenhave toys and equipment with which toplay and attention is paid to helpingthe children transition back to class,the benefits of recess in terms of ex-pressivity, exercise, and socializationsuggest its vital role in the child’sschool day and overall well-being.Some experts believe the real dan-ger is that the misunderstandinghas led to the removal of playtime.49

The reduction of recess and other in-school opportunities to play affect allchildren but may have a particularlydetrimental effect on poorer children,because they are likely to havefewer opportunities to play outsideof school.11,12 In addition, becauseschool is often the first true social-ization environment for vulnerablechildren, the opportunity for socialand emotional learning must not becompromised.

Poor children enter the educationalsystem at a lower level of readiness,averaging 2 years behind their middle-and upper-class peers.50 This may beexplained in part by their increasedexposure to social stressors (higherrates of single mothers who lack so-cial supports and financial resources,absent fathers, limited access to earlychildhood education, unsafe neighbor-hoods, lack of preventive health care).They mainly enter schools in poorcommunities that lack financial re-sources to enhance the educationalprocess.51 Schools, under pressure toincrease academic performance andto decrease the achievement gap ofstudents, have increased direct educa-tional time, including after-school en-richment and tutorial programs.Although it is important to decreaseacademic disparities, enhanced non-academic interactions are also es-sential to prepare children for future

success. If the overall goal is to de-crease school failure, which could ul-timately lead to depression, entry intothe juvenile justice system, and con-tinued economic deprivation, a re-sponse to the problem has to includeefforts to promote school engage-ment.49 As previously discussed, op-portunities for play and social andemotional learning enhance schoolengagement. Quite simply, school en-gagement occurs when childrensucceed academically, have other non-academic opportunities for success(creative arts, physical education),and consider school a place in whichthey feel safe and enjoy spendingtime.

Play in the school day offers benefitsto academic as well as social andemotional learning. A recent reportby Barros and others stated that abreak during the school day of ≥15minutes was associated with betterteachers’ ratings of classroom behav-ior scores.19 Good behavior in theclassroom is associated with a moreproductive learning environment sec-ondary to increased attentiveness.19,20

In addition, children’s ability to storenew information is increased, becausetheir cognitive capacity is enhanced bya drastic change in activity.51–53 Achange in academic subject and evenphysical education class may not offerthe same benefit as free-play recess.49

A reduction of time for physical activitymay have even greater implications forboys. Schools that use only sedentarystyles of learning may be a more dif-ficult environment for boys to navigatesuccessfully and contribute to the dis-cordant academic abilities betweenboys and girls.54,55 These findings sug-gest that decreasing and eliminatingrecess for students at risk for schoolfailure may be counterproductive.

Finally, it is recognized among educa-tors that recess represents the mostpowerful strategy to get the most

children to participate in physicalactivity.56 In its “Physical ActivityGuidelines for Americans,” the US De-partment of Health and Human Serv-ices recommends 1 hour or more ofphysical activity per day, with a majorpart of the hour dedicated to moder-ate to vigorous physical activity atleast 3 times per week for childrenand adolescents.57 Physical educationcurricula should enhance attitudes,habits, and behavioral skills that re-sult in continued physical activitythroughout life.14 Overall, recess offersthe most available opportunity forchildren to play and to engage inphysical activity, followed by physicaleducation classes and after-schoolactivities.58

Reduced Out-of-SchoolOpportunities for Play

Children cannot play safely outside ofthe home in many poor communities—urban, suburban, and rural—unlessthey are under close adult supervisionand protection. This is particularlytrue in areas that are unsafe becauseof increased violence or where otherenvironmental dangers exist.11,12 Inthe past, when neighbors knew eachother and often supervised each oth-er’s children, there was an extra layerof protection for neighborhood chil-dren when they played outside. Intoday’s society, it is not unusualfor neighbors not to know one an-other. Therefore, parents are alonein protecting and supervising theirchildren, which can severely limit out-side playtime.

Children who are not engaged in playand physical activity outside of schoolhours spend time engaged in seden-tary activities, such as viewing hoursof television, playing video games, orlistening to music. This time is oftenspent in isolation without social in-teraction and without adult supervision.In sharp contrast to the benefits of

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active, creative play, there is substantialevidence that excessive screen time hasadverse effects.59–64 The AAP policystatement on media education pre-sented research that associates mediaexposure with negative physical andbehavioral health problems in children,including obesity, violent and aggres-sive behavior, depression, anxiety, ear-lier sexual behaviors, poor academicperformance and self-image, night-mares, and tobacco and substanceabuse.63,64

