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The Decline of Play Outdoors in Children - And the Rise in Sensory Issues

The Decline of Play Outdoors in Children - And the Rise in Sensory Issues
Angela Hanscom, MOT, OTR/L
January 28, 2019

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Editor’s note: This text-based course is an edited transcript of the webinar, The Decline of Play Outdoors in Children - And the Rise in Sensory Issues, presented by Angela Hanscom, MOT, OTR/L.

Learning Outcomes

After this course, participants will be able to:

  • Identify developmental changes between this generation and past generations.
  • Describe the underlying reasons for the increase in sensory, motor, and social issues.
  • Name ways to foster healthy sensory and motor development, creativity, and independence with outdoor play in all environmental settings.


I always like to start my presentations by giving a little bit of my story and how this work came to be. My family was really the core reason why I started this work in the first place. I'm a pediatric occupational therapist. Often a doctor will refer children to an occupational therapist when they have trouble with attention or any sort of sensory issues like not liking loud noises, not liking their hands getting dirty, trouble with balance, and that sort of thing. I’ve worked in all different settings including the school setting, in homes, and in an outpatient therapy clinic, where most of my training occurred.

I have three children, a 12-year-old daughter, a nine-year-old daughter, and a two-year-old son. When I had my second daughter, I realized that I wanted to stay home. I only worked part-time, but I knew childhood was fleeting, and I wanted to take that time to spend it with my children. Before I left the clinic setting, I started making some observations that really intrigued me. Over the years, I filed this information away, and it came to play later in life.

When I worked in one clinic setting, I remember that there was a huge rise in the need for occupational therapy in our clinic and that they kept hiring more and more therapists. We must have had about 15 therapists in that one small clinic. We had a wait list that went out for at least a year. By the time we could take another child, those children had often found therapy services somewhere else. That was really intriguing to me. I started having kids come into the clinic that didn't like having the wind in their face, which was interesting, and I remember thinking, how do I treat that indoors? How do I treat that if they don't like the wind in their face? I even had the thought come to mind, do I get a fan and blow that in their face? I began to be very aware of those situations. Another big issue was a lot of kids not liking getting their hands dirty. The number one issue that we have to treat today is actually with their balance sense. A lot of kids are having trouble with spatial awareness and knowing where their body is in space. These were all things I was paying attention to at the time.

When I decided to stay home, my daughter was in preschool and she was about to be going to kindergarten. A lot of her friends actually needed occupational therapy services. Again, I remember thinking, why this rise in occupational therapy? When I was a young child, I remember that it was very rare for children to get occupational therapy. Occupational therapy was more of a rare profession. It was really reserved for children with more severe disabilities, like muscular dystrophy or cerebral palsy. Having such a large number of children receive occupational therapy was not heard of. At the same time, I recognized that there were not a lot of children playing outdoors. We live on 12 acres of woodland and we are surrounded by another 50 acres. We really live in the woods. We'll be driving somewhere and take a shortcut through a neighborhood. I remember driving through a neighborhood one day with my children and thinking, where are the children?

I grew up in a rural part of Vermont, and we were in the suburbs, but we were outdoors. We would bike to stores and around town and stay outside until the lights went off. That memory was something else I was filing away for later. When my daughter was getting ready to go to kindergarten, I remember I had a speech therapy friend and an educator friend say, "We need to prepare our kids for kindergarten and enrich them and have them practice sitting." I remember thinking, what is this preparation for kindergarten? I remember kindergarten very fondly. I remember the teacher singing “Little Bunny Foo Foo” every day. I remember learning my letters and having a full hour recess session. We only went to kindergarten in the morning. It was very much play-based. I thought that was really intriguing that they were even thinking in the mindset of having to prepare them for kindergarten. I also thought about the fact that sitting isn't a learned skill, and that you can't practice sitting. It's not going to attain attention for the children.

The first day of kindergarten came about, and the teacher had a meeting with the parents prior to the kids starting. I still remember that day like it was yesterday. My daughter had just turned five years old. I remember the teacher looking at us, and saying, "This is not kindergarten like you remember. This is really the new first grade." She said, " If your children can't tie their shoes, you need to have them wear elastic laces, or Velcro would work fine.” She said, "We won't have time for outdoor recess once it snows. We're going to bring them indoors because we don't have time to change them into snow gear." Then she finally said, "We will have a five-minute snack. If that becomes an issue with curriculum, she said we're going to do a working snack.” She mentioned that her husband was going to pre-cut everything at night because they won't have a lot of opportunities to cut with scissors.

I remember thinking at the time, again as an occupational therapist, how developmentally it just wasn't appropriate. We really work a lot on those skills, on cutting and prerequisites to academics. I knew something was wrong, but I just wanted to give it a chance. I thought, okay, we'll see what happens. A month or two went by and my daughter came home and started saying, "I hate school." That really hit my heart, because I enjoyed learning. I still enjoy learning. I did the unthinkable for me, and I ended up pulling her out and homeschooling for a couple of years. I realize now that that was meant to be, because it really forced me to start looking at other educational philosophies, such as Reggio Emilia, where the environment is the third teacher, Finland, where the kids were in the river, dissecting fish and learning through experience, and Waldorf, where there was a nice flow and routine to the day.

