Opinion

Let the children play

Public health experts have been calling for a lifting of restrictions on outdoor activities since Ontario reversed its decision to close children’s playgrounds April 17. But given the ongoing COVID-19 crisis, what should we prioritize for outdoor openings?

Last spring, the initial focus on reopening was on the “playgrounds” typically used by adults – marinas, golf courses and tennis courts. Now, there are calls for opening these activities again. While pandemic-weary adults deserve opportunities to safely spend time outdoors, it is shameful that minimal focus has been placed on promoting outdoor physical activity for those most at risk by indoor confinement – our children and youth.

There is definitive scientific evidence that physical activity and outdoor play protects children from chronic health conditions, promotes learning and is effective at preventing and treating mental health disorders such as depression and anxiety.

Studies during this pandemic, in Canada and across the world, have confirmed that implementation of public health policies meant to protect us from COVID-19 infection have resulted in reduced physical activity and outdoor time and increased screen time for all children. Children and youth are experiencing social isolation and serious mental health problems such as depression, anxiety, and eating disorders.

These effects are most pronounced among children from marginalized communities and children living in poverty. Many have little or no access to safe outdoor spaces. Many have received misguided communication to stay indoors, stoking fears about outdoor COVID-19 exposure. They have suffered from draconian approaches to public health policy such as taping up playgrounds, removing basketball nets and prohibiting children and youth to play or meet together outside.

Prioritizing the health and well-being of children and youth must include an evidence-based public health strategy that encourages safe outdoor activities where the risk of COVID-19 transmission is low. Other countries with similar rates of COVID-19 infections have prioritized the rights of children to safely play outdoors in structured and unstructured sports and activities with their peers during the pandemic. 

Children will be the last group to be immunized – this cannot be an excuse to delay the removal of unnecessary restrictions for them. We know that outdoor transmission of COVID is very low, and the risk can be reduced by wearing masks and keeping distance. 

Now, well into spring, with schools shuttered indefinitely, it is high time to focus on children and their health needs. We need to immediately re-open outdoor public spaces and allow children and youth to play with their peers in parks, playgrounds, schoolyards, sports fields, skate parks, city beaches, pools and camping spaces.

We need to restart outdoor organized sports for children and youth without further delay. Municipalities should organize outdoor community summer camps in all neighbourhoods with the same energy and focus that they are putting in to prepare curbside patios. Provincial and local public health leaders, parks and recreation staff, physical activity and sports organizations, camping associations, and parents, caregivers and children need to work together to implement safe practices for these vital child health-sustaining outdoor activities.

Our children have suffered during the pandemic. An active recovery for children needs to start now.

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3 Comments
  • Ediriweera Desapriya says:

    Very valuable commentary and thank you for sharing. Lifestyle medicine is gaining popular ground lately and we all have a huge responsibility to disseminate the information on enormous health benefits of active lifestyles. Every patient encounter is an opportunity for a “teachable moment”. When a message is coming from a credible source like a physician, it could have a meaningful impact on the population behavior change.
    Accumulating best evidence literature shows that play is important for the emotional, social, cognitive, and physical development of children. Furthermore, play enhances the overall health and wellbeing of our children. Available research shows that the play also develops life skills for children and communication skills among peers and family members.
    A recent American Academy of Pediatrics (AAP) clinical guidelines provides pediatricians with the information they need to promote the benefits of play and encourage writing a prescription for play. Pediatricians must play an important role in emphasizing the role of a balanced curriculum that includes the importance of playful learning for the promotion of healthy child development. The AAP report on school readiness includes an emphasis on the importance of whole child readiness (including social-emotional, attentional, and cognitive skills).
    Moreover there is a need to remove barriers for active lifestyles in our vulnerable communities. Vehicle danger is one of them. In the past we were able to highlight this real deterrent to active lifestyles by publishing a few brief advocacy commentaries. Unfortunately, it got hardly any meaningful attention from any policy maker. It is hard to believe still to date parents and caregivers not allowing their children to cycle or walk to schools due to “vehicle danger”:
    1. https://pediatrics.aappublications.org/content/119/5/1040
    2. https://www.cmaj.ca/content/174/12/1743.1.full?utm_source=TrendMD&utm_medium=cpc&utm_campaign=CMAJ_TrendMD_0
    3. https://www.cmaj.ca/content/182/1/65.2.full?utm_source=TrendMD&utm_medium=cpc&utm_campaign=CMAJ_TrendMD_0
    4. https://pubmed.ncbi.nlm.nih.gov/21278097/
    Finally, pediatricians also must advocate addressing the SES barriers of child play. Often children living in poverty experience these barriers more. The socioeconomic stressors on poor families often conspire against parents having the time, energy, or skills to engage in play with their children. It is also important to emphasize the enormous value of playful learning in preschool curricula, and communicate the message to policymakers, legislators, educational administrators, teachers and the public and parents and care givers.
    REFERENCE:
    An updated AAP clinical report outlines how play is a fundamental part of children’s healthy development. The Power of Play: A Pediatric Role in Enhancing Development in Young Children from the Committee on Psychosocial Aspects of Child and Family Health and the Council on Communications and Media is available at https://doi.org/10.1542/peds.2018-2058

  • Sarah Khan says:

    This is where public health and community organizers need to come together and mobilize accessible outdoor programming for kids ASAP. There is no infection control data to support restricting outdoor play for kids. Get the basketball nets up, the tennis nets up, parks unboarded, and accesible summer camp programming running in ways we have never before.

  • Ayesha Siddiqua says:

    I could not agree more with this important article. It is high time for our government to implement evidence-based practices to reduce the transmission of COVID-19 and protect the health of children, which certainly does not include shutting down outdoor places for sports and other recreational activities.

Authors

Catherine Birken

Contributor

Catherine Birken is a pediatrician and a senior scientist in Child Health Evaluative Sciences at The Hospital for Sick Children (SickKids) and professor of Pediatrics and Health Policy, Management and Evaluation and Nutritional Sciences at the University of Toronto.

Eyal Cohen

Contributor

Eyal Cohen is a pediatrician and program head of Child Health Evaluative Sciences at the Hospital for Sick Children (SickKids) and professor of Pediatrics and Health Policy, Management and Evaluation, and co-director of the Edwin S.H. Leong Centre for Healthy Children at the University of Toronto.

Meta van den Heuvel

Contributor

Meta van den Heuvel is a pediatrician at the Hospital for Sick Children (SickKids) and in the community, as well as an assistant professor of Pediatrics at the University of Toronto.

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