Outdoor risky play and health-related outcomes in children aged 3–12 years: A mixed-methods systematic review
7 affiliations
- 1Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.
- 2British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
- 3Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, British Columbia, Vancouver, Canada.
- 4Deakin Institute for Physical Activity and Nutrition, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia.
- 5Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom.
- 6Queen Maud University College of Early Childhood Education, Trondheim, Norway.
- 7School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
Abstract
Background: Outdoor risky play and its relationship with children’s health, development and well-being have garnered significant attention in recent years. Objective: This systematic review synthesised existing evidence on associations between children’s outdoor risky play and health outcomes. Methods: A systematic search of five electronic databases (SportDiscus, MEDLINE, PsychInfo, ERIC, and CINAHL) was initially conducted in December 2023 and updated three times (April 2024, March 2025, May 2026) during the review development. Studies were eligible if they examined outdoor risky play in children aged 3–12 years and assessed a health outcome. Studies that did not use empirical data or did not have an accessible full-text were excluded. Five reviewers independently screened all articles and two separate reviewers resolved discrepancies. Quantitative narrative synthesis and qualitative framework synthesis were completed, and a mixed-methods synthesis occurred using a Pillar Integration Process. Results: A total of 74 studies met the eligibility criteria for inclusion (48 quantitative; 19 qualitative; 7 mixed-methods). Six health domains (physical health, mental health and well-being, aggression, social, cognitive, and risk competence and injury) and four risky play exposures were identified: general risky play (n = 13 studies); environments that support risky play (n = 21); independent mobility (n = 19); and rough-and-tumble play (n = 21). General risky play and risky play supportive environments were positively associated with health outcomes across physical, mental health and well-being, social, cognitive, and risk competence domains. Independent mobility was positively associated with physical activity, with insufficient evidence to determine associations for other domains. Evidence for rough-and-tumble play was inconsistent across all domains, except for a negative association with aggression (i.e., increased aggression). The overall quality of evidence was low-to-moderate. Conclusion: Outdoor risky play shows promising associations with children's health outcomes. The low number of studies in some health domains and need for higher quality evidence preclude firm conclusions and provide direction for further research in this field. Registration: International Prospective Register of Systematic Reviews (PROSPERO) (No. CRD42023488023).
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BibTeX
@article{ramsden2026outdoor,
title = {{Outdoor risky play and health-related outcomes in children aged 3–12 years: A mixed-methods systematic review}},
author = {Rachel Ramsden and Alethea G Jerebine and Gemma Brailey and Ellen Beate Hansen Sandseter and Hebah Hussaina and Avril Johnstone and Bryony Longdon and G J Melendez-Torres and Rachel Nesbit and Mariana Brussoni and Helen F Dodd},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0347444},
url = {https://doi.org/10.1371/journal.pone.0347444},
note = {CC BY},
}
RIS
TY - JOUR
TI - Outdoor risky play and health-related outcomes in children aged 3–12 years: A mixed-methods systematic review
AU - Rachel Ramsden
AU - Alethea G Jerebine
AU - Gemma Brailey
AU - Ellen Beate Hansen Sandseter
AU - Hebah Hussaina
AU - Avril Johnstone
AU - Bryony Longdon
AU - G J Melendez-Torres
AU - Rachel Nesbit
AU - Mariana Brussoni
AU - Helen F Dodd
PY - 2026
DA - 2026/10/26
JO - PLOS One
DO - 10.1371/journal.pone.0347444
UR - https://doi.org/10.1371/journal.pone.0347444
AB - Background: Outdoor risky play and its relationship with children’s health, development and well-being have garnered significant attention in recent years. Objective: This systematic review synthesised existing evidence on associations between children’s outdoor risky play and health outcomes. Methods: A systematic search of five electronic databases (SportDiscus, MEDLINE, PsychInfo, ERIC, and CINAHL) was initially conducted in December 2023 and updated three times (April 2024, March 2025, May 2026) during the review development. Studies were eligible if they examined outdoor risky play in children aged 3–12 years and assessed a health outcome. Studies that did not use empirical data or did not have an accessible full-text were excluded. Five reviewers independently screened all articles and two separate reviewers resolved discrepancies. Quantitative narrative synthesis and qualitative framework synthesis were completed, and a mixed-methods synthesis occurred using a Pillar Integration Process. Results: A total of 74 studies met the eligibility criteria for inclusion (48 quantitative; 19 qualitative; 7 mixed-methods). Six health domains (physical health, mental health and well-being, aggression, social, cognitive, and risk competence and injury) and four risky play exposures were identified: general risky play (n = 13 studies); environments that support risky play (n = 21); independent mobility (n = 19); and rough-and-tumble play (n = 21). General risky play and risky play supportive environments were positively associated with health outcomes across physical, mental health and well-being, social, cognitive, and risk competence domains. Independent mobility was positively associated with physical activity, with insufficient evidence to determine associations for other domains. Evidence for rough-and-tumble play was inconsistent across all domains, except for a negative association with aggression (i.e., increased aggression). The overall quality of evidence was low-to-moderate. Conclusion: Outdoor risky play shows promising associations with children's health outcomes. The low number of studies in some health domains and need for higher quality evidence preclude firm conclusions and provide direction for further research in this field. Registration: International Prospective Register of Systematic Reviews (PROSPERO) (No. CRD42023488023).
SN - 1932-6203
ER -