This set me on this path that I'm on today. At the same time, I knew I wanted to get kids outdoors, and I thought it was in the form of nature classes until I did one. I had a parent come up to me with her child in hand, and say, "Can you please tell my child why the leaves change color?" I hesitated because I didn't know the exact answer. I knew it had something to do with the pigment in the leaf. I said I would have to get back to her. It was a little embarrassing, but at the same time, it was an opportunity for me to reflect on what gifts am I bringing to the table here. I'm not a naturalist or environmentalist, which is pretty typical for running nature programs. I'm not even a teacher. I thought about the profession of occupational therapy, and how the occupation of a child is play. Many occupational therapists are very good at getting kids independent with play, especially indoors. I kept thinking, “What about outdoor play, why is there no one bringing this outdoors, and getting kids independent with outdoor play?” I started to look at the environment as a great sensory experience when you take it outdoors versus inside.

I actually had a friend say, "I think you should try summer camps because you'll probably get more parents that would be interested in that." It started as a marketing ploy and actually as an experiment. None of this was ever planned. I felt like this would be a great experience for my own children. I'll do three weeks of summer camp. I went to the University of New Hampshire and asked the students if anyone would like to volunteer, to see this unique work for our profession. I had volunteers and was essentially running three weeks of summer camp by myself, with some helpers. By the end of the summer, I was exhausted, and I said, "Okay, I'm all done, that was fun." But something told me to keep going and to see what would happen. Those students went back to the university and came and told other students, and the next year I had 15 volunteers for the camps. I had a wildlife ecologist and a teacher reach out to me saying, "Can we help you? This is very interesting." We started changing the programming in the very beginning. We were entertaining or we were doing activities, and there was little free play. The more we did it, the more I realized how important free play was. We started creating experiences that were child-directed. They would be living and breathing stories in the woods, such as Three Little Pigs, where the kids would create brick, stick, and hay homes out in the woods, and then re-enact the story, living and breathing it, and then have hours of free play after.

What we saw was really exciting. Kids changed in just the course of the week. We knew we were on to something. Fast forward a couple years, and we saw the programs were filling really quick. In fact, about six or seven years ago, I released four weeks of summer camp in February and they filled in one minute. I had parents calling in tears saying, "My kids got in last year and didn't get in this year. What are you going to do about that?" Then I had an occupational therapist and a physical therapist call and say, "Can I replicate your program?" That's when we decided to license the program and to share it. We changed the name of the program from Nature Stepping Stones to TimberNook, which is a hidden place in the woods, away from the adult world, where kids could play again.

I wrote an article called “Why Kids Fidget, and What We Can Do About It.” This was something that I didn't necessarily think was an important article at the time, but I wrote it and put it out there. It ended up going extremely viral. It has over a thousand comments on it. When that went viral, the Washington Post picked it up, and then that exploded and went viral. Then I started writing for the Washington Post about issues on getting kids outdoors and what we can do about it. Some of my articles went viral in the Jerusalem PostTimes of India, and I did a TED talk for Johnson and Johnson. That's how I got a book deal as well. The book is called “Balanced and Barefoot.” Instead of spreading regionally, as we had planned, our program TimberNook went all the way to New Zealand and hit different spots in the United States. We're now going to be in five countries, including the United States, New Zealand, Australia, Canada, and the UK. This concept of getting kids outdoors is really taking off.

What we’re going to focus on today is also what's happening to children because we're not letting them play outdoors enough, especially with restricted movement over and over and the effects on the sensory and motor skills of children. I was asked to observe a fifth-grade classroom in 2012. It's a local charter school that's really respected for art and music. They have a half an hour recess session. This is actually fairly good these days, compared to the standard 15-minute or 20-minute recess sessions a lot of schools are dealing with, especially here in America. What I was expecting is that kids would be tapping their pencil or tapping their shoe. I was not expecting that this fifth-grade classroom would be doing almost extreme fidgeting. When I went in there, I saw kids leaning back in their chairs at extreme angles, so almost only one point of contact was left on the ground of their chair. I saw kids rocking back and forth and another child hitting his head over and over with a bottle. Kids kept getting out of their chairs, finding any excuse to sharpen their pencil or go to the bathroom. All I kept thinking was, boy, these kids really need to move.

