Written by Karen Powell 

Happy New Year to you! To inspire you to have fun despite the pandemic level challenges we might be facing this year, we revisit the foundation and importance of play, and how it relates to the work we do.

Play and Discovery

In 2007 the American Academy of Pediatrics (AAP) published Clinical Reports on the importance of play.  Since then, newer research has provided additional evidence of the critical importance of play in “facilitating parent engagement; promoting safe, stable and nurturing relationships; encouraging the development of numerous competencies, including executive functioning skills; and improving life course trajectories” (1).

Living in the midst of a pandemic reminds us that fostering healthy relationships with those in your social bubble is vital, not only to further promote and encourage the healthy development of children, but also as a means to manage the underlying stress, for parents and children alike.

As occupational therapists (OT’s) we are well aware that an increasing societal awareness on school readiness has led to programmes which promote earlier academic results, even as early as preschool, with a corresponding decrease in playful learning (1).  The new Clinical Report, The Power of Play: A Pediatric Role in Enhancing Development in Young Children (2) by the AAP is very exciting, as it not only provides encouragement to paediatricians for the prescription of play, but provides research and evidence for what we as paediatric occupational therapists know to be true.

This article holds so much value.  You can learn from it, share it, motivate your therapy and causes. The full article is available here for your own review, but below are a few thought summaries to whet your appetite, perhaps a form of “highlight reel” of those issues most relevant to our area of expertise.

Relating to infant play:

  • “Caregiver infant interaction is the earliest form of play, known as attunement, but it is quickly followed by other activities that also involve taking of turns. These serve-and-return behaviours promote self-regulation and impulse control in children and form a strong foundation for understanding their interaction with adults” (2).
  • “By 9 months of age, mutual regulation is manifested in the way infants use their parents for social referencing” (3, 4).
  • “Uncontrollable crying as a response to stress in a 1-year old is replaced as the child reaches 2 to 3 years of age with the use of words to self-soothe, building on caregivers scaffolding their emotional responses” (2).

Relating to didactic learning:

  • “Early learning combines playful discovery with the development of social-emotional skills” (2). Children learn by playing with toys and looking at those around them.  Explicit instructions, however, limit a child’s creativity.  It is argued that we should let children learn through observation and active engagement rather than passive memorisation or direct instruction (2). “Successful programs are those that encourage playful learning, in which children are actively involved in meaningful discovery” (2).
  • Panksepp (5) went so far as to suggest that play deprivation is associated with the increasing prevalence of attention-deficit/hyperactivity disorder (6).

Relating to Sensory Integration, Outdoor Play and Risk

  • “Outdoor play provides the opportunity to improve sensory integration skills. Viewed in this light, school recess becomes an essential part of a child’s day (7).  It is not surprising that countries that offer more recess to younger children see greater academic success among the children as they mature (7,8).”
  • “Physical activity is associated with decreases in concurrent depressive symptoms” (9). [Outdoor] play decreases stress, fatigue, injury and depression and increases range of motion, agility, coordination, balance and flexibility (10).
  • “Rough and tumble play…enables children to take risks in a relatively safe environment, which fosters the acquisition of skills needed for communication, negotiation, and emotional balance, and encourages the development of emotional intelligence. It enables risk-taking and encourages the development of empathy because children are guided not to inflict harm on others” (11, 12, 13). “The goal is not to eliminate risk” (14).

Relating to scaffolding:

  • “A Russian psychologist, Vyygotsky, recognized that learning occurs when children actively engage in practical activities within a supportive social context. He was interested in what he called the ‘zone of proximal development’, which consists of mastering skills that a child could not do alone but could do with minimal assistance (15).  In the zone of proximal development, the ‘how’ of learning occurs through a reiterative process called scaffolding, in which new skills are built on previous skills and are facilitated by a supportive social environment” (2).
  • “According to Vygotsky (15), the most meaningful learning occurs in a social context, where learning is scaffolded by the teacher into meaningful contexts that resonate with children’s active engagement and previous experiences. Scaffolding is part of guided play; caregivers are needed to provide the appropriate amount of input and guidance for children to develop optimal skills” (2).

Relating to stress:

  • “Play and stress are closely linked. High amounts of play are associated with low levels of cortisol, suggesting either that play reduces stress or that unstressed animals play more” (16).
  • “Children need to develop a variety of skill sets to …manage toxic stress. Toxic stress can disrupt the development of executive function and the learning of prosocial behaviour. Play supports the formation of the safe, stable, and nurturing relationships with all caregivers that children need to thrive. The mutual joy and shared communication and attunement that parents and children can experience during play regulate the body’s stress response.”
  • “Play also activates norepinephrine, which facilitates learning at synapses and improves brain plasticity” (2).
  • “Play, especially when accompanied by nurturing caregiving, may indirectly affect brain functioning by modulating or buffering adversity and by reducing toxic stress to levels that are more compatible with coping and resilience” (17,18).

Perhaps we should not overlook the importance of teaching parents to play with their children.  Play is not something facilitated only by the OT once a week in sessions, but is a vital part of every day.  Barriers to play with caregivers need to be removed so that children can experience more effective play interactions on a daily basis.

But it’s not all about the kids.  Play is great for adults too, and we can use this information to motivate parents to set aside uninterrupted play time with those in their charge.

