title: What is the Relationship between Risky Outdoor Play and Health in Children? A Systematic Review.
abstract: Risky outdoor play has been associated with promoting children's health and development, but also with injury and death. Risky outdoor play has diminished over time, concurrent with increasing concerns regarding child safety and emphasis on injury prevention. We sought to conduct a systematic review to examine the relationship between risky outdoor play and health in children, in order to inform the debate regarding its benefits and harms. We identified and evaluated 21 relevant papers for quality using the GRADE framework. Included articles addressed the effect on health indicators and behaviours from three types of risky play, as well as risky play supportive environments. The systematic review revealed overall positive effects of risky outdoor play on a variety of health indicators and behaviours, most commonly physical activity, but also social health and behaviours, injuries, and aggression. The review indicated the need for additional "good quality" studies; however, we note that even in the face of the generally exclusionary systematic review process, our findings support the promotion of risky outdoor play for healthy child development. These positive results with the marked reduction in risky outdoor play opportunities in recent generations indicate the need to encourage action to support children's risky outdoor play opportunities. Policy and practice precedents and recommendations for action are discussed.
authors.affiliation: British Columbia Injury Research & Prevention Unit, Child & Family Research Institute, University of British Columbia, British Columbia Children's Hospital, F511-4480 Oak Street, Vancouver, BC V6H 3V4, Canada. mbrussoni@cw.bc.ca.|Department of Pediatrics, School of Population & Public Health, University of British Columbia, British Columbia Children's Hospital, F511-4480 Oak Street, Vancouver, BC V6H 3V4, Canada. mbrussoni@cw.bc.ca.
authors.forename: Mariana
authors.initials: M
authors.lastname: Brussoni
authors.affiliation: School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6H 3V4, Canada. rlgibbons6@gmail.com.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Gibbons
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada. casgray@cheo.on.ca.
authors.forename: Casey
authors.initials: C
authors.lastname: Gray
authors.affiliation: British Columbia Injury Research & Prevention Unit, Child & Family Research Institute, University of British Columbia, British Columbia Children's Hospital, F511-4480 Oak Street, Vancouver, BC V6H 3V4, Canada. takuro.ishikawa@cw.bc.ca.
authors.forename: Takuro
authors.initials: T
authors.lastname: Ishikawa
authors.affiliation: Department of Physical Education and Health, College of Early Childhood Education, Queen Maud University, Thrond Nergaards Vei 7, NO-7044 Trondheim, Norway. ebs@dmmh.no.
authors.forename: Ellen Beate Hansen
authors.initials: EB
authors.lastname: Sandseter
authors.affiliation: Bienenstock Natural Playgrounds, 64 Hatt Street, Dundas, ON L9H 7T6, Canada. adam@naturalplaygrounds.ca.
authors.forename: Adam
authors.initials: A
authors.lastname: Bienenstock
authors.affiliation: Evaluation Platform on Obesity Prevention, Quebec Heart and Lung Institute, Laval University, 2725 Chemin Ste-Foy, Local Y4283, QC G1V 4G5, Canada. guylaine.chabot@criucpq.ulaval.ca.
authors.forename: Guylaine
authors.initials: G
authors.lastname: Chabot
authors.affiliation: Parachute, 150 Eglinton Avenue East, Suite 300, Toronto, ON M4P 1E8, Canada. pfuselli@parachutecanada.org.
authors.forename: Pamela
authors.initials: P
authors.lastname: Fuselli
authors.affiliation: School of Architecture and Landscape Architecture, University of British Columbia, 379-2357 Main Mall, Vancouver, BC B6T 1Z4, Canada. susan.herrington@ubc.ca.
authors.forename: Susan
authors.initials: S
authors.lastname: Herrington
authors.affiliation: School of Kinesiology and Health Studies, Queen's University, 99 University Avenue, Kingston, ON K7L 2P5, Canada. takuro.ishikawa@cw.bc.ca.|Department of Public Health Sciences, Carruthers Hall, Queen's University, Kingston, ON K7L 2P5, Canada. takuro.ishikawa@cw.bc.ca.
authors.forename: Ian
authors.initials: I
authors.lastname: Janssen
authors.affiliation: Department of Public Health Sciences, Carruthers Hall, Queen's University, Kingston, ON K7L 2P5, Canada. takuro.ishikawa@cw.bc.ca.
authors.forename: William
authors.initials: W
authors.lastname: Pickett
authors.affiliation: Forest School Canada, 411 Corkstown Road, Ottawa, ON K2K 2Y1, Canada. takuro.ishikawa@cw.bc.ca.
authors.forename: Marlene
authors.initials: M
authors.lastname: Power
authors.affiliation: Department of Environmental Studies, Huxley College of the Environment, Western Washington University, 416 High Street, Bellingham, Washington, DC 98225, USA. rlgibbons6@gmail.com.
authors.forename: Nick
authors.initials: N
authors.lastname: Stanger
authors.affiliation: Library Services, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada. casgray@cheo.on.ca.
authors.forename: Margaret
authors.initials: M
authors.lastname: Sampson
authors.affiliation: Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada. ebs@dmmh.no.|Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada. ebs@dmmh.no.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Tremblay
mesh_terms: D002648:Child; D002657:Child Development; D002675:Child, Preschool; D004777:Environment; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010988:Play and Playthings; D012306:Risk
keywords: independent mobility; injury; physical activity; playground; risk taking; supervision