We decided to do a pilot study because we wanted to implement a therapeutic dance program. We were curious to find out if a dance program that got kids moving in all different directions would make changes in the children. We looked at their core strength, their stomach muscles and their back muscles, and then we had them do a simple balance response, where they spin 10 times. You can try this at home if you'd like. After they stopped spinning we looked at their eyes. We were looking for vigorous eye movement. There should be a reflex where your eyes move back and forth after spinning. What we saw is that children would spin very slowly, because that's all they could tolerate, or they would fall on the ground. Your eyes should stop moving after 60 seconds. They should be able to correct themselves. We saw kids with excessive eye movement, that kept going. This means they have a very sensitive balance system. Some had no eye movement at all, which is actually dysfunction of the balance sense. We looked at their core strength and then we compared that to 1984, which is actually when I was a child, to see the average strength from that generation to this generation. When we combined the balance response and the core strength from 1984, in the results of these classrooms, we found that only one out of every 12 children could meet both standards. That was really shocking. That was not something we had planned, or even thought we were going to see.

Recently, I was at a conference for occupational therapists and there were over a thousand therapists attending. There has been talk for a long time about the possibility of changing one of our standardized assessments. This is because kids' strength is not where it used to be, and they're finding that no one was meeting the standards. They have decided to change the norms because the kids were just not meeting the standards from years past. That really scared me, because we're not holding children to the same standards, and that they're losing their strength and balance. This intrigued me.

Rise of Sensory & Motor Issues

  • Decreased attention
  • Fidgeting
  • Decreased strength
  • Poor posture
  • Decreased stamina
  • Frail
  • Falling
  • Endless colds
  • Increased aggression
  • Trouble reading
  • Emotional
  • Rise in anxiety
  • Children not playing

We decided to interview 10 veteran teachers who had been around for at least 30 years. We were curious to see if they were seeing a rise in sensory issues like the therapists were seeing. Lo and behold, yes, the bulleted list above includes the common themes that we were seeing with children. The number one issue teachers are saying that they're seeing is decreased attention, compared to 30 years ago. For instance, one teacher said in the past, in the early 80s, she could teach her classroom as a whole, and maybe one or two kids had trouble paying attention. She said now, on a good day, at least eight out of the 26 kids will have trouble paying attention. She said she's actually had to change her teaching methods, where she breaks them up into small groups and engages them into the task.

Another issue physical therapists and chiropractors are seeing is posturing with a curvature of the upper body at an earlier age. They're also treating back pain at an earlier age. This makes a lot of sense because if their core strength isn't quite where it should be, and they're carrying around these heavy backpacks, that can affect their posture. They're also getting into a head forward posture, most likely because they are also holding technology a lot and looking at a screen.

I did not expect to see falling, but kids are literally falling out of their chairs in school. They are running into each other and even running into the walls at times. One well-respected preschool director that had been around for 40 years said, "I don't remember this being a problem in the past, but kids are literally falling out of the chair at least three times a day, and running into each other and the walls."

Another issue is increased aggression but not in the way you may think. Not bullying per se, but almost like they can't keep their hands off each other. When they go out to play at recess, they're grabbing each other with much more force. They play tag and they're hitting harder than they need to. This is a world problem, too. When I went to Australia, they're seeing the same things. Children are much more emotional, crying at the drop of a hat. They are more easily frustrated. There's been a lot of research about the rise of anxiety in children. Another scary thing is that their play is actually changing. Recess monitors said in the past years they saw much more imaginative type play. Now, children often resort to playing games like tag, if it's not banned from school, or they'll play in a play structure. We're going to talk about why in a moment.

The Big Divide

  • Less prepared than ever before
  • Yes, we are expecting MORE
  • Increased coding
  • Increased children getting reading services, etc.

What's happening is a lot of these kids are coming less prepared than ever before. Their sensory and motor skills and their strength are not quite where they should be, yet we're expecting more from the children. We're expecting them to read in kindergarten and to do more academic work at an earlier age. A lot of these children are getting pulled out for extra services, such as occupational therapy, speech therapy, and reading services, thinking something's wrong with them right from the get-go.

Two Major Changes

What's going on? Well, we definitely have an increase in technology. The research is saying that kids are spending at least seven hours a day on average on some kind of screen. If they're spending that much time on technology, it's replacing their time to play outdoors, where they're digging in the dirt, strengthening their muscles, engaging and organizing the senses. It's bound to have an effect on their development in a pretty profound way. I'm going to speak specifically about this piece of outdoor play and how because they're spending less time outside it's having an effect on them. After viewing this presentation, my hope is that you become an advocate in your community for how important it is for kids to play outside. This next part is about the vestibular system. It’s really important because the rest of the presentation makes sense based on this piece.

