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.

The objective of this systematic review was to examine the relationship between outdoor time and: (1) physical activity, (2) cardiorespiratory fitness, (3) musculoskeletal fitness, (4) sedentary behaviour; or (5) motor skill development in children aged 3–12 years. We identified 28 relevant studies that were assessed for quality using the GRADE framework. The systematic review revealed overall positive effects of outdoor time on physical activity, sedentary behaviour, and cardiorespiratory fitness, although causality could not be assumed due to a lack of RCTs. Motor skill development was unrelated to outdoor time; however, this relationship was only examined in a single study of preschool children. No studies were found that examined associations between outdoor time and musculoskeletal fitness.

A diverse, cross-sectorial group of partners, stakeholders and researchers, collaborated to develop an evidence-informed Position Statement on active outdoor play for children aged 3–12 years. The Position Statement was created in response to practitioner, academic, legal, insurance and public debate, dialogue and disagreement on the relative benefits and harms of active (including risky) outdoor play. The Position Statement development process was informed by two systematic reviews, a critical appraisal of the current literature and existing position statements, engagement of research experts (N = 9) and cross-sectorial individuals/organizations (N = 17), and an extensive stakeholder consultation process (N = 1908). More than 95% of the stakeholders consulted strongly agreed or somewhat agreed with the Position Statement; 14/17 participating individuals/organizations endorsed it; and over 1000 additional individuals and organizations requested their name be listed as a supporter. The final Position Statement on Active Outdoor Play states: “Access to active play in nature and outdoors—with its risks— is essential for healthy child development. We recommend increasing children’s opportunities for self-directed play outdoors in all settings—at home, at school, in child care, the community and nature.” The full Position Statement provides context for the statement, evidence supporting it, and a series of recommendations to increase active outdoor play opportunities to promote healthy child development.

The reduction of child obesity continues to be a challenge worldwide. Research indicates that playing outdoors, particularly in natural play spaces, boosts children's physical activity, potentially decreasing childhood obesity. We present evidence that natural play spaces also provide for more diverse forms of play for children of varying ages and competencies. This is crucial because play spaces designed expressly for physical activity may not increase physical activity among less active children. Moreover, when researchers only examine physical activity in play, they overlook the valuable contributions that play makes to other aspects of children's health and development. To enhance research on children and their play environments, we introduce the theory of play affordances. To assist in the creation of more natural play spaces, we describe the Seven Cs, an evidencebased approach for designing children's play spaces that promotes diverse play. We end with some preliminary insights from our current research using the Seven Cs to illustrate the connections between play, nature, and children's healthy development.

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