The sedentary lifestyle is associatedwith obesity, for which children fromlow income and minority families arealready disproportionally at risk.65 TheAAP and others have reported thatchildren who are obese in earlychildhood are more likely to be obeseadults and to be at risk for thecomorbidities associated with obesity,including type 2 diabetes mellitus,hypertension, coronary artery disease,hypercholesterolemia, hyperlipidemia,asthma, and sleep apnea.14,66,67 In ad-dition to the long-term health effects,obesity may be associated with im-mediate social and emotional con-sequences, including low self-esteem,negative body image, depression, teas-ing and bullying, social marginalization,and discrimination.63,64,66,67 Obesity canhave socioemotional effects on academicachievement and opportunities and can,therefore, thwart educational trajec-tories associated with long-termsuccess.66,67

Family Considerations

Although lower-income parents havethe same desires for their children tosucceed and reach their full potentialas do parents with greater economicand social assets, they must focusprimarily on the family’s day-to-daysurvival. When food and shelter are atrisk, ensuring time for the children tohave free and creative playtime maynot be a priority. Economic hardship

is a major obstacle for these families,in which the parents are more likelyto have a lower educational level orbe single heads of households. Minor-ity households (black and Hispanic)and immigrant parents are at increasedrisk of having children who live inpoverty.1,68 There is more likely to bea history of substance abuse in poorerfamilies. The neighborhoods in whichthey live lack community resources,such as community centers, parks, andfully equipped supervised playgroundsthat offer safe places for children toplay and to gather. Children have feweropportunities to participate in orga-nized sports. Because of fear of vio-lence, families do not venture outsidewith their children for fun physicalactivities, such as walking, bike riding,swinging, swimming, playing tennis, orjogging.11,12,69 In a safe environmentwith community resources, these ac-tivities would not be an additional fi-nancial burden to already challengedfamilies.

Poor families may also be at a disad-vantage in a material-driven culturein which marketing messages, oftenclaims without proof, abound aboutwhat children need to prosper. Theymay absorb the messages that thebest toys are those that are the mostexpensive or that children are onlyacademically prepared for preschool ifexposed to a variety of enrichmenttools and activities that claim to pro-duce high-achieving children. Parentswho cannot afford these market-drivenmaterials may feel disempowered toactively play with and enrich theirchildren using the most effectiveknown tools—themselves. Children’screativity is enhanced with the mostbasic (and least expensive) toys, blocks,dolls, and art supplies. Children’s ac-ademic preparedness may be mostdeveloped with low-cost time spentreading with parents. They will learnto love books when they associate

quality time with their parents withreading.70

Lower-income parents may have fewerresources, including time, to invest inplaying with their children. Becauseplay holds so many benefits, includingfostering connection between parentsand children, less play may be anadded, although rarely mentioned, riskof poverty. No one is certain what skillswill be needed for our children to bebest prepared to lead us into the fu-ture, but we do have insight into whichcharacter traits will produce childrencapable of navigating an increasinglycomplex world. These include confi-dence, the ability to master the envi-ronment, and a connection to others.In addition, to be resilient—to retainhope and to be able to overcomeadversity—young people need theadded character traits of honesty,generosity, decency, tenacity, andcompassion.71 Children gain theseessential traits within a home, whenparents and children interact in asupportive manner and share un-conditional love.71–76 Play is a time-tested way for families to havethese types of interactions.

WHAT ARE THE SOLUTIONS?

Because there are many causes for thedecreased amount of play in the livesof lower-income and poor children,there is no single solution. In addition,simplistic proposed solutions mightnot take into consideration the com-plex interplay of factors that have ledto decreased play, including the needfor safety. For example, if a child doesnot reside in a safe neighborhood, itmay be unwise to simply propose moreoutdoor child-centered play. Similarly,it may be naïve to insist on more re-cess without simultaneously comingup with solutions that address thevery substantive issue of educationaldisparities. It is critical, however, thatas strategies are developed that

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address educational needs and safety,the recognition of children’s need toplay be strongly advocated, becauseplay is known to promote healthydevelopment and resilience.46,52,55,58

To effectively preserve play in the livesof economically disadvantaged children,its presence in schools, communities,and homes must be supported.