The Vestibular System

  • Feeds into the limbic system – center for emotions
  • Turns brain on to pay attention
  • Why kids fidget
  • We are saying, “don’t spin,” “get down from that tree,” “be careful”
  • Kids are becoming more and more unsafe

I often ask my audience how much free play they got outdoors when they were a child. Not sports, but how much actual free play did they have on a typical school day when they were in elementary school. Not on the weekend but during the week. I ask them, "Did you walk to school? Did you walk home from school? How long was your recess session? Did you have more than one? How much free play after?" I get typically get a response of four to five hours at least, for an average. Then I say, “Think of a child that you know today. It could be a child in your family or a child that you work with, and think about, do they walk to school, do they walk home from school, how long is their recess session, and then how much free play outdoors do they have after school, so not sports again.” What I'm getting for that one is 45 minutes to an hour and a half over and over. Sometimes it's more, sometimes it's less, but the average is 45 minutes to an hour and a half. Anytime you change the environment that drastically, where they're spending four to five hours of authentic play outdoors, to 45 minutes to an hour and a half, you're bound to change child development.

What’s happening is that these children are often in an upright position. They're sitting for hours at a time. A therapist was doing a dissertation and had done research on how much, on average, children in America are sitting, and they're finding it’s about nine hours a day. Children are being driven to school often, where they're upright, they're sitting for hours a day at school, and they have little movement breaks and recess time. That's all been restricted. Then they're being driven home, where they’re still upright, and now have homework to do. When I was growing up, you might have had a worksheet to do, but then you were out the door. Last year, my eight-year-old daughter had three hours of homework a day. This overabundance of homework is really a problem. In addition, a lot of kids are over structured with activities, so they'll be driven from one event to the next, or they might have a sibling that has an event. They're constantly being driven around in the car and sitting, or they might be doing a sport like soccer, where they're still upright.

They're not climbing trees and they're not going upside down or spinning in circles. In order to have a strong balance sense in your vestibular system, you need to have rapid acceleration. You need to roll down the hill, go upside down, and move in all different directions because in the inner ear there are little hair cells. The fluid in there needs to move back and forth to stimulate those hair cells and develop a really strong vestibular system. That sense is actually key to all the other senses. It's called the unifying sense. If it's not working right, or it's not as strong as it should be, it can affect everything. It can affect your vision, attention, emotional regulation, and your activity level. I'm going to explain that just a little further here because it's a really important piece that a lot of people don't know about.

The first thing the vestibular system does is it tells you where your body is in space. It really helps you walk from point A to point B safely. It helps you stay in your seat without falling. It's really good for safety awareness. In a clinic setting, we'll treat this through spinning or we'll use swings and move them in all different directions. Sometimes I'll hear parents or adults saying, "Don't spin, because you're going to get dizzy." We have to be careful about doing that too much because a child's neurological system will actually seek out the sensory input it needs at that given time to help organize the senses. We need that sensory organization to lay the foundation for learning. In order to develop properly, we do need to let them move in those directions.

Another thing the vestibular system does is it turns on the reticular activating system in the brain to pay attention. That's why kids fidget. Those kids in that fifth-grade classroom were moving back and forth in their chairs to ignite the vestibular system, to turn that brain on and pay attention. A lot of teachers, though not all, will say, "Sit still." But those kids in that classroom needed to move, not just at that moment, but they needed to move throughout the day so that they could have the skill and be able to pay attention when they need to.

The vestibular system also supports all six eye muscles. It acts as a tripod for a camera and allows the eyes to be able to scan and track across for reading and writing, to be able to go across the middle of the body. Just because a child can read an eye chart just fine in the nurse's office, like a Snellen chart, does not mean they have perfect vision. One time we had a little boy that was holding an eye come in for a treatment and he read the eye chart in the nurse's office just fine. He was having trouble with reading though. We had him spin and then we looked at his ability to go from point A to point B with his eyes. As soon as he got to the middle, his eyes would loop like a rollercoaster, every time. Since his eyes were looping around, he was going to have trouble reading. Can you imagine your eyes doing that every time you tried to scan? He had two weeks of vestibular treatment and was then able to control his eyes. Lo and behold, he could read. Movement is key to being able to have strong eye muscles that could work as a team. Behavioral optometrists that work on complete vision will often work with occupational therapists to treat the eyes. If you go to the gyms in their offices, they actually have trampolines and swings, just like we do, because they use all of that to help treat vision.

Just to recap, the vestibular system helps with spatial awareness, attention, visual skills such as reading and writing, and lastly, emotional regulation and activity regulation. If a child is off the wall, we call it, or really hyper, it’s really important to be able to naturally bring that child back down again. It’s the same with emotions. If they're very angry, it’s important to be able to naturally bring them back down again and to be calm again.

As I mentioned, in occupational therapy clinics you'll often see swings hanging from the ceiling. We position children in all different ways to stimulate the hair cells in different directions so that they will have that regulation piece. It's a very big piece of sensory integration. In a lot of classrooms these days, children are really having trouble with attention and teachers are getting to the point where it's very hard to teach. Occupational therapists are now teaching a lot of coping skills, meditation, exercises, yoga, and Pilates. I think it’s to the point where we feel like we need to and we have to.

However, I want us to stop and think, why is this happening in the first place? Why is it that we are having to have these treatment protocols put in place? That should tell us something is wrong. I would argue that if children got enough outdoor play, on a regular basis, the number of children that needed services would go way down. Something to think about.

