Importance: Playgrounds facilitate important opportunities for growth and development during childhood. Despite accessibility regulations, these experiences are not afforded to children with disabilities as a result of environmental and societal barriers. Objective: To identify and synthesize existing research on the relationship between key areas of development and accessible play settings for children with disabilities to inform evidence-based interventions and advocacy work. Data Sources: The following databases were searched on January 30, 2021: Academic Search Complete/EBSCO, CINAHL/EBSCO, Education Research Complete/EBSCO, ERIC, OTseeker, and PubMed. Study Selection and Data Collection: This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were peer-reviewed, included children with disabilities ages 3 to 12 in an accessible play setting, and had outcomes related to areas of childhood development. Validated tools were used to determine risk of bias and quality of evidence. Findings: Nine articles met inclusion criteria: 1 Level 3b matched case–control study, 4 Level 4 cross-sectional studies, 3 Level 5 qualitative studies, and 1 mixed-methods study with Levels 4 and 5 evidence. Eight of 9 studies reported that social participation, play participation, and motor skills development were negatively affected despite playgrounds being labeled accessible. Conclusions and Relevance: Children with disabilities have decreased engagement in activities that provide opportunities for play, social participation, and motor skills development. Practitioners should address occupational injustice in the playground setting by engaging in program development, policy, and playground design to reduce stigma and increase accessibility. What This Article Adds: By addressing play accessibility, occupational therapy practitioners could significantly reduce instances of play inequity. Creating interdisciplinary teams to address accessible playground design locally would allow occupational therapy practitioners the opportunity to make a lasting impact for the children in their community.