In schools, the need to support socialand emotional learning and healthychild development must be heldalongside the need to increase ac-ademic scores. Otherwise, schoolengagement might suffer and effortsat creating a better-prepared genera-tion might fail. The bottom line toschool engagement is that schoolsshould be the kind of places thatchildren and adolescents want to be.This means that educators and policymakers must make opportunities forlower-income children to gain thebenefits offered from physical educa-tion, recess, and the arts so they canreach their highest potential for cog-nitive, social, and physical developmentand so children and adolescents willlike school. Advocates can also promoteprograms such as Head Start, thepurpose of which is the promotion ofschool readiness for low-income chil-dren. Head Start provides an envi-ronment that enhances students’emotional, social, and cognitive de-velopment and has demonstrated ef-fectiveness.77 One of the keys to thesuccess of Head Start has been theinvolvement of parents in social in-teraction with their children in play-ing, reading, and reading-relatedactivities.78

Policy makers and community leadersmust work together to prioritize theneed for safe spaces for familiesto gather and for children to play.Supervised after-school programs canbe critical to children who live incommunities where outside playingmight be dangerous or unsupervised.

Community-based programs that offera wide variety of services, rangingfrom homework assistance to athleticprograms and from character devel-opment to the creative arts cancontribute heavily to the positivedevelopment of youth. Keeping schoolfacilities open for use by communityfamilies in the evenings and onweekends when they are usuallyclosed may increase engagementin these activities. Communities canalso offer strategies to link familiesat or below the poverty level to earlyeducation, health care, family sup-port, and parenting education.

Parents of all income levels should usetime together at home to engage inboth free and structured play withtheir children. Playtime is bondingtime for families. A first step may beeducation about the value of play thatsimultaneously refutes false notionsthat for play to be effective, it mustinvolve expensive toys. Parents fromacross the economic spectrum need tounderstand that it is their presenceand their attention that enrich theirchildren and that one-on-one play isa time-tested, effective way of beingfully present. In parallel, we must besensitive to the fact that time itself is acommodity when struggling for eco-nomic survival. The most compre-hensive solutions, therefore, mustaddress broader economic disparitiesand other factors that create stress-es for economically disadvantagedparents.

Certainly, these solutions are broadand societal, going beyond the purviewof the pediatrician’s office. But as childhealth professionals committed to theattainment of optimal physical, men-tal, and social health and well-beingfor all infants and children, pedia-tricians have a role in advocating forbroad-based solutions that will pre-serve child play.

ADVICE FOR PEDIATRICIANS

As caring, objective child health pro-fessionals, pediatricians have a natu-ral role to advocate for the conditionsthat allow for the optimal physical,emotional, and social development ofchildren and adolescents. Because playcontributes substantially to the healthydevelopment and well-being of children,it is important that pediatricians pro-mote the inclusion of play in homes,schools, and communities.†

� Pediatricians can educate parentsabout the importance of free, un-structured play in the normal de-velopment of children.

� Parents may be influenced by mar-keting messages that suggest thebest toys are those that are finan-cially out of reach. They should beeducated that simple, inexpensivetoys, such as dolls, jump ropes,blocks, balls, and buckets, are moreeffective in allowing children to becreative and imaginative than moreexpensive toys, which can makeplay a more passive and less phys-ically involved experience.

� Pediatricians can educate parentsabout the benefits of using play asan opportunity to engage fully withtheir children. Playtime offers op-portunities for parent-child bond-ing. Playtime offers parents theopportunity to promote healthysocial-emotional development intheir children through active en-gagement and shared imagination.

� Pediatricians can encourage pa-rents to use love and understand-ing to encourage children to tryagain even when at first they fail.Parents can be informed that

†The guidance in this report is offered by the AAPand, therefore, is targeted to pediatricians. Otherhealth professionals who serve children andadolescents, including other physicians, pediatricand family nurse practitioners, and physicianassistants are welcome to consider incorporatingthis guidance into practice.

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positive reinforcement goes furtherthan negative responses as chil-dren engage in play alone and withothers.

� Pediatricians can use well-child en-counters to educate parents aboutthe benefits of play to enhance phys-ical activity that can help preventchildhood obesity. Parents shouldbe educated about the potential forlifelong obesity in obese children,the lifelong health morbidities asso-ciated with obesity, and the long-term psychosocial impact of obesity.

� Parents should be encouraged toparticipate in physical activities withtheir children that will not have a fi-nancial impact on the family.

� Pediatricians can provide parentswith information about resourcesthat can provide financial, educa-tional, and mental health assis-tance to families that have beenmarginalized by poverty. This mayaddress the underlying stressorsthat interfere with parents’ abilityto engage fully in play activities.

� Pediatricians can educate parentsabout the negative impact of mediaexposure on children and encour-age them to limit screen time andsubstitute other activities, includingplaytime and outdoor activities, forscreen time. This is an opportunityto educate parents about the AAPrecommendations regarding nomedia time for children youngerthan 2 years and fewer than 2hours per day for older children.

� Pediatricians can provide parentsand families with informationabout community resources thatprovide physical activities for chil-dren, such as team sports andcamps. They should provide infor-mation about organizations thatprovide “scholarships” or grantsthat pay for activities that haveassociated costs.