Right and Surprisingly Wrong Ways to Get Kids Moving

  • Bouncy balls, fidgets, and movement discs
  • Not enough movement
  • Not fully engaging the senses
  • Outdoors offers both

When my article went viral and I talked about movement and how important that was, people got very creative. You began to see a lot of articles about putting kids on exercise balls in the classrooms, thinking that would help with children being able to pay attention. People also tried standing desks and even those chairs with pedals that were attached to it, so children could bike while they're in the classroom.

Knowing this information, it's really important to think about why would that not solve the issue? Why would sitting on a bouncy ball not solve the underlying issue that is going on? If you think about it, in all those situations, from the pedal bikes to sitting on a ball, they're still upright. They're not moving in all different directions. That vestibular system is not going to change. It's a temporary fix, so if they're bouncing on a ball, it will temporarily help with attention in that situation, but it will not create a stronger vestibular system.

It reminds me of exercise. If we only exercise once a week, are we going to get really strong and buff? No, we're not. We need to remember that kids need to move in all different directions for hours a day in order to maintain a strong vestibular system. It's one reason why many adults can't tolerate rides as they could in years past. Maybe you could do roller coasters and spinning rides when you were a kid, but you can no longer tolerate it. One reason for that is because we're not moving as much as we should. You'll hear a lot of therapists talk about the importance for the older generation, and geriatrics too, to move often to prevent falls. The thing to keep in mind here is that as adults we're often given a choice if we want to move or not. With children, we don't always give them the choice. We often say, "No, you need to sit right now" and we do that for lengthy periods of time, which is actually affecting development. It's important to recognize that, and also be aware that kids are starting to become more unsafe because of this, where they are falling and becoming clumsy. That's a safety issue. We do need to let kids go upside down, roll down the hill, climb trees, and do all the things we did as kids.

The Proprioceptive System

Another sense that's being affected is the proprioceptive system. This is the senses in the joints and muscles and it’s actually treated with heavy work. The proprioceptive system helps children know where their limbs are in space. It also helps them to know how much force to use when playing games like tag, holding a baby chick without squeezing too hard, writing with a pencil without breaking the lead every time, or writing hard enough (using enough force). They're having trouble with knowing how much force to use.

Again, we treat that in a clinic setting through what we call heavy work. This includes doing things to give resistance to the joints and muscles and developing that sense properly, such as carrying buckets of water. You'll hear a lot of therapists talk about using weighted vests or having children carry around their backpacks to help with the sense. Chores such as raking and shoveling work on this too. The more I thought about this, I realized that outdoor play does this in a really great and meaningful way for children. When they are playing outdoors, they'll naturally be working on this sense, such as digging in the dirt for hours, climbing trees, and building forts. When you build forts, you're picking up heavy logs, and it's giving nice senses to the joints and muscles. This will help with those skills that we talked about. One reason why schools are banning tag is that kids are having trouble regulating force. I feel like instead of banning tag or getting rid of these types of activities, we really need to think about why this is happening in the first place.

Nature is the Ultimate Sensory Experience

Another thing to keep in mind is that nature is the ultimate sensory experience. When you're outdoors, you engage multiple senses at once. Take a moment and think about sitting inside a room and compare that to being outdoors. Then think about what senses are engaged outside that are not in the room that you're in. You'll probably think about the wind, the sunshine beating on you, the warmth, the temperature outside, and maybe even the ground. The ground outside is uneven, so it's challenging the senses, whereas inside, it's flat, and you really don't have to think about it very much. Multiple senses are engaged outside. The more senses that are engaged, the more synapses that are firing in the brain. Your chances of sensory integration and organization are going to be higher outdoors than inside.

You also want to be in a calm but alert state for sensory integration to happen. If I were to ask you to look outside and tell me what colors you see you would probably say, “Green, blue, and brown.” These happen to be very common colors, and we know that we often paint our preschools and prisons those colors. Think about nature sounds. If you go for a massage, they often play nature sounds to calm you. Research about smells is out there, talking about how certain smells of trees will reduce the cortisone levels in the brain. They're just very calming stimuli. However, you're alert when you're outside because you need to pay attention. The ground is uneven. There could be an animal that runs by. You have to pay attention to where you're going. You're in this calm alert state that happens to be ideal for sensory integration.

It's important to think about what percentage of the time children are in an environment that is conducive to the organization of the brain and what percentage of the time are they in an environment that is disorganizing. Maybe they're in a classroom where there are many posters on the walls. Maybe there are many children in a very small space, or the noises are very loud. Thinking about what kind of environments children are in the majority of time is really key because the environment plays a big role in the development of children. Of course, some of it is hereditary, but a big part is also environmental.

I started thinking about our sensory clinics and took a step back to look at them in a different light. I often show some visuals to portray what I'm talking about.

One set of feet on sensory balance beam and one set feet walking on a branch in the forest

Figure 1. Sensory balance beam and log.