  • “Parents learn to see the world from their child’s perspective and are likely to communicate more effectively with their child, even appreciating and sharing their child’s sense of humour and individuality” (2).
  • “To be passionately and totally immersed in an activity…and to experience intense joy” (2).
  • “Positive parenting experiences result in decreases in parental experiences of stress and enhancement in the parent-child relationship” (19, 20, 21).


And lastly,

“Play is not frivolous; it is brain building.  Play has been shown to have both direct and indirect effects on brain structure and functioning.  Play leads to changes at the molecular (epigenetic), cellular (neuronal connectivity, and behavioural levels (socioemotional and executive functioning skills) that promote learning and adaptive and/or prosocial behaviour” (2).

Wishing all SAISI members a playful 2021, for all the right reasons!



  1. Ginsburg KR; American Academy of Pediatrics Committee on Communications; American Academy of Communications on Psychosocial Aspects of Child and Family Health. The importance of play in promoting healthy child development and maintaining strong parent-child bonds. Paediatrics. 2007; 119 (1): 182-191.
  2. Yorgman M, Gardner A, Hutchinson J, Hirsh-Pasek K, Golinkoff RM. Clinical Report: Guidance for the Clinician in Rendering Pediatric Care. The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics. 2018; 412 (3): 1-18.
  3. Campos JJ, Klinnert MD, Source JF, Emde RN, Svejda M. Emotions as behaviour regulators: social referencing in infancy. In: Plutchik R, Kellerman H, eds. Emotion: Theory, Research and Experience. Vol 2. New York, NY: Academic Press; 1983: 57-86.
  4. Sorce JF, Emde RN, Campos JJ, Klinnert MD. Maternal emotional signalling: its effect on the visual cliff behaviour of 1-year-olds. Dev Psychol. 1985; 21 (1): 195-200.
  5. Panksepp J. Can PLAY diminish ADHD and facilitate the construction of the social brain? J Can Acad Child Adolesc Psychiatry. 2007; 16(2): 57-66.
  6. Christakis DA. Rethinking attention-deficit/hyperactivity disorder. JAMA Pediatr. 2016; 170 (2): 109-110.
  7. Murray R, Ramstetter C; Council on School Health; American Academy of Pediatrics. The crucial role of recess in school. Pediatrics. 2013; 131(1): 183-188.
  8. Pelligrini AD, Holmes RM. The role of recess in primary school. In: Singer D, Golinkoff R, Hirsh-Pasek, K eds. Play = Learning: How Play Motivates and Enhances Children’s Cognitive and Socio-Emotional Growth. New York, NY: Oxford University Press; 2006.
  9. Korczak DJ, Madigan S, Colasanto M. Children’s physical activity and depression: a meta-analysis. Pediatrics. 2017; 139(4): e20162266.
  10. Goldstein J. Play in children’s development, health and well-being: technology and play. In: Pellegrini DA, ed. Oxford Handbook of the Development of Play. New York, NY: Oxford University Press; 2011.
  11. Burghardt GM. The Genesis of Animal Play: Testing the Limits, 1st ed. Cambridge, MA: MIT Press; 2005.
  12. Pellis SM, Pellis VC, Bell HC. The function of play in the development of the social brain. Am J Play, 2010; 2: 278-296.
  13. Pellis Sm, Pellis VC. Play fighting of rats in comparative perspective: a schema for neurobehavioral analyses. Neurosci Biobehav Rev. 1998; 23(1): 87-101.
  14. Barry E. In British playgrounds, bringing in risk to build resilience. New York Times. March 10, 2018. Available at: https://nytimes.com/2018/03/10/world/europe/britain-playgrounds-risk.html . Accessed April 27, 2018
  15. Vygotsky LS. Play and its role in the mental development of the child. In: Bruner J, Jolly A, Sylva K, eds. Play. New York, NY: Basic Books; 1976: 609-618.
  16. Wang S, Aamodt S. Welcome to Your Child’s Brain: How the Mind Grows from Conception to College. New York, NY: Bloomsbury USA; 2011.
  17. Siviy SM. Effects of pre-pubertal social experiences on the responsiveness of juvenile rats to predator odors. Neurosci Behav Rev. 2008; 32(7): 1249-1258.
  18. Garner AS, Shonkoff JP, Siegel BS, et al; Committee on Psychosocial Aspects of Child and Family Health; Committee on Early Childhood, Adoption, and Dependent Care; Section on Developmental and Behavioral Pediatrics. Early childhood adversity, toxic stress, and the role of the paediatrician: translating developmental science into lifelong health. Pediatrics. 2012; 129(1). Available at: www.paediatrics.org/cgi/content/full/129/1/e224
  19. Berkule SB, Cates CB, Dreyer BP, et al. Reducing maternal depressive symptoms through promotion of parenting in pediatric primary care. Clin Pediatr (Phila). 2014; 53(5): 460-469.
  20. Weisleder A, Cates CB, Dreyer BP, et al. Reading is not just for language: promoting cognitive stimulation also enhances sosioemotional development. In: Pediatric Academic Societies Annual Conference; April 30 – May 4, 2016; Baltimore, MD.
  21. Cates CB, Weisleder A, Dreyer BP, et al. Leveraging healthcare to promote responsive parenting: impacts of the Video Interaction Project on parenting stress. J Child Fam Stud. 2016; 25(3): 827-835.