� Pediatricians can educate parentsabout the importance of children’splay outdoors in nature. Spendingunstructured time in nature, sur-rounded by dirt, trees, grass, rocks,flowers, and insects inspires child-ren’s play and offers physical andemotional benefits.

� Pediatricians can advocate for safeplay spaces for children who livein communities and attend schoolswith a high proportion of low-incomeand poor children by emphasizingthat the lifelong success of childrenis based on their ability to be cre-ative and to apply the lessonslearned from playing.

� Pediatricians may consider offeringpresentations to help educators, com-munity leaders, faith-based groups,and politicians understand the de-velopmental benefits of play tochildren.

� Pediatricians may advocate forpolicies that reduce educationaldisparities while supporting theinclusion of recess, physical out-lets, and the creative arts asmeans to enhance social andemotional learning and schoolengagement.

CONCLUSIONS

Children who live at or below povertylevel in the United States experienceeducational and health disparitiesfrom early childhood. These children de-serve additional resources to achieveacademically, foster school engage-ment, and develop their social andemotional competencies. Many chil-dren reside in families that facestresses related to daily survival, in-cluding whether they will have food orsafe shelter, leaving less energy tofocus on enrichment opportunities, in-cluding play. Some live in neighbor-hoods where violence may be the norm

and children playing on neighborhoodplaygrounds the exception. School sys-tems are focused on overcoming theiracademic deficiencies in a safe envi-ronment often at the expense of timefor arts, recess, physical educationclasses, and after-school activitiesthat include playing, despite evidencethat supports that what happens inplay contributes substantially to socialand emotional learning, even in theclassroom.

Regardless of their socioeconomicstatus, all children have the right tosafe places to play regularly, duringwhich they develop cognitive, com-munication, problem-solving, negotia-tion, and leadership skills. They havethe right to engage in safe and regularphysical activity that will decrease theincidence of lifelong health disparities.The physically and emotionally healthychildren of today will become theproductive citizens who will contributepositively to society in the future.

LEAD AUTHORSRegina M. Milteer, MDKenneth R. Ginsburg, MD, MSEd

COUNCIL ON COMMUNICATIONS ANDMEDIA, 2011–2012Deborah Ann Mulligan, MD, ChairpersonNusheen Ameenuddin, MD, MPHAri Brown, MDDimitri A. Christakis, MD, MPHCorinn Cross, MDHolly Lee Falik, MDDavid L. Hill, MDMarjorie J. Hogan, MDAlanna Estin Levine, MDGwenn S. O’Keeffe, MDWendy Sue Swanson, MD, MBE

FORMER EXECUTIVE COMMITTEEMEMBERSGilbert L. Fuld, MD, Immediate Past ChairpersonTanya Remer Altmann, MDKathleen Clarke-Pearson, MDBenard P. Dreyer, MDRegina M. Milteer, MDKathleen G. Nelson, MDDonald L. Shifrin, MDVictor C. Strasburger, MD

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LIAISONSMichael Brody, MD – American Academy ofChild and Adolescent PsychiatryJennifer Pomeranz, JD, MPH – American PublicHealth AssociationBrian Wilcox, PhD – American PsychologicalAssociation

STAFFGina Ley SteinerVeronica Laude Noland

COMMITTEE ON PSYCHOSOCIALASPECTS OF CHILD AND FAMILYHEALTH, 2010–2011Benjamin S. Siegel, MD, ChairpersonMary I. Dobbins, MDMarian F. Earls, MDAndrew S. Garner, MD, PhDLaura McGuinn, MDJohn Pascoe, MD, MPHDavid L. Wood, MD, MPH

LIAISONSRonald T. Brown, PhD – Society of PediatricPsychology

Terry Carmichael, MSW – National Association ofSocial WorkersMary Jo Kupst, PhD – Society of PediatricPsychologyD. Richard Martini, MD – American Academy ofChild and Adolescent PsychiatryMary Sheppard, MS, RN, PNP, BC – NationalAssociation of Pediatric Nurse Practitioners

CONSULTANTGeorge J. Cohen, MD

STAFFKaren S. Smith

REFERENCES

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DOI: 10.1542/peds.2011-2953 originally published online December 26, 2011; 2012;129;e204Pediatrics 

FAMILY HEALTH and Deborah Ann MulliganAND MEDIA COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND Regina M. Milteer, Kenneth R. Ginsburg, COUNCIL ON COMMUNICATIONS

Maintaining Strong Parent-Child Bond: Focus on Children in PovertyThe Importance of Play in Promoting Healthy Child Development and

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