The picture on the left in figure one shows a sensory balance beam. It's plastic and has sensory nodules on it and is considered a sensory experience. The child on the right side of the figure one is walking on a log outdoors. I’m not necessarily saying there's anything wrong with walking on a plastic balance beam. However, if our true objective is to provide a rich sensory experience for sensory organization of the brain, which one would inspire and engage more senses? When I do my talks, I often have people say the right side – the child on the log. I like to ask people why because I really want them to dive deep into the reasons why that one engages more senses. Some of the responses I often hear are that the one on the right is dynamic, so when they're walking on the log balance beam it actually moves while they walk. This is challenging the muscles and the senses more. If you look at the child’s feet, they are actually curving around the log on the right side. Even the little foot muscles and the muscles in the ankle are going to be challenged more. Often, participants will say that the feet are dirty in the picture on the right side. This adds a whole element of temperature, dirt, and water. Whereas on the left side of the picture it's pretty sterile. There is no tactile experience except for touching the nodules. There's an element of risk on the right. They're actually taking a risk with that one. Then I often ask which one is truly more meaningful to the child and which one do you think they'll stay with longer? Looking at the big picture of it too, sometimes the one on the left might feel like it's an activity or a task that's predetermined by a therapist or an adult. Whereas the one on the right, the child might start on the log and then might be doing something completely different. He might be in the water looking for critters. It can lead to creative play as well.

Kids playing in a sandy creek and sensory bin with sand and objects for early childhood education

Figure 2. Outdoor water and sensory water bin.

Here is another great example. The image on the right side of figure two is a sensory bin. These are very popular in early childhood settings and in clinics. The image on the left side of figure two is a child looking for frogs in a giant mud puddle with a couple of other children in the water behind her. Again, I’m not saying anything is wrong with the sensory bins, I use them from time to time. But if we're looking at which one truly engages more senses, then you would probably say the one on the left. When I ask people, "Well why?" people start dissecting it and looking at it from different points of view. The first thing I hear a lot is, "Well, the child is fully engaged on the left side." Their whole body is immersed. Whereas on the right, you're restricted again. You might be able to place your hands or even your feet in, but you might worry about making a mess. In the picture on the right, it looks like there's a preconceived activity that an adult likely set up, based on gardening. It's not real life. The one on the left has real frogs in the water that are moving, so your visual skills will be challenged more. There are other children. The space is really important to keep in mind at your locations. Do you have space outdoors, or even indoors, where there's plenty of room for the child to be fully engaged in their sensory experience? That really does make a difference, because the whole body can move. She can't see her feet and it's uneven ground. There are other children that can inspire higher levels of play in that situation as well. Also, with the sensory bins, sometimes there's a little bit of pressure. The children might feel pressured to do it when it's set in front of them. That’s different than the one in the mud puddle where they can regulate when they're ready. They can stay on the outside for a bit then start moving into the mud puddle if they're ready to.

Nature is Therapeutic

  • Fosters listening
  • Improves visual skills
  • Enhances the sense of touch
  • Going barefoot
  • Playing in the dark
  • Light touch sense

Even just stepping outdoors is therapeutic for a child. A great example of that is listening to bird sounds. In the therapy world, we sometimes use therapeutic listening. There's special training that you get, and the child wears special headphones and listens to CDs. It's very expensive, but it's been well researched. So many beautiful things are happening because of it. The child has better body awareness and better attention after listening to the music. It helps with bed wetting, spatial awareness, and many other things. One day I was looking at the CDs and saw one that said spatial awareness on it. I listened to it and it was all bird sounds. I called the founder and while talking to her I asked, "So, tell me, if children were outdoors more, and listening to bird sounds, would that make a difference with their spatial awareness?" She said, "Absolutely. First of all, the recordings were done in Australia, where there's a huge range of bird sounds. That was enhanced for the recording. If you think about it, if a child is outdoors and hears a bird sound in one direction, and then a bird sound behind them, and then maybe another bird sound in the distance, what they're doing is they're orienting themselves to the sounds around them. That's the basis for spatial awareness." So, even just stepping outdoors and listening to bird sounds will help the children with their body awareness.

We don't often think about it, but there are a lot of good things that can happen from going barefoot. There are special barefoot shoes that they make for children now. What's nice about those is that you actually feel the ground through the shoes. The unevenness of the ground and the rocks underneath your feet help mold the feet to be stronger. The research is showing that people that wear barefoot shoes actually have stronger feet and ankles than those that don't. Imagine how going barefoot is even better because you're coming in contact with the ground itself. We see this as we watch kids here at TimberNook. We'll watch them walk on logs and see their little ankles working hard and their little feet twitching back and forth. They're working very hard on the muscles.

