CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care The Power of Play: A Pediatric Michael Yogman, MD, FAAP,a Andrew Garner, MD, PhD, FAAP, b Jeffrey Hutchinson, MD, FAAP, c RoleKathy Hirsh-Pasek, in PhD, Enhancing d Roberta Michnick Golinkoff, PhD, Development e COMMITTEE ON PSYCHOSOCIAL inASPECTS Young OF CHILD AND FAMILY Children HEALTH, COUNCIL ON COMMUNICATIONS AND MEDIA Children need to develop a variety of skill sets to optimize their development abstract and manage toxic stress. Research demonstrates that developmentally appropriate play with parents and peers is a singular opportunity to promote the social-emotional, cognitive, language, and self-regulation skills that build executive function and a prosocial brain. Furthermore, play aDepartment of Pediatrics, Harvard Medical School, Harvard University and Mount Auburn Hospital, Cambridge, Massachusetts; bDepartment supports the formation of the safe, stable, and nurturing relationships with of Pediatrics, School of Medicine, Case Western Reserve University and University Hospitals Medical Practices, Cleveland, Ohio; cDepartment all caregivers that children need to thrive. of Pediatrics, F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, Maryland; dDepartment of Psychology, Brookings Play is not frivolous: it enhances brain structure and function and promotes Institution and Temple University, Philadelphia, Pennsylvania; and executive function (ie, the process of learning, rather than the content), eSchool of Education, University of Delaware, Newark, Delaware which allow us to pursue goals and ignore distractions. Dr Yogman prepared the first draft of this report and took the lead in reconciling the numerous edits, contributions, and suggestions from When play and safe, stable, nurturing relationships are missing in a child’s the other authors; Drs Garner, Hutchinson, Hirsh-Pasek, and Golinkoff made significant contributions to the manuscript by revising multiple life, toxic stress can disrupt the development of executive function and the drafts and responding to all reviewer concerns; and all authors learning of prosocial behavior; in the presence of childhood adversity, play approved the final manuscript as submitted. becomes even more important. The mutual joy and shared communication This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have and attunement (harmonious serve and return interactions) that parents filed conflict of interest statements with the American Academy and children can experience during play regulate the body’s stress response. of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of This clinical report provides pediatric providers with the information they Pediatrics has neither solicited nor accepted any commercial need to promote the benefits of play and and to write a prescription for involvement in the development of the content of this publication. play at well visits to complement reach out and read. At a time when early Clinical reports from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external childhood programs are pressured to add more didactic components and reviewers. However, clinical reports from the American Academy of less playful learning, pediatricians can play an important role in emphasizing Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent. the role of a balanced curriculum that includes the importance of playful The guidance in this report does not indicate an exclusive course of learning for the promotion of healthy child development. treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. To cite: Yogman M, Garner A, Hutchinson J, et al; AAP INTRODUCTION COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH, AAP COUNCIL ON COMMUNICATIONS AND MEDIA. The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics. 2018;142(3):e20182058 Since the publication of the American Academy of Pediatrics1, 2 (AAP) Clinical Reports on the importance of play in 2007, newer research has provided additional evidence of the critical importance of play in Downloaded from www.aappublications.org/news by guest on October 1, 2021 PEDIATRICS Volume 142, number 3, September 2018:e20182058 FROM THE AMERICAN ACADEMY OF PEDIATRICS facilitating parent engagement; private reality, contains elements of that the teaching methods of the past promoting safe, stable, and make believe, and is nonliteral.‍ 2 centuries, such as memorization, be nurturing relationships; encouraging replaced by innovation, application, Depending on the culture of the 18 the development of numerous and transfer.‍ adults in their world, children competencies, including executive – learn different skills through play.‍ NATURE OF LEARNING AND PLAY functioning skills; and improving life 3 5 Sociodramatic play is when children course trajectories.‍ An increasing act out the roles of adulthood from societal focus on academic readiness having observed the activities of their 20 (promulgated by the No Child Left Bruner et al stressed the fact that elders.‍ Extensive studies of animal Behind Act of 2001) has led to a play is typically buffered from real- play suggest that the function of play focus on structured activities that life consequences.‍ Play is part of is to build a prosocial brain that can are designed to promote academic 11 our evolutionary heritage, occurs interact effectively with others.‍ results as early as preschool, with a in a wide spectrum of species, is corresponding decrease in playful Play is fundamentally important for fundamental to health, and gives learning.‍ Social skills, which are learning 21st century skills, such us opportunities to practice and part of playful learning, enable as problem solving, collaboration, hone the skills needed21 to live in a children to listen to directions, and creativity, which require the complex world.‍ Although play is pay attention, solve disputes with executive functioning skills that are present in a large swath of species words, and focus on tasks6 without critical for adult success.‍ The United within the animal kingdom, from constant supervision.‍ By contrast, a Nations Convention on the Rights of invertebrates (such as the octopus, recent trial of an early mathematics the Child has enshrined the right to lizard, turtle, and honey bee) to intervention in preschool showed engage in play that is appropriate to mammals (such as rats, monkeys, “ 12 22 almost no gains in math achievement the age of the child in Article 21.‍ and humans), social play is more 7 – ” in later elementary school.‍ Despite In its 2012 exhibit The Century of prominent in animals with a large “ 23 criticism from early childhood the Child: 1900 2000, the Museum neocortex.‍ Studies of animal experts, the 2003 Head Start Act of Modern Art noted, Play is to behavior suggests that play provides reauthorization ended the program the 21st century what work was to animals and humans with skills evaluation of social emotional skills industrialization.‍ It demonstrates a that will help them with survival ” 24 and was focused almost exclusively8 way of 13knowing, doing,14 and creating and reproduction.‍ Locomotor on preliteracy and premath skills.‍ value.‍ Resnick has described 4 skills learned through rough-and- The AAP report on school readiness guiding principles to support creative tumble play enables escape from includes an emphasis on the – learning in children: projects, predators.‍ However, animals play importance of whole child readiness passion, peers, and play.‍ Play is not even when25 it puts them at risk of (including social emotional, ’9 just about having fun but about predation.‍ It is also suggested that attentional, and cognitive skills).‍ taking risks, experimenting, and play teaches young animals what Without that emphasis, children s testing boundaries.‍ Pediatricians they can and cannot do at times ability to pay attention and behave can be influential advocates by when they are relatively free from 26 appropriately in the classroom is encouraging parents and child care the survival pressures of adult life.‍ disadvantaged.‍ providers to play with children and to Play and27 learning are inextricably allow children to have unstructured linked.‍ A Russian psychologist time to play as well as by recognized that learning occurs when The definition of play is elusive.‍ encouraging educators to recognize children actively engage in practical However, there is a growing playful learning– as an important activities within a supportive social consensus that it is an activity that is complement to15 didactic18 learning.‍ context.‍ The accumulation of new intrinsically motivated, entails active Some studies note that the new knowledge is built on previous engagement, and results in joyful information economy, as opposed learning, but the acquisition of new discovery.‍ Play is voluntary and to the older industrial 1, demands skills is facilitated by social and often has no extrinsic goals; it is fun more innovation and less imitation, often playful interactions.‍ He was ’ “ ” and often spontaneous.‍ Children are more creativity and less conformity.‍ interested in what he called the often seen actively engaged in and Research