Sometimes I hear that because of regulations people aren't allowed to let their kids go barefoot. This could be great information to look into to see if in fact you really do have a rule against it. What I'm hearing is some early childhood settings will think that they cannot let their children go barefoot, and then when they do further research, they realize there's not even a rule for that. There are a lot of people that have been starting to let their kids go barefoot. It's always important to investigate. If it is a rule, you can ask why and do some education and work with your licensure to possibly change it. This information is very helpful for parents to know as well.

The other thing I want to talk about is playing in the dark. A lot of children aren't actually playing in the dark as in years past. I remember playing games like flashlight tag and hide and seek. If children’s vestibular systems are not quite where they should be, they're really going to rely on their vision to get around. When you are playing in the dark, you're taking that visual piece away, and those kids are going to really need to work on their other senses, such as balance and smell. Playing in the dark is a great way to enhance the other senses.

A lot of kids don’t like getting glue on their fingers or getting dirty. That's a light touch sense and sometimes it feels really yucky for kids to get dirt or something on their fingers. That's overridden by deep pressure. If you think about it, if a child is outdoors and digging in the dirt, they're not only touching the dirt which is light touch but because they're digging and they're getting that deep pressure at the same time, it overrides the light touch sense and actually helps to integrate that sense. The more we get children outdoors and exposed to situations like that, the more that light touch sense will be integrated. This can be done by having children do heavy work and build a dam where they get dirty while they're building it. They just need more time outside.

Even our recess and our playgrounds are changing. One thing I always think about is the swings and how we used to jump off the swings. I'm sure some of you remember doing that, or spinning on them or going upside down. One day I asked a child I was working with to spin on her swing when she went to school. She came back and she said, "I can't, it’s too dangerous." I said, "Why?" and she said, "I just, you know, they feel like I could get hurt." I talked to the recess monitor and she said, “It's true, we're not allowed to let them spin on swings. They can't go on their bellies anymore, or stand, or do anything but stay upright.” I find that really ironic because as therapists, we're doing the opposite. We want to get them in a position that's not upright. We want them to be in anti-gravity positions. We want them to go upside down and move in different directions so they can be more capable of knowing where their body is in space and to be safer in the long run. But here we are not allowing them to do those things and working almost in complete opposite of each other. It's really important for the educational world and the health care world to work together on these goals to foster healthy development because that healthy development is going to help with academics.

We've also changed our playgrounds. We've taken away the long stainless-steel slides. The swings have shortened. Children are now getting less sensory input with these activities. One piece of playground equipment that I often think about is the merry go round and how we're starting to take those away. One day I was treating a child where I was in the middle and I was spinning the child around in a hammock around me. I looked at my OT book and it said that this is a very powerful vestibular input and it works on grounding and sustained attention. I kept thinking, this is like a merry go round. We would sit on the outside of the merry go round and have kids run around and spin us. We would get this centrifugal force in the inner ear. The hair cells would bend in one direction. That actually worked on attention and grounding. That really fascinated me, because we took it away deeming it unsafe, but it was actually very therapeutic.

We also want to pay attention to our playgrounds and what kind of sensory opportunities are we giving children. We do want to be able to challenge them. Many kids at the age of five have already mastered the playground equipment. It's not challenging them enough. We do need to challenge their muscles and their senses in order for them to get to the next level of development.

Boy with cape on playing with stick on a fallen tree trunk outside

Figure 3.  Boy in New Zealand.

Figure three shows a little boy in New Zealand. I was watching him one day for two reasons. One, he was playing with a stick for a good 45 minutes by himself. I kept thinking, wow, how often do we allow kids to play with sticks? The second thought that came to mind was, how often are we constantly right there intervening with this play, or watching? I kept thinking of the child. I was an only child and I really enjoyed my time with my parents and doing fun things with them, but I also really enjoyed my time alone. I wonder how much time are we giving children to be away from the adult world, where there are constant stimulation and expectations to do certain things? They do need their downtime and they also need the opportunity to think for themselves. Often, we become the idea giver, and children don't have the opportunity to come up with their own ideas. That can be really key down the road, because the job force is headed towards entrepreneurship, and you need to be an idea person for that.  Being an idea person starts with play.

When I was in New Zealand, I decided to interview a principal there that was famous for getting rid of the rule book at recess time. He worked with a local university and they selected three schools to get rid of rules and see what would happen. The result was interesting. They actually saw a decrease in bullying and a rise in better attention because of this. These are the things that he implemented. I realized that what he did was very much in line with what we did at TimberNook.

Ways to Enhance the Play Experience

1.     Adults step back. He will say that you don't see the adults at all in this program, even though they're there. It's very similar to TimberNook. We will literally hide in the woods so the kids feel like they're creating societies and building their own worlds on their own. But we're there for safety and in case something comes up or there’s a danger.

2.     Extend the time. He went from half an hour recess session to a full hour. He said after that change, the attention was way better. At TimberNook, we allow for an hour and a half to two hours of free play every three hours. Even our experiences are child-directed and open-ended and are driven by the children. Then there's actual free play, where they do whatever. What we notice is it takes a good 45 minutes for the kids to dive into deep play. It takes time to figure out who are they going to play with, what are they going to play, and then to play out that play scheme. We interviewed children last year about recess time and we asked them, "So, do you enjoy recess?" A lot of them kept saying over and over, that they really didn't. They got pretty frustrated because right when they were getting to the good part, then the bell rang and they had to go back in.

Another important thing to keep in mind is that after playing for a full hour, it takes time for them to bring their activity level back down again. Kids might be really fidgety, sitting for hours at a time right before recess. Then you let them out and the first thing that happens is their activity level goes up. If you allow for a 15- or 20-minute recess and then say, "Alright come back in," then they're really off the wall. You'll hear a lot of teachers say, "Well why bother with recess?" Well, it's because they're not allowing enough time. If they allowed more time, at least 45 minutes to an hour, then that activity level would come back down again. They would have time to regulate so that they would be ready to learn.

3.     Fewer rules. With TimberNook, we have really two rules. I won't go into all of this, but it's really putting a lot of trust in the children. At Swanson Elementary School where this principal got rid of the rules, he said there are no rules, just that they don't kill each other. It's a little extreme, but it's interesting that there was a decrease in bullying when they gave more trust to the children.

4.     Loose parts. We both have materials that the children can use that allow for multiple opportunities and ideas and inspiration for creativity. For example, we have tires like you see in figure 4.  We also have planks, sticks, and baskets with nothing in them.

Two boys lying back on old tires in the forest on the ground

Figure 4. Old tires.

5.     Freedom to get dirty. The principal I interviewed said this one was by far the hardest part to get the teachers on board with but was really key though. He said the first week the children all did mudslides. Once they got it out of their system, he said it really made a big difference.

I'm going to end with a story to give you an example of why it's so important to step back and allow children to play. We were in the woods a couple years ago and we were training other providers to do TimberNook. Anytime you're training, you want things to go well. A little fight broke out in the woods. These girls were building a teepee and this boy went up to them and said, "You need to let me play." The girls formed a chain and linked arms, and said, "No, no, no, we don't." Right away, our adult instinct was, okay let's fix this, we need to fix this situation for a positive outcome. Something told me to just wait, so I said, "Let's just see what happens." To make matters worse, he had scissors in his hand, which of course always puts adults on edge. We were there watching for safety if we felt like anything was out of control. He went up and he cut the twine on their teepee and then he reached in, grabbed their fake gems, and ran off running in the woods. The girls chased after him, and they made a couple circles around the woods. Finally, he turned and he said, "Fine, just take the gems." The girls took the gems back, went back and remade their teepee, and they were all happy and singing. He went over by a tree sulking and was really mad.

After a couple of minutes, one of the little girls went over and sat down beside him. Right away that got our attention. We couldn't hear exactly what they were saying, but we could hear the volume. She started talking to him and he raised his voice, and he says "Ah blah blah." He was yelling back at her. She put her hand up as if to form a stop sign, and he got quiet. Then he got loud again, "Blah blah blah." She put her hand up again, patiently, and waited for him to calm down. Then she ended up talking to him. His voice came down. By the end of the conversation, she invited him to play with them. Now that little boy was included for the rest of the week in their play.

If we had gone in right from the very beginning, and said, "No, you need to let that little boy play," I always like to ask, what opportunities would they have missed out on? There's a lot. The little girl practiced empathy, which is something you have to experience firsthand. The little boy learned maybe yelling at a group doesn't work. The girls learned to stand up for themselves. The boy learned to regulate his anger and his emotions. The girls learned inclusion. They also authentically asked him to play, and that little boy was authentically accepted. Now if we had said, "Now you need to let him play," they could have had resentment towards him and he could have been resentful towards them. That could have been an ongoing issue that needed constant adult interaction. Instead, they solved the problem on their own.

I like to ask; how often do we allow those opportunities for kids to think of their own solutions and come up with their own ideas? This is something that's needed more than ever in the world that we live in today. If you have any questions for me, feel free to email me (email address is on the last slide in your handout). You can also go to and read some of the articles. We're also on Facebook. Take a look at some of the work that we're doing with children these days. 


Hanscom, A. (2018). The decline of play outdoors in children - and the rise in sensory issues. - Early Childhood Education, Article 23129. Retrieved from

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angela hanscom

Angela Hanscom, MOT, OTR/L

Angela J. Hanscom is a pediatric occupational therapist and founder of TimberNook—an award-winning developmental and nature-based program that has gained international popularity. She is also the author of Balanced and Barefoot: How Unrestricted Outdoor Play Makes for Strong, Confident, and Capable Children. Awarded a “Hometown Hero” by Glamour magazine for her innovative work with TimberNook, Hanscom has also been a frequent contributor to The Washington Post, and was featured on the NPR education blog, Children & Nature Network, Edutopia, and Johnson & Johnson TEDx Talks.

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